Micro-injections of Transparent Hyaluronic Acid Gel (Restylane® Silk) for Rejuvenation of the Aging Cheek

This is a single center, prospective, open-label, clinical trial using micro-injections of
Restylane® Silk for correction of mid to low cheek fine lines and wrinkles. Twenty (20)
subjects will be enrolled. Each subject will receive Restylane® Silk to a defined area of mid
to low cheeks. The injections will be delivered intradermally via multiple 0.02 cc
microinjections distributed in a grid array pattern with 1 cm between each injection point. A
total surface area of 9-15 cm2 per cheek will be treated depending on the extent of fine
lines in each subject. Following completion of injection treatment, manual massage will be
applied to the full area to promote even distribution of the product. Each subject will
undergo a total of three treatment sessions, one month apart, day 1, week 4, and week 8. The
maximum amount of Restylane to be used per treatments session/per cheek is 1.5cc (not to
exceed a total of 9 cc) per treated patient. Three dimensional digital photography utilizing
the Vectra 3D System (Canfield) will be utilized to document pre-treatment status, sites of
injection, and post-treatment effect. Subjects will be followed up at 4 weeks, 8 weeks,
post-treatment day 90, and day 180.

Inclusion Criteria:

1. Male or female in general good health age 18 or over.

2. Mild to moderate static rhytids involving at least a 9 cm2 area of the mid to low
cheeks.

3. Must be willing to give and sign a HIPPA form, photo consent and informed consent
form.

4. Must be willing to comply with study dosing and complete the entire course of the
study.

5. Female patients will be either of non-childbearing potential defined as:

1. Having no uterus

2. No menses for at least 12 months. Or;

(WOCBP) women of childbearing potential must agree to use an effective method of birth
control during the course of the study, such as:

1. Oral contraceptive pill, injection, implant, patch, vaginal ring, intrauterine
device

2. Intrauterine coil

3. Bilateral tubal ligation

4. Barrier method used with an additional form of contraception (e.g., sponge,
spermicide or condom)

5. Abstinence (If practicing abstinence must agree to use barrier method described
above (4) if becomes sexually active).

6. Vasectomized partner (must agree to use barrier method described above (4) if
becomes sexually active with un-vasectomized).

6. Negative urine pregnancy test results Baseline prior to study entry (if applicable)

Exclusion Criteria:

1. Pregnant, planning pregnancy during the course of the study or breastfeeding

2. Severe static rhytids to the mid to low cheeks

3. Previous use of any form of soft tissue augmentation in the treatment area within the
past 12 months

4. Pre-existing medical or dermatologic condition in the treatment area that may affect
the treatment or interpretation of treatment effect (at investigator discretion)

5. Presence of tattoo and/or scar in the treatment area that in the investigators opinion
would interfere with study assessments

6. Use of oral/topical retinoids within 1 month of Baseline

7. Previous use of botulinum toxins in the treatment area within the past 6 months

8. Previous surgical procedure in the treatment area within the past 12 months

9. Presence or evidence of any conditions that in the opinion of the investigator might
impede the subject's ability to give consent or comply with protocol requirements.

10. Current participation or participation within 30 days prior to the start of this study
in a drug or other investigational research study

11. History of non-compliance with clinical research protocols

12. Ablative laser resurfacing to on their face within 12 months

13. Non-ablative laser or light procedures to their face within the past 3 months

14. Known allergy to Restylane® Silk or any of its constituents