# Panorama — the whole injectable atlas on one page > Cross-catalog synthesis + memory aids. Numbers are **data-derived** (see `panorama/` sheets, built by > `tools/build_panorama_stats.py`). Mnemonics and inferences are learning aids — **adversarially > reviewed** (codex + Claude agent); caveats kept inline. Verify specifics against IFU/SmPC/FT. > > **Canonical mnemonics → `mnemonics.md`** · recall deck (spaced repetition) → `recall.md`. ## 1. The atlas at a glance (live counts) | Catalog | Curated products | Spain regulatory list | |---|---|---| | Botulinum toxins | 27 | CIMA: **15** authorized SKUs | | HA fillers | 166 | AEMPS CE registry routes **436** SKUs here | | Skinboosters / PN | 56 | registry **64** | | Biostimulators | 25 | registry **43** | | Compounded | 35 | registry **34** | | PRP / PRF | 54 | AEMPS CCPS closed-systems: **45** entries | | Threads / technique | 59 | registry **9** PDO threads | | **Total products** | **~422** | + **586**-SKU AEMPS CE registry (separate layer) | ## 2. Three Spain regulatory layers — one mental model **Devices get LISTED, medicines get AUTHORIZED.** The same "aesthetic injectable" umbrella spans three different legal frameworks — knowing which one applies is a compliance reflex. ```mermaid mindmap root((Spain regulatory panorama)) Fillers - CE device REGISTRY Listado implantes de relleno CCPS 586 SKUs total - 436 pure HA MDR 2017/745 communication not approval aemps-registry.xlsx PRP - closed-system device CLASSIFICATION CCPS PRP working group list 45 entries - 8 cerrado / 37 exp minima on the list means closed system not an aesthetic indication prp-map sheet 09 Botox - MEDICINAL register CIMA buscador botulinica 15 SKUs authorized and marketed indications only in the Ficha Tecnica neurotoxin-map sheet 11 ``` ## 3. Filler classes — the memory framework the user asked for **One idea:** every HA filler = a **rheology ladder** (soft→structural) built on **one crosslink technology**. Learn the 6 houses' technologies and the product names decode themselves. ```mermaid mindmap root((HA filler decode)) Rheology ladder - depth follows G' low G' soft - lips / fine lines / tear trough mid G' - folds / NLF high G' firm - cheek / chin / jaw / to bone Crosslink tech by house Restylane - NASHA firm + OBT/XpresHAn flexible Juvederm - Vycross low-swell + Hylacross legacy Belotero - CPM cohesive polydensified smooth Teoxane - RHA resilient network + classic Teosyal BDDE Stylage - IPN-Like + mannitol antioxidant Neauvia - PEG crosslink - more resistant to hyaluronidase but still HA Two safety flags G' is a guide not a rule - plane follows product indication and IFU low G' Redensity II is placed DEEP in tear trough PEG-HA slower to dissolve but still HA - in occlusion flood hyaluronidase anyway CaHA PLLA PCL PDLLA are NOT reversible ``` **Mnemonic — brand → crosslink tech** ("**R**eally **J**ust **B**e **T**he **S**mart **N**inja"): **R**estylane=NASHA/OBT · **J**uvederm=Vycross (+ legacy Hylacross) · **B**elotero=CPM · **T**eoxane=RHA (+ classic Teosyal/BDDE) · **S**tylage=IPN+mannitol · **N**eauvia=PEG. *(Maps each house's signature tech — most also have legacy/other lines, so verify the specific SKU.)* **Mnemonic — depth from stiffness (a GUIDE, not a rule):** *soft usually floats, stiff usually sinks.* High-G′ firm gels tend to go deep/supraperiosteal (cheekbone, chin, jaw); soft gels tend to go superficial (lips, fine lines). **Exception:** some low-G′ *cohesive* gels are placed DEEP on purpose (e.g. Redensity II in the tear trough) — follow the product's indication + IFU, not G′ alone. **Mnemonic — reversibility:** *BDDE bends back; PEG resists; powder doesn't.* BDDE-crosslinked HA dissolves readily with hyaluronidase; **PEG-HA (Neauvia) is more resistant** (slower, needs higher doses) but is still HA — expect harder/partial *elective* dissolving. **CaHA, PLLA, PCL, PDLLA are genuinely not reversible.** Hybrid HArmonyCa: its HA part reverses, its CaHA does not. **SAFETY:** in a vascular-occlusion emergency, flood with high-dose hyaluronidase **regardless of product** — never withhold it because a gel is "PEG" or "hybrid". ## 4. Biostimulators — 4 chemistries ```mermaid mindmap root((Biostimulators)) PLLA - Sculptra / Lanluma needs a COURSE - 3-3-3 rule pure collagen no immediate volume reconstitute - NEVER intradermal CaHA - Radiesse calcium - immediate plus collagen hands and decollete on-label hyperdilute 1 to 2 for skin quality PCL Ellanse - S M L E - 1 / 2 / 3 / 4 yr - S approx 18 mo - dual filler plus stimulator Gouri - liquid PCL - no S M L E ladder PDLLA - AestheFill / Juvelook / Lenisna amorphous PLLA - Korean - faster onset ``` **Mnemonic — PCL longevity ladder (Ellansé only):** *S-M-L-E → "SMILE" gets longer* (Ellansé S 18mo · M 24 · L 36 · E 48). Gouri is a *liquid* PCL — same chemistry, no S/M/L/E ladder. **Mnemonic — the whole class:** *biostimulators burn the bridge* — none are FULLY reversible (the hybrid HArmonyCa's HA part reverses, its CaHA doesn't), and all build collagen over weeks (do not over-correct in one session). ## 5. Toxin units — the two families ```mermaid mindmap root((BoNT-A units)) IU-type club - about 1 to 1 - 4 U per 0.1 mL onaA Botox / Vistabel incoA Xeomin / Bocouture letiA Letybo praboA Jeuveau / Nuceiva Speywood - Ipsen - 20 U per 0.1 mL aboA Dysport / Azzalure / Alluzience about 2.5 to 3 Speywood equals 1 onaA Own scales - no cross-conversion relaA Relfydess - RTU 10 U per 0.1 mL DU - Daxxify Type B - Myobloc Aesthetic sister names Vistabel is aesthetic Botox Bocouture is aesthetic Xeomin Azzalure is aesthetic Dysport ``` **Mnemonic — units:** *One number fits four; Dysport speaks Speywood.* Botox/Xeomin/Letybo/Jeuveau share the number (~1:1); Dysport/Azzalure/Alluzience use Speywood units (numbers ~2.5–3× bigger, NOT interchangeable). The ~1:1 among the four is *registration non-inferiority, not proven dose-identity* — reassess on a switch, don't blind-swap. (Relfydess and Daxxify each have their own units too.) **Mnemonic — 1 mL syringe:** *syringe "units" are volume, toxin units are potency.* On a U-100 insulin syringe each mark = 0.01 mL; at 4 U/0.1 mL each mark = 0.4 U, so a 4 U point = 0.1 mL = the "10" mark. ## 6. PRP — the DEPA 2×2 ```mermaid mindmap root((PRP DEPA)) Pure LP P-PRP liquid - Arthrex ACP / BTI PRGF P-PRF fibrin - Selphyl Leukocyte-rich LR L-PRP liquid - RegenKit / EmCyte LR L-PRF membrane - Choukroun / IntraSpin Not actually PRP - flag Orthokine is ACS serum QREM is cytokine serum WINT is DKK-1/Wnt joint product ``` **Mnemonic:** *Pure vs Leukocyte × Plasma(liquid) vs Fibrin(gel)* = the 4 DEPA boxes. AGA hair is the one Class-A **aesthetic** PRP indication; other aesthetic uses are B–C. (L-PRF is also Class A — but for **dental/oral surgery**, not aesthetics.) ## 7. Inferences from the heterogeneous data (labeled — not hard facts) 1. **Origin of Spain's fillers:** ~half the CE-registered filler SKUs are **Korean (26%) + Italian (25%)**; Spanish-made is ~**11%** (65/586). *Caveat: the registry counts SKUs communicated as marketed, NOT units sold or clinical market share — do not read it as "most-used".* 2. **HA hegemony:** **83%** of registered filler SKUs are pure HA; all biostimulators (CaHA+PLLA+PCL+PDLLA) ≈ **7%**. *Inference: biostimulator clinical prominence far exceeds its SKU count — few brands, concentrated use — so "rare in the registry" ≠ "rare in practice".* 3. **Legal heterogeneity is the real complexity:** a single injectables clinic day touches THREE Spanish frameworks (CE device · closed-system device · medicinal product). The safety/consent paperwork differs by layer, not by how "similar" the products feel. 4. **The two traps that cause harm:** (a) **unit non-interchangeability** (Speywood ≠ IU) and (b) **irreversibility** (biostimulators, CaHA, PEG-HA). Both are cross-catalog, not single-product, risks. 5. **OEM consolidation:** many "brands" are a few makers (T-Biyoteknoloji behind ≥5 PRP kits; **VAIM behind Juvelook + Lenisna — but AestheFill is Regen Biotech**; Ipsen makes all Speywood toxin, while **Galderma markets the aesthetic Azzalure/Alluzience**). *Caveat: shared maker ≠ identical spec — verify per SKU.*