• Injection Depth & Delivery: Target the supraperiosteal or deep subcutaneous plane. A 25G 40mm cannula supports safe, maximum-depth structural delivery.
• Anesthetic Profile: Co-formulated with mepivacaine hydrochloride (3 mg/mL) to maximize patient comfort. Unlike lidocaine, mepivacaine provides mild inherent vasoconstriction without an added vasoconstrictor, alongside a shorter anesthetic duration that allows for faster post-procedure outcome assessment. Regional block anesthesia remains optional.
• Clinical Technique: Maintain strict aseptic technique throughout. Avoid intravascular injection entirely. This maximum-volume product requires specific training and experience in deep-plane and supraperiosteal injection techniques.
• Post-Treatment Care: Advise patients to avoid sun and heat exposure until initial redness and swelling subside. Note that deep-plane swelling may be more pronounced and persist longer than with superficial filler formulations.
• Safety Warnings: Monitor closely for signs of vascular occlusion, skin necrosis, or visual disturbance. Transient bruising and localized swelling at the injection site are common but temporary side effects.

• Can address volume loss involving severe-to-extreme facial volume deficit in the cheeks, temples, midface, and jawline.
• Designed for maximum-depth structural volumization, including cheekbone augmentation, chin projection, and jawline definition at the supraperiosteal plane.
• Treats nasolabial folds and marionette lines with an extreme volume component, as the deepest correction layer in the STYLAGE® range.
• Prescribed when STYLAGE® XL or lighter formulations cannot achieve the required structural outcome; not for moderate correction, wrinkle treatment, or superficial lines. Prescribed for licensed aesthetic medicine professionals with supraperiosteal injection experience; not for self-administration.

Product Specifications

• Active ingredient: Cross-linked hyaluronic acid 21 mg/g; mepivacaine hydrochloride 3 mg/mL; mannitol.
• Format: Injectable gel supplied in 2 × 1 mL prefilled syringes, 1 × 25G 40 mm cannula, 2 × 27G ½” needles, and 1 × 23G ½” needle.
• Manufacturer: Laboratoires VIVACY, France.
• Drug class: Injectable cross-linked hyaluronic acid dermal filler; supraperiosteal and maximum-depth formulation with mepivacaine.
• Packaging: Deep green and white box (updated visual identity as part of the BI-FLEX® rebrand).
• Regulatory status: CE-marked for EU use; US FDA status should be verified by jurisdiction before procurement.

Contraindications

• Do not administer to patients with known hypersensitivity to hyaluronic acid, mepivacaine, amide-type anesthetics, or any excipient in the formulation.
• Do not inject into areas with active skin infection or inflammation at the intended treatment site.
• Avoid use during pregnancy or breastfeeding as a precaution, due to limited safety data in these populations.

• For supraperiosteal or deep subcutaneous injection only; reserve for cases of extreme volume deficit where STYLAGE® XL or lighter formulations are insufficient.
• Regional block anesthesia is optional, as mepivacaine hydrochloride is co-formulated at 3 mg/mL; its neutral pH and built-in anesthetic profile support patient comfort during extensive deep-plane procedures.
• Allow the syringe to reach room temperature before administration.
• The product is intended for single use only; discard any unused gel, syringe, and needle after the procedure.
• Screen for hypersensitivity to hyaluronic acid, mepivacaine, and amide-type anesthetics before treatment and refer to the full IFU.

STYLAGE® XXL BI-FLEX® with Mepivacaine is a CE-marked medical device manufactured by Laboratoires VIVACY (France). Its regulatory status in other jurisdictions, including the United States, should be verified before procurement. Practitioners who wish to buy dermal fillers or buy STYLAGE® may contact the Med Supply Solutions support team for sourcing information and documentation support.

1. Ordynowski Ł. Cross-Linked Hyaluronic Acid for Cleft Lip and Palate Aesthetic Correction: A Preliminary Report. Aesthet Surg J Open Forum. 2022;4:ojac052. Published 2022 Jun 8. doi:10.1093/asjof/ojac052
2. Ramos-E-Silva M, Fonteles LA, Lagalhard CS, Fucci-da-Costa AP. STYLAGE®: a range of hyaluronic acid dermal fillers containing mannitol. Physical properties and review of the literature. Clin Cosmet Investig Dermatol. 2013;6:257-261. Published 2013 Oct 23. doi:10.2147/CCID.S35251

The contents of this page are meant for licensed medical professionals. They serve informational purposes only and are not to be taken as medical advice.