All she wanted was to have her "old" boobs back – the way they were before the birth of her two children. But in opting for breast augmentation Lea Baumann (not her real name) wasn't aiming for a D cup: just an attractive, natural-looking bosom. That's why she opted for Macrolane.

A mistake, as it turned out. The gel didn't do for the 41-year-old Swiss woman what the ads promised: give her "a natural looking result without the risks of an operation." In fact, it left the shape of her breasts looking decidedly odd. Disappointed, Baumann turned to Acredis, an independent plastic surgery consulting firm in Zurich. Managing director Stephan Hägeli says he gets contacted by one to three frustrated Macrolane customers per month.

He says the complaints are always the same. The injected gel doesn't last as long as the manufacturer, Q-Med, and doctors quoted by them, claim. Sometimes, one breast shrinks and the other doesn't, and righting the situation costs money. Not that the initial injections are cheap: depending on the size of the breasts, first injections of Macrolane, which contains hyaluronic acid, cost between 4,700 and 5,300 euros. Should any problems occur within the next few months, add 2,560 euros to that.

A source of anger to some women is a source of profit for Nestlé: the company earns something from every injection. Anyone who thought that Nestlé was all about coffee, baby formula, ice cream and cat food has another think coming -- for 30 years, along with the French firm L'Oreal, Nestlé has been driving the Lausanne company Galderma, a producer of pharmaceuticals that is rising fast in the beauty market.

Galderma's anti-wrinkle cream, Azzalure, now competes with Allergan, the producer of Botox. With a turnover of one billion euros in 2010 and 85% market share, Botox is number one in the beauty sector. However, since its introduction two years ago, Azzalure has won 15% share. Galderma's recent purchase of Macrolane maker Q-Med for some 850 million euros is part of this picture. Galderma doesn't release its own figures, but for this skin-care company known for acne and nail fungi treatments, and anti-hair-loss products, the beauty market is increasingly important.

"Buying Q-Med is a direct result of our strategy to expand in this fast-growing market," says Galderma spokesperson Peter Nicholson.

Azzalure is one of the central components in that strategy, albeit not the only one: the company recently launched an anti-wrinkle gel called Emervel. Alongside Macrolane, in a joint venture with Nestlé and L'Oréal Q-Med also produces Restylane – injections that fill out deep-set facial wrinkles and plump up lips. That was another reason for the growth of Galderma turnover – 1.2 billion euros in 2010.

Just how much Nestlé is earning is anybody's guess. According to Elmar Wiederin of the Boston Consulting group, the company needs Galderma as a lab to gather experience in the wellness sector, in dealing with health authorities, and in product approval. "Those factors are also playing an ever greater role in food products,"" he says.

Werner Bauer, head of research at Nestlé, sits on Galderma's board. Bauer's job is to ensure 5% annual growth in the 3.5 billion euro beauty market. There are some risks to the strategy, as that market is often accused of bringing products onto the market prematurely, before adequate test runs are completed – which, says Acredis boss Hägeli, is the case with Macrolane breast filler.

And it's the reason Acredis doesn't recommend Macrolane; neither does the Swiss Society for Plastic, Reconstructive and Esthetic Surgery. Galderma says that five independent – albeit company-sponsored – studies have been conducted on the product and that a study to determine longer-term effects of the injections is on-going. Galderma is not particularly concerned that many women complain about Macrolane: "Everybody reacts differently to medical treatments," says spokesperson Nicholson.

Business, in the meantime, goes on. Zurich plastic surgeon Jens Otto says his Beauty Clinic has seen a "surprisingly high" demand for Macrolane; so far, some 400 clients have been injected with it. Otto sees the product as "a real alternative to complicated surgical procedures." Because it is also used to tone male chest muscles and calves, and rejuvenate women's decolletés, he sees "continued big market potential" in Macrolane.

Small consolation for unhappy patients, who face the difficult decision between risking complications and, if all goes well, annual top-up injections, or going the surgery route with silicone breast implants. Lea Baumann has almost made her mind up, and thinks she'll probably go with implants.

Read the original story in German

photo - macrolane