Global Facial Rejuvenation Using a New Cohesive, Highly Concentrated Hyaluronic Acid Filler: A Descriptive Analysis of 35 Cases

Abstract

Cosmetic procedures using fillers have gained importance over the last decades due to their ability to offer rejuvenation and beautification quickly with no (or minor) side effects. Hyaluronic acid (HA) gel is the most used filler in cosmetic dermatology; its physical and chemical properties vary according to the manufacturing process. The characteristics of the final product are crucial for its clinical indication. Specific physicochemical properties of HA gel are required to fill, volumize, sustain, and contour different anatomical areas and layers. Ideally, HA gels should have a consistency similar to that of the surrounding tissue to promote a natural feel, but, at the same time, they should be able to sustain their shape against constant physical strain caused by muscle contraction during mimic movements. Generally, softer gels are indicated to fill superficial layers, and are not usually meant to perform lifting or volumizing, for which stiffer gels are proposed. Therefore, combining gels with different characteristics is indicated for global facial treatment. The Brazilian market recently introduced a new Korean HA filler. Still, clinical evaluation of global facial treatment using these products is lacking in the literature. This study aims to describe clinical results, patient satisfaction, and side effects of facial treatment using these fillers. We analysed the clinical impact of global facial treatment in 35 patients performed by seven dermatologists. Patients of both sexes desiring beautification or rejuvenation were included, and all of them had indications for the filling procedure. Three Korean HA gels (e.p.t.q. S100, S300, and S500, Jetema ®) with high HA concentrations and cohesiveness, varying only in their crosslinking degree, were used. The dermatologists chose the product for each procedure based on their rheological properties and clinical assessment. S100 gel was indicated for refinement, and S300 and S500 gels for structure and volume. The doctors evaluated the clinical outcomes of rejuvenation or beautification using the Global Aesthetic Improvement Scale (GAIS), and patient satisfaction using the Likert scale, 1, 3, and 6 months after the procedures. Patients treated included 4 males and 31 females with a mean age of 43.08 years. An average of 6.33 syringes was used. After 30 days, 80% of patients showed excellent or accentuated improvement, with 94.2% satisfaction. After 3 and 6 months, 80% of patients showed excellent or accentuated improvement, which increased their happiness (97%). Immediate common side effects occurred in 17 patients. One patient had a vascular occlusion, which was quickly reverted using hyaluronidase. Most patients had accentuated improvement and great satisfaction. This new cohesive, highly concentrated HA gel promoted a sustained global improvement and patient satisfaction with expected transitory side effects.