Hyaluronic Acid Dermal Fillers Research Articles

Efficacy of a New Hyaluronic Acid Dermal Filler on Nasolabial Folds Correction: A Prospective, Comparative, Double-Blinded Clinical Trial.

Hyaluronic acid-based dermal fillers are the cornerstones of wrinkle correction and facial contour redefinition. To assess the efficacy and safety of ESTLF compared with RESL for the treatment of nasolabial folds (NLFs). In this prospective, split-face, randomized, investigator and subject-blinded trial, 45 subjects with moderate-to-severe symmetrical NLFs were randomized to ESTLF on one side of the face and RESL on the other side and were followed up for 9 months. The primary end point was change in WSRS score from the baseline to Month 1 (M1). Secondary end points included changes in WSRS score at other time points, aesthetic improvement, wrinkle volume quantification, adverse events, and local tolerance. The efficacy difference between ESTLF and RESL at M1 was in favor of ESTLF (-0.16, CI, -0.28 to -0.03]), demonstrating its noninferiority. Considering other time points, significant differences were observed at 3 and 6 months for ESTLF, assessed with WSRS, GAIS, or NLF volume quantification. Both treatments were well tolerated. ESTLF is effective and well tolerated for the treatment of NLFs.

The Posthyaluronidase Syndrome: Dosing Strategies for Hyaluronidase in the Dissolving of Facial Filler and Independent Predictors of Poor Outcomes.

Hyaluronic acid dermal fillers are used extensively in periocular aesthetic medicine, and the incidence of filler-related complications is increasing. This study aimed to investigate the optimal dosing strategy for hyaluronidase and to identify predictors of poor outcomes. We performed a retrospective review of 157 orbits of 90 patients treated with hyaluronidase over a 4-year period. Demographic data, indication, and details of hyaluronidase treatment and outcomes were recorded. The primary indication for dissolving filler was swelling in 52%, lumpiness in 20%, and before surgical blepharoplasty in 17%. The most frequently used hyaluronidase concentration was 150 U per mL in 66%, followed by 75 U per mL in 31%, 37.5 U per mL in 3%, and 100 U per mL in 1%. Outcomes were characterized as follows: 59% with a satisfactory result; 24% as insufficient treatment requiring further hyaluronidase; and 18% complaining of facial changes such as hollowing, indicating a post hyaluronidase syndrome. There was no statistical difference in outcomes between the 75 and 150 U per mL dosage groups (P = 0.625). A significant correlation was identified between posthyaluronidase syndrome and duration of filler in situ (P = 0.00019) and volume of filler (P = 0.000017). The posthyaluronidase syndrome may be related to previous filler volume and duration, rather than the concentration or dose of hyaluronidase used. All patients should be informed about the risks of adverse effects after hyaluronidase treatment; patients with longer histories of filler use and higher total volumes should be advised of the increased risk.

(051) Safety of Novel Hyaluronic Acid Dermal Filler Injections for Penile Girth Enhancement

Abstract Introduction Limited data exist regarding safety of penile girth enhancement treatments. Reported options for girth enhancement include injections of autologous fat, liquid silicone, hyaluronic acid (HA), or polymethyl-methacrylate, grafting with dermal fat, porcine dermal acellular matrix, or acellular collagen matrix, and surgical placement of a silicone implant. Objective The purpose of our study was to retrospectively evaluate safety in a cohort of men undergoing penile girth enhancement with HA dermal filler at a single site by reporting on post-procedure complications. Methods We performed a retrospective review of men who underwent penile girth enhancement with HA dermal filler from August 2020 through April 2023. Results 471 men underwent penile girth enhancement with HA dermal filler. Two patients experienced injection site infections related to non-compliance post treatment with infection resolution after completing a course of oral antibiotic. One patient reported urinary tract infection symptoms shortly after HA dermal filler procedure and subsequently underwent additional filler injections without recurrence of urinary symptoms. One patient underwent reversal with hyaluronidase after his initial treatment. Three patients developed granulomas which were completely resolved with a single treatment of hyaluronidase. All three of these patients underwent additional HA injections without granuloma formation. Three patients experienced priapism treated without long term sequelae when intracavernosal injection (ICI) therapy was used for tumescence at time of filler injection. Once ICI was no longer used, no patients reported priapism. No patients reported erectile dysfunction or loss of sensitivity. Conclusions Our study suggests that injection of HA dermal filler may be a safe option for men interested in penile girth enhancement. While rare complications may occur, our research suggests they are easily treatable in the outpatient setting without long term sequelae. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: PhalloFill.

(216) Efficacy of Novel Hyaluronic Acid Dermal Filler Injections for Penile Girth Enhancement

Abstract Introduction There has been renewed public and professional interest in the topic of cosmetic penile girth enhancement. Hyaluronic acid (HA) injections have been proposed as a safer alternative to surgical options, however limited data exist regarding efficacy. Objective The purpose of our study was to evaluate average girth changes and related metrics in men undergoing penile girth enhancement with sequential administration of HA dermal filler at a single site. Methods We performed a retrospective review of men who underwent penile girth enhancement with HA from May 17, 2022 to April 28, 2023. Results 155 men underwent penile girth enhancement with HA filler and were instructed to follow a strict post-injection protocol. On average, men experienced a 0.633 cm increase in girth per treatment receiving an average of 12.5 total syringes over 2.2 treatments. Ultimately, all men receiving multiple treatments experienced an average girth increase of 1.8 cm as measured prior to their final treatment. 23 men who received 4 treatments or more experienced an average girth increase of 2.952 cm as measured prior to their final treatment. Of the 155 men treated, 19 (12.3%) required cosmetic correction with either hyaluronidase or abobotulinumtoxinA. Conclusions Our study suggests that injection of HA dermal filler is an effective option for men desiring non-surgical penile girth enhancement. Further studies are needed to better characterize outcomes and optimal treatment protocols. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: PhalloFill.

(050) Safety and Efficacy of Hyaluronic Acid Injections Using the UroFill™ Technique for Penile Girth Enhancement

Abstract Introduction Penile girth enhancement (PGE) has gained significant popularity and is in high demand among individuals seeking to improve their sexual experiences and self-confidence. Perception of penile length and girth are integral components of the male psyche. Unfortunately, current treatment options for motivated patients looking to enhance penile girth fall short of patient and clinical expectations. While the safety of penile augmentation methods has been a subject of debate, hyaluronic acid (HA) fillers have demonstrated proven efficacy and safety, offering potential solutions for those interested in PGE. Advancements in the field of penile cosmetics with HA has led to the development of the UroFill™ patented technique for PGE. Objective To assess the safety and efficacy of injecting HA using the UroFill™ technique for PGE. Methods We performed a retrospective analysis of men undergoing penile girth enhancement with FDA-approved HA fillers between October 2021 and March 2023. Patients completed a series of validated questionnaires including the COPS-P, IIEF, and BAPS. Peri- and post-procedure adverse events were closely monitored. Physician follow-up appointments and patient questionnaires were utilized to identify and document these events. The determination of unsatisfactory cosmetic outcomes and the need for revision was made by the treating physician in consultation with the patient. The UroFill™ standardized technique was employed for all injections. Results A total of 300 men (mean age: 37, range 21-80) received treatment using the UroFill™ standardized technique. 4,879 injections were performed over this time. Mean injection volume was 16.5 cc (range: 4-78cc) of HA once treatment had been completed. The study observed an average of 3.85 injection sessions (range: 1-44 sessions) and 5.25 post-injection modeling sessions (range 0-55) per patient. After receiving HA dermal fillers, patients experienced local injection site reactions such as bruising, tenderness, swelling, and erythema. These events were generally mild in intensity, and no patient reported bruising lasting longer than 7 days. None of the patients in this cohort required removal of filler. Adverse reactions were limited to 8 cases of localized skin infections which were successfully treated with conservative antibiotic therapy. All localized skin infections were a result of premature sexual intercourse or shaving in the area following injection. Patients reported high levels of satisfaction with 272/300 (91%) reporting “completely satisfied” or “mostly satisfied”. Mean filler retention was 90% after 12 months. Conclusions This study provides evidence that the UroFill™ standardized technique for penile girth enhancement using HA fillers is both safe and efficacious. With no instances of filler removal and successful management of adverse reactions, the safety profile of HA fillers is further supported. These findings reinforce HA’s potential for sustainable penile enhancement. It is essential these procedures be performed in the described fashion by qualified urological professionals. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Coloplast, Boston Scientific, UroFill.

A Cross-Sectional Survey on Pain Management in Dermal Filler Injections from Physicians' and Patients' Perspectives.

Hyaluronic acid (HA) dermal fillers injection is a common procedure in patients with cosmetic needs. Concomitant pain is a major complaint among patients undergoing HA filler injections. Relevant research is limited and there is no consensus on pain management of dermal filler injection. To assist physicians in determining a more appropriate treatment approach, and to better provide treatment suggestions. A nationwide (China) cross-sectional survey was conducted using questionnaires designed for physicians and patients, respectively. A total of 62 semi-structured questionnaires were administered to aesthetic physicians via face-to-face interview, whereas 123 online-based questionnaires were collected from patients who have ever undergone HA treatment. The collected questionnaire information was analyzed using descriptive statistics and content analysis. 42 (67.74%) physicians observed that over 50% of their patients were concerned about pain during injection. 101 (82.11%) of patients were concerned about impending pain ≥5 points (a total score is 10) before injection. For preferred pain relief modalities, 48 (77.42%) physicians would choose a hyaluronic acid dermal filler with lidocaine, and 82 (66.67%) patients would choose anesthetic-containing products. 59 (95.16%) physicians who injected lidocaine-containing hyaluronic acid found patients had a comfortable treatment experience. Pain management during hyaluronic acid dermal fillers injection is important from both perspectives of physicians and patients. This survey showed that compared with other analgesic methods, lidocaine-containing hyaluronic acid has offered a more satisfying experience. It also provides insights to physicians and patients in pain management. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Clinical Perspectives on the Injectability of Cross-Linked Hyaluronic Acid Dermal Fillers: A Standardized Methodology for Commercial Product Benchmarking with Inter-Injector Assessments.

The injectability of cross-linked hyaluronic acid (HA) dermal fillers is influenced by polymer concentration, polymer cross-linking type and degree, the presence of lidocaine or other functional excipients, types of syringes, and injection techniques. Finished product injectability constitutes a critical quality attribute for clinical injectors, as it strongly influences product applicability and ease of use in aesthetic medicine. While injectable product extrusion force specifications are provided by the respective device manufacturers, the qualitative informative value of such datasets is low for injectors wishing to compare product brands and technologies from an injectability standpoint. Therefore, the present study comparatively assessed 28 cross-linked HA dermal fillers (JUVÉDERM®, Restylane®, BELOTERO®, TEOSYAL RHA®, and STYLAGE® brands) using various injectability benchmarking setups for enhanced clinical-oriented relevance. Manual product injections were performed by three specialized and experienced clinicians, whereas automatic product extrusion was performed using a Texture Analyzer instrument. The various hydrogel products were injected into ex vivo human skin and into SimSkin® cutaneous equivalents to appropriately account for injection-related counterpressure. The injectability results revealed important variability between and within product brands, with a strong influence of the local anesthetic lidocaine, HA contents, and needle gauge size. Critical appraisals of the investigated products were performed, notably from manufacturing process-based and clinical ease of application-based standpoints, centered on respective experimental injectability quality levels. Generally, it was confirmed that each HA-based dermal filler product requires specific expertise for optimal injection, mainly due to differing viscoelastic characteristics and injectability attributes. Overall, the present study set forth evidence-based and clinical-oriented rationale elements confirming the importance for injectors to work with injectable products with which they are experienced and comfortable to optimize clinical results.

Delayed Diagnosis of Septal Ulcer after Hyaluronic Acid Nasal Filler Injection.

The utilization of fillers, notably hyaluronic acid, has increased due to their proven effectiveness, versatility, and generally favorable safety profile. In the field of rhinoplasty, hyaluronic acid dermal fillers have been employed for the correction of nasal deformities and surface irregularities. Nevertheless, the intricate vascular network of the nasal region, involving anastomoses between the external and internal carotid arteries, predisposes it to serious vascular complications. We report a case of a severe septal ulcer secondary to local ischemia following an injection of a hyaluronic acid nasal filler. The patient presented with immediate pain and nasal discomfort; however, there was an unfortunate delay in diagnosis and treatment. This report discusses the intricacies of the case and imparts crucial insights gleaned from the incident.

Non-surgical Rhinoplasty (NSR): A Systematic Review of Its Techniques, Outcomes, and Patient Satisfaction.

Surgical rhinoplasty (SR), commonly known as nose job,is a widely practiced cosmetic surgery globally, aimed at addressing diverse aesthetic and functional concerns related to the nose. In recent years, non-surgical rhinoplasty (NSR) has gained popularity due to advanced techniques involving hyaluronic acid (HA) dermal fillers, offering advantages such as affordability, reduced side effects, and faster results. However, concerns persist about the suitability of dermal fillers for nasal anatomy and potential complications, prompting this comprehensive review. This study systematically evaluated the techniques, fillers, safety, and patient satisfaction associated with NSR, with the intent of providing valuable insights for clinicians and patients considering NSR or SR for improved aesthetic outcomes. The literature search, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, yielded 16 relevant studies from an initial pool of 1002 articles. These studies covered various aspects of NSR, including techniques, complications, limitations, and positive results. In conclusion, NSR appears to be a quick and safe option for addressing minor nose shape issues, particularly through the use of HA fillers, but further discussion and standardization are necessary to address risks and limitations. A randomized controlled trial (RCT) using photographic evidence could significantly propel the progress of this evolving treatment. RCTs offer an optimal method to assess NSR's adverse effects and overall outcomes by allowing controlled comparisons between treatment and control groups. This approach minimizes biases and generates reliable statistical data, which is critical for evaluating safety, efficacy, and potential risks, thereby guiding informed clinical decisions.

Performance assessment of an injectable hyaluronic acid/polylactic acid complex hydrogel with enhanced biological properties as a dermal filler.

Injectable hyaluronic acid (HA) hydrogel plays an important role in dermal filling. However, conventional HA dermal fillers mostly lack bio-functional diversity and frequently cause adverse reactions because of the chemical stiffness of highly modified degree and crosslinker residues. In this study, polylactic acid (PLA) was embedded into HA hydrogel as a bioactive substance and 1,4-butanediol diglycidyl ether was used as a crosslinker to prepare the HA/PLA composite hydrogel with enhanced biocompatibility and biological performance. We aimed to investigate the properties of HA/PLA composite hydrogels as dermal fillers by assessing the rheological properties, surface microstructure, enzymolysis stability, swelling ratio, degradation rate, cytotoxicity, and anti-wrinkle effect on photo-aged skin. The results showed that the stability and stiffness of the composite hydrogel decreased with an increasing amount of PLA, while the in vivo safety of the HA/PLA hydrogel was enhanced, showing no adverse reactions such as edema, redness, or swelling. Moreover, the composite hydrogel with 2 wt% PLA exhibited excellent anti-wrinkle effects, showing the highest collagen production. Thus, the PLA-embedded HA composite hydrogel showed potential as a dermal filler with high safety, easy injectability, and excellent anti-wrinkle effects.

In Vitro Analysis of Dissolution of 18 HA-based Dermal Fillers with Tailored Hyaluronidase Dosing to Achieve Urgent Reversal of Vascular Complications

Introduction: Hyaluronidase (HYAL), a hyaluronic acid-degrading enzyme, is commonly used “off-label” as part of the gold standard management of hyaluronic acid (HA) dermal filler complications. It is paramount that injectors be cognizant to diagnose and treat filler complications, particularly vascular emboli, where there may be a narrow window for timely treatment. There is a paucity of studies, however, that provide HYAL dosage guidelines in the setting of acute vascular obstruction that are specific to each of the 18 reversible HA-based dermal fillers commercially available on the current US market. Differences in resistance to HYAL degradation is based on variation in cross-linking technique, concentration of HA, and cohesive properties that each filler may possess. This in vitro study investigates optimal dosage parameters of HYAL to achieve gross dissolution of every reversible HA-based filler commercially available to better improve outcomes after filler-induced vascular complications. Methods: Standardized in vitro analysis using 0.5-mL aliquots of all 18 commercially available HA-based fillers included all Restylane products (Lyft, Restylane-L, Silk, Refyne, Defyne, Kysse, Contour), Juvederm products (Volbella, Vollure, Voluma, Ultra XC, Ultra Plus XC), Revanesse products (Versa+, Lips+), Teoxane products (RHA 2, RHA 3, RHA 4), and Belotero. Hylenex, recombinant human HYAL, was used in 150 IU increments for total quantities of either 300, 450, 600, or 750 IU to achieve timed assessment of the gross dissolution of filler using photographic and videographic documentation. Inert dye was used to improve filler visibility against the HYAL. Mechanical integration of HYAL into the filler mimicked massage technique commonly implemented to incorporate HYAL into the perivascular soft tissue to help relieve a filler-induced vascular obstruction. Results: The cross-linking technology utilized by each HA-filler manufacturer played a significant role in the readiness of filler dissolution with HYAL. Fastest dissolution times ranged from 11 seconds to approximately 32 minutes, with a strong correlation with Restylane products dissolving the fastest, followed by Juvederm & Revanesse products. The slowest to achieve gross dissolution were Belotero and the RHA series. Discussion: All 18 HA-based fillers achieved complete gross dissolution within the first 32 minutes, however, due to differences in cross-linking technology and molecular properties, there was large variation in in vitro HYAL-induced degradation that can be extrapolated clinically to help reverse urgent vascular obstruction. This may also help beginner injectors strategically choose the HA-based dermal fillers that have the fastest degradation response to HYAL. Further in vivo studies are necessary to integrate these into clinical practice.

Current Landscape of Hyaluronic Acid Filler Use in the United States.

Hyaluronic acid (HA) fillers are among the most used fillers for soft-tissue augmentation. There are now many FDA-approved HA products, and the successful use of injectable HA fillers requires an understanding of the available options.  Objective: The purpose of this manuscript is to provide a comprehensive list of HA fillers and their indications. An overview of their biochemical properties and formulations will aid dermatologists in appropriate use. A comprehensive search of all the FDA-approved dermal fillers was conducted via the FDA "pre-market approval" (PMA) site. Additional details regarding filler properties were obtained using the respective agent's package inserts.  Results: A total of 28 HA dermal fillers were identified and key pharmaceutical properties were discussed. These findings will help the physician match the appropriate HA filler with the area that is to be treated.  Conclusion: Understanding the available fillers and their properties can help physicians select the appropriate fillers for more predictable and sustainable results.  J Drugs Dermatol. 2024;23(1):1247-1252.    doi:10.36849/JDD.7858.

Hyaluronic Acid Dermal Fillers for Treatment of Congenital and Acquired Lip Asymmetries and Deformities

Hyaluronic Acid Dermal Fillers for Treatment of Congenital and Acquired Lip Asymmetries and Deformities

"A.D.O.R.E. - A Novel Treatment Technique for Severe Dynamic Lip Lines".

Dynamic lip lines pose a challenge in perioral rejuvenation despite the availability of numerous hyaluronic acid (HA) dermal filler products. In this article, we introduce the Additive Orthodiagonal Rhytidoplasty of the Ergotrid (ADORE), a novel technique for the treatment of severe dynamic lip lines. Based on an objective analysis of treatment outcomes, the ADORE technique demonstrates the ability to confer substantial improvement in lip line severity, with a median reduction in lip line intensity of 79% (average = 70%, St. Dev = 19%) at 1 month and 72% (average = 61%, St. Dev = 21%) at 6 months, with a high degree of patient satisfaction.

Investigation of Crosslinking Parameters and Characterization of Hyaluronic Acid Dermal Fillers: From Design to Product Performances.

Despite process similarities, distinctive manufacturing technologies offer hyaluronic acid dermal fillers with different in vitro physicochemical and rheological properties due to peculiar crosslinked hydrogel networks. A better understanding of dermal filler properties could provide specific clinical indications and expectations with more accurate performance correlations. In this study, with an emphasis on the degree of modification, hyaluronic acid concentration and molecular weight, these process parameters were able to modulate dermal filler properties, especially rheology. Moreover, an extensive characterization of commercial hyaluronic acid injectables of the Hyal System line was described to present product properties and help to elucidate related clinical effects. Standardized methodologies were applied to correlate in vitro parameters with feasible clinical indications. In view of an optimized dermal filler design, the results of the extrudability measurements allowed the quantification of the effect of hydrogel composition, rheological properties and needle size on injectability. Composition, dynamic viscosity and needle size showed an impactful influence on hydrogel extrudability. Finally, the positive influence of 200 KDa hyaluronic acid in comparison to fragments of ether-crosslinked hyaluronic acid on fibroblast recognition were shown with a migration assay.

Treating young patients with cosmetic botulinum toxin and hyaluronic acid dermal fillers

Treating young patients with cosmetic botulinum toxin and hyaluronic acid dermal fillers

Safety and aesthetic outcomes of using fillers with different cross-linking agents. A case report.

Of the several dermal fillers developed in recent decades, hyaluronic acid fillers have become the material of choice. They are safe, long-lasting, non-immunogenic, available to most patients, and can be removed with hyaluronidase. Unfortunately, early and delayed complications can also occur after HA filler injection. Below, we present the case of a 42-year-old patient who had complications after the aesthetic procedure using hyaluronic acid dermal fillers in the past. Surprisingly, the treatment performed with hyaluronic acid cross-linked with another cross-linking agent was without complications. The affected places were the chin and malar area. In 2021, after performing augmentation with hyaluronic acid in the chin area, a patient developed swelling, which subsided after using hyaluronidase (Hylase Dessau 300 I.E.) and corticosteroids. The patient repeated the procedure in 2022, where she was administered 2 ml of hyaluronic acid in July 2022. About 3 weeks after injection, oedema and nodules appeared at the injection site in the zygomatic/malar area; after using Prednisone, the changes subsided. In September 2022, 3 ml of PEG-cross-linked hyaluronic acid was successfully performed with no side effects. In the described case, an important role was played by the ability of the hyaluronic acid hydrogel to modulate human immunological functions, which was associated with a very low risk of immune-related side effects and accompanying cellulitic processes.

Connections between cohesion and properties that related to safety and effectiveness of the hyaluronic acid dermal fillers: A comparative study of the cohesive and non-cohesive gels.

Although the importance of the cohesion of a hyaluronic acid (HA) filler has been recognized, the relationship between the cohesion and the other performance that related to safety and effectiveness, as well as the underlying mechanism is barely studied. Much efforts need to be made on this subject to provide guidance for clinical practice. Two types of the HA fillers (cohesive and particulate gels) were selected for the comparison of the cohesion and the other key physicochemical properties. Hyalumatrix, with significantly higher cohesion, was homogeneously smooth and showed a linearly oriented morphology, whereas Matrifill and Restylane were particulate and showed obvious boundaries between particles. The high cohesion of Hyalumatrix is beneficial to the properties that related to safety and effectiveness, including recovery under shear stress, injectability, tissue integration and in vitro resistance to enzymolysis. The underlying reason was that the strong internal interactions of the cohesive gel protect the network structure from collapse and keep the gel as an intact whole when the gel was subjected to the stress. The homogeneously smooth morphology further improved the tissue compliance and injectability. The G' of Hyalumatrix is in the middle level of the commercially available HA fillers. Hyalumatrix is a rare HA filler product to possess good cohesion and intermediate G' simultaneously. More clinical practice is needed to verify the connection between the cohesion of Hyalumatrix and the clinical performance.

Adverse Events Associated with Hyaluronic Acid Filler Injection for Non-surgical Facial Aesthetics: A Systematic Review of High Level of Evidence Studies.

Hyaluronic acid (HA) dermal fillers are widely used in aesthetic medicine. While generally safe, potential complications can arise. This systematic review aims to identify and classify potential complications linked to the use of HA dermal fillers, as informed by high-quality, low-risk-of-bias studies. This review follows the Cochrane review standards for clinical systematic reviews. This systematic review analyzed 48 high level of evidence studies on the use of hyaluronic acid (HA) dermal fillers in non-surgical facial aesthetics and the adverse events that occurred.The inclusion criteria were randomized control studies on HA dermal fillers and their complications. Excluded were case reports, case series, observational studies, and other non-randomized research due to their inability to provide generalized conclusions and their inherent publication bias. Adverse events were classified into three categories: expected reactions, product or technique-related adverse events, and severe adverse events. Most adverse events were short-lived injection site reactions, which resolved spontaneously. Specific HA fillers and injection techniques influenced the occurrence of adverse events, which generally resolved within weeks without treatment. Severe adverse events were rare, persisting for months and requiring active medical intervention. This classification system can enhance understanding, prevention, and treatment of HA filler complications, and support patient education. The common complications were injection site reactions, with persistent symptoms treated with topical steroids, NSAIDs, or hyaluronidase. Severe complications included severe edema, angioedemaand others, often necessitating specific treatments. HA dermal fillers are generally safe and effective, with most adverse events being transient and mild to moderate in severity. Severe adverse events, although rare, do occur and are generally non-treatment related. Informed consent, patient education, and professional training are crucial for safe and successful outcomes. Level of Evidence II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Elevating Aesthetics: Patient-Specific Treatment with Hyaluronic Acid Fillers to Improve Appearance and Psychosocial Wellbeing

Perception of beauty is changing from a rigid concept (i.e., the universal idea of beauty) to a multifaceted and personalised view of one’s appearance. One of the main concerns of patients is looking artificial and losing their unique facial expressions, which encourages them to seek aesthetic procedures that yield the most natural results. Patients also wish to increase their self-esteem and, ultimately, improve their quality of life. It is now well-established that treatment with hyaluronic acid (HA)-based dermal fillers improves the psychosocial state of patients. The assessment of facial anatomy and patient needs, accompanied by the proven holistic benefit and good safety profile of HA dermal filler treatment, is also a key factor for an optimal outcome. In addition, clear communication between patient and physician is crucial to manage patient expectations, maximise satisfaction, and minimise procedural risks. The availability of a wide range of HA dermal fillers, customised for specific anatomical areas and facial movements, allows physicians to develop patient-specific treatment plans. This review of the ‘Elevating Aesthetics’ symposium held at the International Master Course on Aging Science (IMCAS) 2023 shares insights into the patient’s facial anatomy and possible danger zones presented during a cadaver workshop. Several successful treatment plans tailored to different patient profiles (i.e., patients seeking full-face aesthetic improvement, patients with facial asymmetry, low lip volume in mature and millennial women) were also implemented live. A comprehensive and patient-specific HA dermal filling treatment should be considered by physicians to achieve natural outcomes and improve the general wellbeing of the patient.