Hyaluronic Acid Filler Research Articles

Fibrotic reaction to hyaluronic acid fillers in the face.

Hyaluronic acids (HAs) can have very different actions not only depending on injector and host factors but also depending on their molecular weight. Whereas short chain HA has immunological activity long chain HA influences fibroblasts and may stimulate them to produce collagen. Although this is generally thought to be a positive feature it may be disadvantageous in certain localizations. We have encountered 23 patients who developed fibrous tissue next to the nasolabial folds accentuating them and becoming very obvious while smiling. Hyaluronidase injection did not reduce this mass. Intralesional triamcinolone acetonide injection led to rapid improvement. Fibrotic tissue reaction not responding to hyaluronidase may be the result of HA injection and can effectively be treated with intralesional steroid injection.

Anti-aging trends in Australia.

Anti-aging trends in Australia have changed considerably since the country emerged from the lockdowns associated with the SARS-Cov2 pandemic. People now rely on social media influencers for skin care advice and skin care products, including professional skin care treatments that can be purchased on Internet platforms. The quest for the perfect 'zoom face' led to a 300% rise in cosmetic procedures across Australia in the year to April 2021. People now want to use less products on their skin, while looking healthy and natural (termed 'skin minimalism'). The popularity of retinoid derivatives for preventing wrinkles has been superseded by non-irritating actives like hyaluronic acid (HA) and niacinamide that provide skin barrier protection, skin hydration, plumping and anti-inflammatory effects. Botulinum toxin injections remain the most popular non-surgical cosmetic procedure, followed by HA fillers, and biostimulators that promote the synthesis of collagen and give longer lasting but more gradual results than HA fillers. Laser resurfacing is widely used for epidermal resurfacing and skin tightening, as well as non-ablative lasers, intense pulsed light and radiofrequency or ultrasound skin tightening devices. Superficial chemical peels are still popular because they are relatively gentle, inexpensive, and require no downtime, whereas medium-to-deep chemical peels have largely been superseded by laser technology. However, the most efficient approach to prevent skin aging is adopting a healthy lifestyle and taking action against all factors of the skin aging exposome.

Immune system triggers as a factor for the formation of foreign body granuloma after hyaluronic acid fillers treatment.

Immune system triggers as a factor for the formation of foreign body granuloma after hyaluronic acid fillers treatment.

JOLT: A Noninvasive Solution for the Correction of the Jowl.

Sagging and loss of elasticity of the facial skin and tissues leads to jowling and an aged appearance. Jowling is a common reason for aesthetic surgical consultations. Prospective open-label study of the JOLT (jowl lifting) technique using hyaluronic acid (HA) fillers in healthy women 40-65 years of age with Fitzpatrick skin phototypes II-IV (n = 8). To be eligible, patients had jowling grade 2-3 on the jowl appearance scale as assessed by both the physician and patient. Treatment was administered at the baseline visit and consisted of an average of 6 mL of HA filler, 3 mL per side. Efficacy was assessed at baseline, week 4, and week 12. Assessment measures included the jawline rating scale (JRS) and a five-point global aesthetic improvement scale performed by two independent observers. Success was defined as an improvement of 1-2 grades on JRS. The mean JRS was improved from 2.75 at baseline to 1.53 at 90 days, which was considered a significant improvement. Mean global aesthetic improvement scale scores at 90 days were 1.44 ± 0.66 (range 1-3), indicating a "very much improved" appearance compared with baseline on both investigator and subject ratings. The procedure was well tolerated by all patients. Injection-related side effects (bruising and localized swelling) resolved spontaneously within 1 week of treatment. No other adverse events were reported. The JOLT technique effectively uses HA fillers to lift and tighten the lower face/neck and camouflage the remaining jowl, diminishing marionette lines, defining the mandibular border, and improving jowl sagging.

Comparison of the Impact of Chin Augmentation Treatments by Genioplasty versus Hyaluronic Acid Filler Injection on Facial Attractiveness of Patients with Mild to Moderate Microgenia

Comparison of the Impact of Chin Augmentation Treatments by Genioplasty versus Hyaluronic Acid Filler Injection on Facial Attractiveness of Patients with Mild to Moderate Microgenia

Skin & SMAS layer remodeling technique (SSRT): Achieving both volume and lifting effects with filler treatments

AbstractBackgroundThe skin & SMAS layer remodeling technique (SSRT) represents a significant advancement in facial aesthetic treatments. Traditional methods primarily address wrinkles and volume loss, whereas SSRT focuses on achieving both volume and natural lifting effects through strategic filler injections. This technique emphasizes the anatomical and dynamic properties of facial tissues, particularly the SMAS, to enhance facial symmetry and contours while maintaining natural movement.Materials and MethodsSSRT employs a combination of firm and soft hyaluronic acid fillers to sculpt a youthful, dynamic appearance, simulating the natural lift of a smiling expression. This study explores the effects of gravity on facial tissues and uses advanced imaging techniques to corroborate the shifting of tissues. The technique is compared with other recognized methods, such as true lift and myomodulation, to evaluate its effectiveness in balancing volume enhancement and dynamic facial expressions.ResultsThe results indicate that SSRT uniquely balances volume enhancement and dynamic facial expressions, achieving a visibly lifted but natural appearance. The use of advanced imaging techniques substantiates SSRT's effectiveness by showing the shifting of tissues. SSRT reduces the risks associated with excessive filler use and aligns with contemporary aesthetic preferences.ConclusionSSRT offers a novel approach by mimicking the facial lift observed when lying down, providing insights into potential transformative “lifts” when upright. By strategically combining firm and soft hyaluronic acid fillers, SSRT achieves a balance of volume and lift, enhancing facial symmetry and maintaining natural movement. This technique represents a significant advancement in facial aesthetic treatments, offering a natural and dynamic alternative to traditional methods.

Objective Noninvasive Measurement of the Volumizing Effect of a Dermal Filler: An In Vivo Study

BackgroundInformation about the volumizing effects of dermal fillers is critical for physicians’ understanding of product features and prudent decision-making in clinical practice. It is important for material engineers to develop and optimize new dermal fillers, especially when comparing the physiochemical properties of a new product with those of existing fillers that are used worldwide.ObjectiveThis study aimed to establish a reliable, noninvasive method for in vivo quantitative evaluation of the filling effect in order to predict possible effectiveness after filler injection and to evaluate the degradation trend over time.MethodsA rabbit model of ear injection with dermal fillers was established. Hyaluronic acid (HA) filler was injected into the subcutaneous layer of rabbit ears, resulting in a stable skin bulge. Ultrasonography was used to noninvasively measure the skin bulge for volume calculation; the volume change was analyzed periodically until 38 weeks. Pathological examination, the gold standard, was performed to confirm degradation.ResultsThe immediate volumizing effect of HA filler injection was macroscopically observed as a local skin bulge. Ultrasound was able to precisely detect the shape of the filler and calculate the length, width, and height of the skin bulge at each time point. The degree of uplift and amount of residual samples in the pathological evaluation were consistent with the results of morphological observation using ultrasound.ConclusionEvaluation of the volume impact of dermal filler through the rabbit ear injection model evaluation enables material science evaluation in the early stage of material development, and has certain clinical reference value.Level of Evidence IThis 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.

The Contribution of Fillers Used in the Correction of Malar Depression to Visual Quality and Quality of Life.

Objectives: This study aims to investigate the contributions of the filler procedure performed in the malar region to the patient's appearance as visual quality and quality of life. Methods: A total of 72 patients who underwent a malar filler procedure between March 2022 and March 2023 were included in the study. Each patient received a 2 cc injection of hyaluronic acid filler, with 1 cc administered on the right and 1 cc on the left. Photos before the malar filler procedure and photos taken in the first month after the procedure for individuals included in the study were independently evaluated by 2 physicians. Change criteria were rated on a scale of 1 to 5 as follows: (1) no change, (2) slight change, (3) moderate change, (4) significant change, and (5) very significant change. The satisfaction of the patients related to the malar filler procedure was evaluated by a Visual Analogue Scale (VAS) scale of 1 to 10 (0 showing no satisfaction, 10 showing maximum satisfaction). Results: Physicians evaluated the visual appearance of the patients as a "very significant change" in all patients (100%). Of the 72 patients, 66 (91.6%) expressed satisfaction with the procedure, while 6 (8.4%) found the treatment insufficient and requested further interventions. Conclusion: Hyaluronic acid fillers applied to the malar region caused patient satisfaction in 91.6%. However, a few patients requested further interventions. Patients' requests for unnecessary operations should be noted and treated with caution since they may lead doctors in the wrong direction.

Ultrasonographic features of nonvascular complications of hyaluronic acid fillers: a retrospective study at a reference center for dermatologic ultrasonography

Hyaluronic acid filler injections have been associated with early, temporary, and delayed-onset complications. High-resolution ultrasound with Doppler analysis has been increasingly used to detect and identify such complications. We comprehensively describe the most common ultrasonographic findings of nonvascular complications associated with hyaluronic acid filler injections. This retrospective, cross-sectional, observational study was conducted at a reference center for dermatologic ultrasound in Bogotá, Colombia. Ultrasound reports documented the ultrasonographic findings of nonvascular complications of hyaluronic acid filler injections. Fifty-two complications were documented in a cohort of 50 patients (women, 88%). The infraorbital region was the most common site affected (23%), followed by the nasolabial region (22%). The Tyndall effect was the most common complication (25% of all), followed by changes in rheology (21%) and pseudosarcoidal (foreign body granuloma) reaction (15%). The Tyndall effect stood out for its distinctive ultrasonographic characteristics. We discuss the ultrasonographic findings and pathogenesis of other complications, including filler migration, early hypersensitivity, aseptic abscess, overcorrection, and filler material interaction. The clinical presentation of hyaluronic acid filler complications can be confusing, delaying timely diagnosis and treatment. High-resolution ultrasound with Doppler analysis is a valuable tool for avoiding unnecessary treatments and ensuring timely diagnosis and treatment.

Static and Dynamic Filler-Associated Tear Trough Deformities: Manifestations and Treatment Algorithm.

Fillers are popular substances for the correction of tear trough deformity. Despite well-documented complications increasing gradually, standardized treatment algorithm for deformity secondary to improper injection is still limited. Between April 2020 and April 2023, a total of 22 patients with filler-associated tear trough deformity with static bulges or dynamic swells after injection of tear trough were enrolled. For patients who received hyaluronic acid (HA) and unknown fillers, hyaluronidase dissolution was performed. For patients who received non-HA fillers and unknown fillers that failed to dissolve, a magnetic resonance imaging (MRI) examination was conducted. Surgical approaches were selected based on the filler distribution and the condition of the lower eyelid. Ligament releasement and fat transposition were accomplished when fillers were excised. Aesthetic outcomes were evaluated by double-blind examiners using the Global Aesthetic Improvement Scale after patients were followed up. In total, the study included 3 patients with simple static deformities, 1 patient with simple dynamic, and 18 patients with both. Fourteen patients underwent transconjunctival surgery and 8 patients underwent transcutaneous surgery, among which 18 patients underwent hyaluronidase dissolution and 8 patients underwent MRI prior to surgery. A total of 4 patients with self-limited complications recovered after conservative treatment. 90.9% of patients expressed satisfaction or high satisfaction with the treatment results. Filler-associated tear trough deformities could be classified into static and dynamic deformities, which could appear separately or simultaneously. Treatment of deformities should be based on characteristics of fillers, in which MRI could serve as a promising tool. 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.

One-Year Safety Evaluation of New Hyaluronic Acid Fillers (YYS Series): A Prospective, Multicenter, Observational Study.

With the continuous increasing availability of new filler products, each hyaluronic acid filler brand has distinctive pharmacokinetics, which may be associated with different complications. Therefore, the long-term safety of new generations of fillers should be evaluated. This prospective, multicenter, observational, postmarketing study ( ClinicalTrials.gov identifier: NCT04738019) aimed to investigate the incidence of delayed-onset nodules and adverse reactions after the injection of new hyaluronic acid fillers (YYS series) into the facial skin. Subjects scheduled to receive an injection YYS series filler were followed up for 52 weeks. The authors aimed to determine the incidence of a self-reported delayed-onset nodule-a visible or palpable nodule or mass at the injection site that was detected beyond the 14th day following the injection-during the 1-year follow-up period. Among the 1,022 subjects who received an injection of the YYS series, the incidences of delayed-onset nodules were 0% for YYS 360, YYS 540, and YYS 720. A 0.21% incidence (1 delayed hypersensitivity reaction) of a delayed-onset adverse reaction was noted for YYS 720, although none were reported for YYS 360 and YYS 540. In this study, a notably low frequency of adverse reactions associated with the YYS series was observed.

Nonsurgical Gluteal Volume Correction with Hyaluronic Acid: A Retrospective Study to Assess Long-term Safety and Efficacy

Background: Augmentation and reshaping of body volume, particularly in the gluteal area, presents a significant challenge in aesthetic surgery. Hyaluronic acid (HA) fillers have emerged as an effective and safe tool for such indications, but literature examining nonsurgical gluteal reshaping with HA remains limited. This study aims to evaluate the long-term safety of using recommended volumes of HA body fillers for nonsurgical gluteal augmentation. Methods: A retrospective, observational study was carried out across multiple centers in Italy and the United Arab Emirates. The study involved participants between 22 and 53 years of age who underwent gluteal augmentation using HA body filler (HYAcorp MLF1/2) between 2017 and 2021, with up to 4 years and 7 months of follow-up. Participants and investigators independently evaluated the procedure’s effectiveness by comparing pre- and posttreatment photographs. The Global Aesthetic Improvement Scale was used to assess posttreatment satisfaction by both participants and investigators. All adverse effects (AEs) were recorded. Results: The study included a diverse group of 91 participants. No serious adverse events were reported, with the majority of AE occurring shortly after treatment and resolving in 1 week. AEs were more frequently observed in participants with previous treatments using different substances in the treatment area. Conclusions: The real-world application of HA body filler (HYAcorp MLF1/2) for gluteal augmentation in the participants of this study showed the treatment’s effectiveness, with no severe adverse events reported among the participants. High levels of satisfaction were reported among both participants and investigators.

D91. Patient Reported Outcomes and 3D imaging to evaluate the Efficacy of an FDA-approved Hyaluronic Acid Filler to Treat Infraorbital Hollowing

D91. Patient Reported Outcomes and 3D imaging to evaluate the Efficacy of an FDA-approved Hyaluronic Acid Filler to Treat Infraorbital Hollowing

Triamcinolone Injection in the Treatment of Malar Edema.

Tear-through deformities can be a detectable sign of facial aging. Over recent years, minimally invasive procedures such as hyaluronic acid filler injections have been shown to be effective in improving this area. Malar edema is the accumulation of fluid over the malar eminence persisting for 1 month or more. Given its nature, the management remains problematic. The most commonly reported treatment modality is injection with hyaluronidase. To determine the safety and efficacy of triamcinolone injection in the treatment of malar edema. A total of 15 female patients with malar edema, with a mean age of 43.77 years, were treated with triamcinolone injections. The volume injected was chosen by the investigator. Prior to the triamcinolone injection, all patients had been treated with hyaluronidase, which turned out to be ineffective in all cases. Patients were asked to note all adverse effects. Satisfactory results were achieved after a single treatment session for 14 patients and after two treatments for one patient. Overall, injections with triamcinolone were well tolerated and no adverse reactions were reported. Injection with triamcinolone appears to be a safe and effective option for the management of malar edema following hyaluronic acid filler injection. Nevertheless, further research with larger patient groups is compulsory.

Self-crossing hyaluronic acid filler with combination use of polydioxanone thread in minipig model.

The advances of self-crossing hyaluronic acid (SC-HA) fillers combination use with polydioxanone thread in minipigs were examined for compatibility, effectiveness, and immune response. A 12-week experiment was conducted using 6 minipigs (3 male and 3 female each) to evaluate the effects of SC-HA filler. The molecular weight of SC-HA filler was fixed at 200 kDa and alternative storage modulus of G80, G250, and G500 were examined. The procedure involved injecting SC-HA filler and polydioxanone threads into the skin tissue of anesthetized minipigs, and tissue sampling after 1 month (three minipigs), and 3 months (three minipigs) for histological staining and analysis. The immune reaction was observed during the experiment. The practitioner reported it was easy to inject the SC-HA filler in combination with polydioxanone threads. All four storage modulus of SC-HA fillers were injectable within the polydioxanone thread containing cannula. Also, during the procedure, there were no immune responses at the treated sites. The results of the histological tissue examination confirmed that there was no chemical interaction between SC-HA filler and the existing polydioxanone thread, and it was observed that SC-HA filler was more uniformly distributed within the tissue with lower storage modulus, resulting in a higher production of collagen in the surrounding filler. When combined with scaffold polydioxanone thread, the scaffold polydioxanone thread helped spread the filler evenly, resulting in a more evenly distributed collagen around the filler. Today, the combination therapy of filler and polydioxanone thread in one procedure is challenging due to the high viscosity of conventional fillers. However, this study confirmed that combination therapy of filler and polydioxanone thread is possible with SC-HA fillers. Additionally, it was found that polydioxanone thread does not seem to interfere with the crosslinking reaction of SC-HA filler, and if used with a higher pH of polydioxanone, it may enhance the cross-linking reaction and achieve a higher viscosity value. Finally, the study resulted in the idea of concrete as SC-HA filler and reinforcing rod for polydioxanone thread.

9-point Injection Technique for Lip Augmentation and Lip Corner Lifting Using Sonographic Imaging of the Labial Artery Pathway.

As lip enhancement with fillers has grown in popularity, practitioners have sought to identify injection methods that achieve aesthetically pleasing results while avoiding adverse events such as arterial injury due to intravascular injection. The primary objective of this study was to establish a safe injection technique for creating appealing, proportionate, and aesthetically pleasing lips while elevating the lip corners with filler. Before injection, the locations of the superior and inferior labial arteries were established by sonography and a 9-point injection technique (9-PIT) was devised to reliably achieve fashionable lips. Particle hyaluronic acid filler was administered to 50 patients by the 9-PIT and these patients were monitored for 3 months. The extent of lip corner elevation and the angle of lip corners were quantified by 3-dimensional analysis, while changes in the length and curvature along the upper peristomal lines were evaluated after 1 week. The superior and inferior labial arteries originated from the deep lateral aspect of the lip and gradually traversed toward the midline in the superficial layer. Superficial arterial branches were identified in the submucosal layer near the midline. All patients expressed satisfaction with the lip shaping and corner elevation, without any adverse effects or vascular complications. The angle of lip corners decreased by 8.80%, and lip corners were lifted by 1.02 mm. The upper lip exhibited a more pronounced S-shape, with the upper lip line being elongated by 6.5%. This accentuated S-shape contributed to the appearance of lifted lip corners. The 9-PIT facilitated safe and aesthetically pleasing lip volumization with corner elevation in a consistent manner, while elucidating vascular pathways. Lip corner elevation was achieved solely using HA filler.

High-dose pulsed hyaluronidase for managing nasal skin necrosis following hyaluronic acid treatment in nasolabial folds: A case report

The growing popularity of soft tissue filler injections has brought attention to the associated risks, particularly vascular complications, and their treatments. This case report focuses on a 34-year-old female who developed nasal skin necrosis following hyaluronic acid (HA) filler injection for nasolabial fold (NLF) enhancement. Despite the careful procedure, complications emerged rapidly, emphasizing the critical importance of prompt diagnosis and intervention. A total of 10,000 turbidity reducing units (TRU) of hyaluronidase (HSE) were administered in a high-dose pulsed manner, alongside hyperbaric oxygen therapy. The patient experienced a gradual but significant improvement over 60 days. This case underscores the need for constant vigilance in aesthetic medicine and the potential consequences of even minute HA amounts, exceeding zero, in causing severe vascular events.

Blending Hyaluronic Acid and Calcium Hydroxylapatite for Injectable Facial Dermal Fillers: A Clinical and Ultrasonography Assessment

Both hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) fillers have well-established indications in cosmetic medicine. Nevertheless, limited data are available on the effectiveness of combining CaHA and HA. The purpose of this report was to demonstrate the safety, tolerability, and clinical and ultrasonographic improvement of facial skin laxity using a blending technique that admixes HA and CaHA. Fifteen regular patients, including three men, between 25 and 71 years of age were reported. The participants were subjects who came regularly to the dermatologic office seeking a lifting effect without surgery. They were submitted to injection of an admixture of HA and CaHA and followed for 180 days. The clinical assessment consisted of photographic evaluation by two blind investigators, and a consensual subjective evaluation was performed by the physicians (PGAIS) using the five-point Global Aesthetic Improvement Scale. Dermal thickness was analyzed in jaw areas using high-frequency ultrasound. Subjects completed a satisfaction questionnaire with responses scored according to the five-point Global Aesthetic Improvement Scale (GAIS) to evaluate patient satisfaction. After 180 days of follow-up, clinical assessments by blinded physicians found that all patients improved. All the participants were highly satisfied with the results and reported exceptional improvement. Dermal thickness increased by 9.4% (8.2–10.8%), 14.0% (12.2–15.9%), and 18.8% (16.2–21.9%) at D90, D120, and D180, respectively, by ultrasonography. In conclusion, an injection technique using an admixture of CaHA and HA fillers was well tolerated, offering high satisfaction and long-lasting progressive benefits. The authors believe that this procedure optimizes the treatment time and results because HA promotes early volume restoration and CaHA stimulates long-term dermal remodeling through the synthesis of collagen and elastin.

A Multicenter, Randomized, Evaluator-Blinded Study to Examine the Safety and Effectiveness of Hyaluronic Acid Filler in the Correction of Infraorbital Hollows.

Hyaluronic acid injections are increasingly administered for correction of infraorbital hollows (IOHs). The objective of this study was to examine the effectiveness (IOH correction) and safety of Restylane Eyelight hyaluronic acid (HAEYE) injections. Patients with moderate/severe IOHs, assessed with the Galderma infraorbital hollows scale (GIHS), were randomized to HAEYE injections (by needle/cannula) (Day 1 + optional Month 1 touch-up) or no-treatment control. The primary endpoint was blinded evaluator-reported Month 3 response, defined as ≥1-point GIHS improvement from baseline (both sides, concurrently). Other endpoints examined investigator-reported aesthetic improvement on the Global Aesthetic Improvement Scale (GAIS), patient-reported satisfaction (FACE-Q satisfaction with outcome; satisfaction questionnaire), and adverse events. Overall, 333 patients were randomized. Month 3 GIHS responder rate was significantly higher for HA-EYE (87.4%) vs control (17.7%; P < .001), and comparable between HA-EYE-needle and HA-EYE-cannula groups (P = .967). HAEYE GAIS responder rate was 87.5-97.7% (Months 3-12). Mean FACE-Q Rasch-transformed scores were 64.3-73.5 (HAEYE) vs 14.1-16.2 (control) through Month 12. Patients reported looking younger (≥71%) and less tired (≥79%) with reduced undereye shadows (≥76%) and recovered within 3-5 hours posttreatment. Efficacy was maintained through Month 12 (63.5% GIHS responders) and through Month 18, after Month 12 retreatment (80.3% GIHS responders; 99.4% GAIS responders; FACE-Q scores 72.5-72.8). Forty patients (12.7%) reported typically mild adverse events (4.9% HAEYE-needle; 20.9% HAEYE-cannula). HAEYE treatment was effective in correcting moderate/severe IOHs at the primary endpoint (Month 3). Efficacy was sustained through Month 12 after first treatment for 63.5% and through Month 18 for 80.3% (after 1 retreatment) with needle or cannula administration. Safety outcomes were reassuring.

Consideration of the diameter of superficial temporal arteries related to filler injections in the temporal region.

The concavity of the temple due to adipose tissue atrophy from aging accentuates the zygomatic arch and lateral orbital rim, leading to an aged appearance. The use of hyaluronic acid filler in the temporal region has gained popularity due to its procedural simplicity and consistent outcomes. To evaluate the safety of administering hyaluronic acid filler in the temporal region concerning the frontal branch of the superficial temporal artery, which is at risk of injury. Empirical observations were conducted on the internal diameter of the frontal branch of the superficial temporal artery, a critical anatomical site for potential injury. A significant proportion of the artery segments exhibited an internal diameter below 1 mm. Given that the outer diameter of an 18-gauge cannula is 1.27 mm, this method can be considered a relatively secure approach for enhancing the temporal region. The use of an 18-gauge cannula for hyaluronic acid filler administration in the temporal region appears to be a safe and effective method, with the potential risk to the frontal branch of the superficial temporal artery being minimal.