Hyaluronic fillers revolutionized aesthetic Dermatology as they constituted the first truly safe heterologous material that could be used both for skin smoothing and wrinkle filling, as well as for contouring the face and addressing the loss of volume and fat that occurs with aging.
Hyaluronic acid is a naturally biodegradable material found in our skin, aiding in its hydration, elasticity, and firmness. Scientists managed to isolate this material in the laboratory and process it in such a way as to delay its absorption. Precisely because we obtain it from a laboratory and not from the body itself, it is characterized as heterologous. Previous attempts with other heterologous materials such as silicone and collagen often resulted in side effects and very unsatisfactory outcomes, leading us to be cautious and await its use in our clinic, as it had already proven its safety and ability to provide nice and natural results.
Before hyaluronic acid, the only filler we used in our clinic was the patient's fat, which constitutes an autologous filler as we obtain it through a minor liposuction from the patient and transfer it to another area of the face where volume loss exists. This is a technically alternative method to hyaluronic acid that we still use with very nice and natural results, but it is more complex and time-consuming.
How is hyaluronic acid applied?
The application of hyaluronic acid is easy, quick, and almost painless in our clinic, using small injections at very specific points and depths. The choice of locations is not only a matter of aesthetics to achieve a natural result, but also a matter of safety, as excellent knowledge of anatomy and the course of vessels in the face is required to avoid negative outcomes that can result from injection into these vessels.
An essential prerequisite for the application of hyaluronic acid is to have hyaluronidase readily available in the clinic, which can dissolve hyaluronic acid, both for aesthetic and safety reasons.
What are the application points?
When hyaluronic acid use began, applications were usually made in the nasolabial folds and within certain wrinkles for smoothing and skin leveling. Unfortunately, incorrect placement and exaggerations sometimes led to swelling and an unnatural appearance. Over time, it became apparent that deeper knowledge of the fat compartments in the face and understanding of the significant ligaments and septa between them would allow targeted placement of material at points where volume loss has occurred due to aging or weight loss, with optimal natural aesthetic results. For us, this was something that came very smoothly since for years we had been using fat as an autologous filler, the placement of which was largely based on this rationale.
Gender is also crucial, as there are differences in facial contouring between men and women, and therefore different points look more beautifully accentuated in each gender.
Common application points include the cheeks, the forehead area, along the jawline, the chin, the cheeks, under the eyes along the tear trough line, the lips, and the nasolabial folds. In some cases, a specific material can also be placed within the upper eyelid to reverse hollowing that may occur over the years or after an aggressive blepharoplasty.
In our clinic, we do not inject hyaluronic acid into the nose and mid-forehead as these are the areas with the most frequent adverse effects worldwide.
In what cases is it recommended?
Over time, there is fat loss in deeper compartments of our faces and subsequent volume loss. Additionally, there is a reduction in volume in the bones of the face. This loss of support, combined with loosening due to changes in collagen quality in the upper skin layer, leads to a more tired and aged appearance. Hyaluronic acid can partially reverse this appearance and make us look more refreshed and rejuvenated. Unfortunately, there are so many changes over the years that it cannot naturally fully reverse the aging process. However, it can make you look like the best version of yourself for your age.
In some cases, we can inject hyaluronic acid to accentuate certain areas, especially in younger individuals, such as in the lips and chin. However, we generally do not advocate for exaggeration and over-inflation, which has also led to the refusal of applications from our side.
How long do the results last?
It should be explained that the breakdown and absorption of hyaluronic acid essentially start from the day of injection. Therefore, it occurs very gradually and controlled, and not abruptly at the end of a certain period. The higher concentration and quantity of hyaluronic acid can lead to a greater result and duration of effect – something not always desirable! Additionally, greater cross-linking somewhat protects it from breakdown, reducing access to the body's enzymes that break it down.
The duration of the result varies significantly and depends on several factors. Firstly, it depends on the material used. Each company has materials with different concentrations and cross-linking of hyaluronic acid. Generally, higher concentration and cross-linking lead to longer duration. Secondly, it depends on the site of placement. Injection into an area with high mobility leads to faster absorption of the material, while injection into an area with less mobility of the same material can last up to 4 times longer. Thirdly, it depends on factors such as whether someone is a smoker, has fluctuations in weight, and if they have swelling.
In general, injection of highly concentrated and cross-linked material for facial contouring usually lasts over a year, while injection of more fluid material in mobile areas lasts around 6 months to a maximum of one year.
What is the cost?
The cost of the procedure depends on both the quantity and type of material used the specificity of the face and the technical difficulty of the injection in the particular location. For this reason, a history should be taken and each case evaluated before pricing the application.