Perspectives in the selection of hyaluronic acid fillers for facial wrinkles and aging skin

Abstract

Aesthetic surgery is, in the USA at least, no longer a taboo subject. Outside North America, public acceptance continues to grow as more procedures are performed each year. While there appears, anecdotally, to be a decrease in patients undergoing cosmetic treatments because of the global financial crisis, the overall trend remains upward. Although popular television programs espouse the benefits of surgery, it is nonsurgical procedures that account, numerically, for the majority of procedures performed; in the USA, there was a 48% growth from 2000 to 2008 in nonsurgical treatments undertaken by women, and 64% in men and while the average surgeon might perform 60 blepharoplasty operations in 2007, (s)he would also undertake 375 botulinum injections, and almost 200 filler injections of varying sorts. Clearly there is enthusiasm for nonsurgical treatments, and this trend appears to be rising. With this in mind, we present an overview of the commonest filler injection material, hyaluronic acid. We present the mechanism of action, the purported risks and benefits, and briefly discuss technique.

Keywords: filler injection; hyaluronic acid; nonsurgical procedures; technique.

Figure 1

Tissue engineering substrate made of hyaluronic acid. Water has been applied to one end of this sheet in order to demonstrate the solubility of the material.

Figure 2

The chemical composition of hyaluronic acid. This diamer is polymerized into macromolecular chains which are then stabilized.

Figure 3

(A) Restylane SubQ®, a large-granule product, for deep dermal placement. (B) Juvederm Ultra 2®, a finer product for more superficial use. Note the difference in texture and the needles used for insertion; the former is placed using a cannula, whilst the latter is injected using a fine-gauge needle.