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. 2025 Oct 1;156(4):550-559.
doi: 10.1097/PRS.0000000000012135. Epub 2025 Apr 1.

A Large Prospective Volumetric and Patient-Reported Outcome Analysis of Hyaluronic Acid Facial Fillers

Harrison D Davis  1   2 , Daniel Mazzaferro  1 , Theodore E Habarth-Morales  1   3 , Charles A Messa 4th  1 , Ankoor A Talwar  1 , Abhishek A Desai  1 , Phoebe B McAuliffe  1 , Robyn B Broach  1 , Joseph M Serletti  1 , Ivona Percec  1
Affiliations

A Large Prospective Volumetric and Patient-Reported Outcome Analysis of Hyaluronic Acid Facial Fillers

Harrison D Davis et al. Plast Reconstr Surg. .

Abstract

Background: Hyaluronic acid (HA) facial fillers are a nonsurgical treatment for age-related changes. Literature on long-term volumetric results and patient-reported outcomes (PROs) is limited. This prospective study aimed to precisely define and measure objective tissue metrics and PROs of HA fillers in different facial regions over 12 weeks.

Methods: Women 40 to 65 years of age received injections in facial regions using HA fillers: Restylane-L in nasolabial folds and marionette lines, Restylane-L Lyft in the malars, and Restylane Silk in the lip border. Patients completed the FACE-Q, and were photographed with 3-dimensional Vectra M3 imaging software before injection, immediately after injection, and at 2, 4, and 12 weeks after injection. Volumes were analyzed from 8 regions: left and right malars and extended midface, upper perioral, lower perioral and jawline, and lips. Tissue displacement factor (TDF) and effective volume (EV) were calculated. Statistical analyses included Mann-Whitney U tests and risk-adjusted linear regression.

Results: A total of 101 women participated. Restylane-L Lyft had the highest TDF (1.25), followed by Restylane-L (1.14) and Restylane Silk (0.56). EV for Restylane-L Lyft was highest (89.8%), followed by Restylane-L (89.7%) and Restylane Silk (70%). Volume maintenance was 65.5% (whole face), 79.2% (malars and extended midface), 62.7% (upper perioral), and 37.2% (lips) over 12 weeks. PROs demonstrated improvements in facial appearance, treated regions, and psychologic and social function.

Conclusions: The authors defined novel tissue metrics-TDF and EV-relative to HA treatments, with greatest volume maintenance in the midface and greatest loss around the mimetic areas through 12 weeks. Significantly improved PROs were observed for patients undergoing large-volume HA filler injections.

Clinical question/level of evidence: Therapeutic, IV.

Trial registration: ClinicalTrials.gov NCT03460158.

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References

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