Injectable Hyaluronic Acid

What is injectable hyaluronic acid?

Injectable hyaluronic acid (HA) is a type of temporary dermal filler. Hyaluronic acid is found naturally through out the body, with the highest concentrations in the joints, eyes, and skin. In the skin hyaluronic acid attracts water, which allows the skin to become more hydrated. As we age, the fat, muscles, bone, and skin in our face begins to thin. This loss of volume leads to either a sunken or sagging appearance of the face, fine lines, wrinkles, folds, and thin lips. Injectable HA is used to reduce the appearance of fine lines and wrinkles, facial folds, and to create structure, framework, and volume to the face and lips. The effects of injectable hyaluronic acid are seen immediately.

Before (left) and after (right) - Restylane to upper and lower lip.
Photo courtesy of C. Burgess

Before and after endovenous laser ablation
Photo courtesy of  Mitchel Goldman

Before (left) and after (right) - Hyaluronic Acid to lips. 
Photo courtesy of J. Peterson 

 

A variety of injectable HAs are currently available include: Belotero Balance, Juvederm Ultra, Juvederm Ultra Plus, Restylane, Restylane Silk, Restylane Lyft, and Voluma. Each of these HA fillers has unique characteristics, which influence what location(s) on the face they are best injected, what level they should be injected in the skin, and their longevity after injection.

For example, Belotero and Restylane Silk are often used for the correction of shallow, fine lines. For improving fine lines around the lips and/or lip volume and/or structure, Restylane Silk, Restylane, Juvederm Ultra, and Belotero are commonly used. To reduce of the appearance of nasolabial folds and marionette lines, Juvederm Ultra, Juvederm Ultra Plus, Restylane, Restylane Lyft, and Belotero Balance may be selected by your ASDS physician. Finally, cheek augmentation is most commonly performed with either Voluma or Restylane Lyft to create structure, elevate, and reposition the cheek into a more youthful appearance.

Outcomes and longevity vary from patient to patient and are influenced by the location of the injection, the individual properties of the hyaluronic acid filler, the age of the patient, and the individual characteristics of the patient’s skin. For example, results in the lips may last 6 months, but those in the nasolabial folds may last 9-12 months or longer. Voluma can last up to 24 months when injected in to the cheeks. After that time, additional injections are required to maintain the desired effect.

Your doctor will evaluate the areas of your face and/or lips needing improvement in lines, structure, and/or volume. Topical or injection numbing medication may be used for added comfort prior to your procedure. For additional patient comfort lidocaine, an anesthetic, is mixed with the many of the available injectable hyaluronic acids.

 

Before (left) and after (right) - hyaluronic acid injection to hands.
Photo courtesy of C. Burgess

Before (left) and after (right) Restylane Earlobes.
Photo courtesy of  S. Manjula Jegasothy

Before (left) and after (right) Restylane to Nasolabial Folds and Upper Lip. 
Photo courtesy of S. Manjula Jegasothy 

What should first be done before considering injectable hyaluronic acid?

First, an ASDS dermatologist will review the patient’s medical history and examine the condition to be treated. Areas to be treated should be kept clean. If there is a skin infection, then treatment needs to be postponed until it resolves. Patients who take blood thinners (such as aspirin, ibuprofen, certain herbal medications) should stop them two weeks prior to injection with the approval of their prescribing doctor.

When is injectable hyaluronic acid appropriate?

HA dermal fillers have been used for:

  • Wrinkles
  • Nasolabial folds
  • Marionette lines
  • Pre-jowl sulcus
  • Lips
  • Fine lines around the mouth
  • Under the eyes
  • Cheek augmentation
  • Earlobes
  • Volume loss on the back of hands

Who is not a candidate for hyaluronic acid?

HA is not recommended for patients who have:

  • Active facial or oral herpes infection
  • Infection in the treatment area
  • Uncontrolled diabetes
  • Blood-clotting problems
  • Allergy to any components of injectable hyaluronic acid
  • Patients whom are pregnant or breast-feeding

HA should be used with caution in patients who have:

  • Current immunosuppressive therapy

Before (left) and after (right) Botox treatment to the masseter/jawline area.
Photo courtesy of Shannon Humphrey, MD - Vancouver, Canada

Before (left) and after (right) MW 2 syringes of Voluma to midface
Photo courtesy of Suzanne Bruce, MD - Vancouver, Canada

Before (left) and after (right) Botox to glabella, IPL to skin, Restylane to tear troughs and outer eyebrow.
Photo courtesy of B. Fitzgerald

Is injectable hyaluronic acid painful?

Topical numbing agents or anesthetic injections can be used to improve patient comfort during the injection process. Also, lidocaine is commonly incorporated into most brands of HA fillers for further comfort measures. Before and following treatment, ice may be given to ease discomfort and swelling.

What are the complications or potential side effects of injectable hyaluronic acid?

Common side effects include:

  • Swelling
  • Bruising
  • Bleeding
  • Lumps and bumps
  • Redness

Uncommon side effects include:

  • Numbness
  • Allergic reactions
  • Infection
  • Blisters and cyst;
  • Inflammatory reactions
  • Migration of filler material to another site
  • Bluish discoloration
  • Vascular occlusion
  • Scarring
  • Blindness

Before (left) and after (right) Voluma temples and preauricular area.
Photo courtesy of K. Butterwick - Vancouver, Canada

Before (left) and after (right) Voluma and Juvederm.
Photo courtesy of J. Peterson

 

What can I expect after having had injectable hyaluronic acid?

HA fillers are temporary, the longevity of the filler depends on the composition of the HA, location of the injection, and the patient. Patients require maintenance treatments to achieve the best results.