Correction of Age-Related Midface Volume Loss With Low-Volume Hyaluronic Acid Filler

Abstract

IMPORTANCEThe pivotal approval trial for a smooth, highly cohesive, viscous, 20-mg/mL hyaluronic acid filler demonstrated sustained aesthetic improvement, with a mean injection volume of 6.65 mL. In daily practice, however, it is not often practical or necessary to use large injection volumes to achieve the desired cosmetic outcome.OBJECTIVE To assess the efficacy, longevity, and patient satisfaction associated with correction of age-related midface volume loss using the low volumes of hyaluronic acid filler more commonly used in day-to-day practice. DESIGN, SETTING, AND PARTICIPANTSA 2-center, retrospective cohort study examined medical records of 61 healthy patients who underwent treatment for facial volume loss with hyaluronic acid filler from November 1, 2013, through April 31, 2014. Follow-up visits were conducted at 1, 3, 6, and 12 months after the procedure. Data were pooled from a private facial plastic surgery practice in Weston, Florida, and a private cosmetic dermatology practice in San Diego, California.INTERVENTIONS Patients were treated with hyaluronic acid filler according to the investigator's usual practices. MAIN OUTCOMES AND MEASURESThe main outcome measure was patient-graded Global Aesthetic Improvement Scale scores at 1, 3, 6, and 12 months after treatment. Scores range from 1 to 5; 1 indicates very much improved and 5, worse.RESULTS A total of 61 consecutive, healthy adult patients (mean [SD] age, 57.4 [12.8] years) with mild to severe facial volume loss were enrolled in the study. A total of 46 patients (75%) were white, 3 (5%) were black/African American, 9 (15%) were Hispanic/Latino, 1 (2%) was Asian/Pacific Islander, and 2 (3%) were other. Three patients (5%) were male, and 58 (95%) were female. Mean initial treatment volume was 1.6 mL. At follow-up, 29 patients (48%) elected to have a touch-up treatment; mean total touch-up volume was 1.4 mL. The patient-graded Global Aesthetic Improvement Scale scores at 1, 3, 6, and 12 months after treatment demonstrated that 73% (41 of 56) to 89% (24 of 27) of the study patients reported being very much or moderately improved. Most patients were rated by investigators on the Global Aesthetic Improvement Scale as very much or moderately improved at the 12-month follow-up. At 12 months after the procedure, 43 of 51 patients (84%) reported satisfaction with their outcome. At all time points, most patients would elect to undergo the procedure again (range, 17 [68%] to 61 [100%]). Adverse events were mild, and all resolved spontaneously within 14 days. At the 2-year follow-up, there were no reports of delayed adverse events.CONCLUSIONS AND RELEVANCE Midface volumization using the low volumes of hyaluronic acid filler more commonly used in daily clinical practice is effective and well tolerated.LEVEL OF EVIDENCE 3.

<p>Subjective Evaluation of the Results of Injectable Hyaluronic Acid Fillers for the Face</p>

“…29,30 In a study by Baumann et al, the majority of the patients undergoing injectable HA gel therapy for facial fossa reported "a younger look" after treatment. 30 According to Wilson et al, 31 over 80% of the participants with agerelated volume loss of the facial skin reported significant improvement, even up to 12 months after treatment. A high level of satisfaction with the appearance of the facial skin after tear trough and temporal fossa augmentation was noted by Tung et al, and Berguiga et al 32,33 Jegasothy et al, 34 also reported beneficial effects (wrinkle depth reduction, improved skin hydration, firmness and elasticity) of low molecular nano-hyaluronic acid injections.…”

Temporal Augmentation: A Systematic Review

“…20 Creating a measure termed "Hollowness Severity Rating Scale" (subsequently used by Huang, as discussed in the Fat Grafts section) to grade the degree of hollowness in the temporal areas, the study showed significant improvement comparing pre-and postinjection scores. Most patients were satisfied, although the degree of satisfaction dropped from the 6-to 12-month mark (►Table 2). No major adverse effects were reported (►Table 3).…”

Hyaluronic Acid Fillers for Midface Augmentation: A Systematic Review

“…Patients who received 1 mL and 2 mL were more likely to report significant improvements at 1, 3, and 6 months compared with those who received higher initial volume injections. 25 However, patients who initially received greater than 3 mL reported the greatest improvement at 12 months. Of note, 48% of patients received touch-up treatments with a mean volume of 1.4 mL, and 10% of patients underwent a second touch-up injection.…”

“…Greater initial treatment volumes were associated with longer lasting results. 25 However, greater volumes may be associated with lumpiness. Therefore, care must be taken to find the lowest amount of filler to produce a positive result.…”