The evolving role of hyaluronic acid fillers for facial volume restoration and contouring: a Canadian overview

Abstract

Recent advancements, including more versatile facial fillers, refined injection techniques and the adoption of a global facial approach, have contributed to improved patient outcome and increased patient satisfaction. Nine Canadian specialists (eight dermatologists, one plastic surgeon) collaborated to develop an overview on volume restoration and contouring based on published literature and their collective clinical experience. The specialists concurred that optimal results in volume restoration and contouring depend on correcting deficiencies at various layers of the facial envelope. This includes creating a foundation for deep structural support in the supraperiosteal or submuscular plane; volume repletion of subcutaneous fat compartments; and the reestablishment of dermal and subdermal support to minimize cutaneous rhytids, grooves and furrows. It was also agreed that volume restoration and contouring using a global facial approach is essential to create a natural, youthful appearance in facial aesthetics. A comprehensive non-surgical approach should therefore incorporate combining fillers such as high-viscosity, low-molecular-weight hyaluronic acid (LMWHA) for structural support and hyaluronic acid (HA) for lines, grooves and furrows with neuromodulators, lasers and energy devices.

Efficacy of Skinfill plus filler in the management of facial aging: a multicenter, post-marketing clinical study

“…Overall, patient satisfaction is a key parameter when evaluating the performance of dermal fillers, since esthetic interventions are optional and the patients play a decisive role in treatment choice. Our results, showing high patient satisfaction, corroborate the findings of several publications that show good patient outcomes, immediate results, and high satisfaction when using HA fillers for treatment of lines and wrinkles (Ginat & Schatz, 2012;Carruthers et al, 2010) and for volume restoration (Muhn et al, 2012). Volumes of < 8 mL were sufficient for optimal esthetic outcomes and this can be explained by the fact that SFP has optimal rheological properties and a homogeneous pattern of tissue integration after intra-or subdermal implantation (Goh et al, 2014;Tran et al, 2014).…”

“…Commonly observed adverse events are temporary, mild, and mainly related to the injection itself (burning, redness, itching, swelling, edema) (Brandt & Cazzaniga, 2008;Carruthers et al, 2009;Palm, 2014). Despite the high safety profile of hyaluronic acid, the literature documents rare isolated cases of more serious adverse events and/or delays such as granulomas of the skin at a distance up to 2 years after the first injection, which is not found in the follow-up of patients treated with SFP (Ginat & Schatz, 2012;Carruthers et al, 2010;Muhn et al, 2012).…”

HR007: a family of biomaterials based on glycosaminoglycans for tissue repair

“…In the case of dermal repair, the regeneration and growth of skin tissue requires the permanent reinstatement of dermal structure (Lee et al , ). Currently, numerous injectable fillers are available, formulated with calcium hydroxylapatite, polymethyl‐methacrylate, poly‐ l ‐lactic acid and, above all, HA for skin volume restoration (Muhn et al , ). The dermis is very rich in HA, contains a small quantity of sGAGs and can be easily treated for repair by injecting hydrogels.…”

Rheology of hyaluronic acid and dynamic facial rejuvenation: Topographical specificities

“…These characteristics are supported by several essential parameters: The type(s) of hyaluronic acid used, particularly the length of the chains implicated. The cross‐linking and formulation procedures. The final concentration of hyaluronic acid. …”