After the advent of collagen in the 1980s, the second revolution that occurred in the use of new materials was the advent
of hyaluronic acid
, in the 1980s and 1990s.
There is no material so widely used in recent decades as hyaluronic acid, and treatments performed with this material would amount to a few million worldwide.
Hyaluronic acid is a natural substance in the body that can be injected under wrinkles to improve them.
In addition to boasting an important volumetric effect, it always allows revitalization of the treated area with stimulation of collagen and elastin formation.
It is a fully resorbable product and is among the safest on the market, especially the latest ones released on the market, which are very purified and have increasingly harmless cross-linking processes (the process that allows it not to be reabsorbed very quickly).
In this regard, it should be remembered that there are no completely safe products: even water or an injectable antibiotic can cause problems. And even hyaluronic acid in very rare cases and particularly the more durable and cross-linked acids can generate some intolerance.
It must also be remembered that while for other resorbable fillers (collagen and agarose) there are not many products on the market and all meet well-documented safety and sourcing criteria, this is not always true for hyaluronic acids. Every year, at our congresses, we find new materials at lower and lower costs whose provenance is not always fully known. This aspect is among those that determine the price of the session. As I always say one should be wary of too low prices that may hide a less safe and cheaper material. In these things, in my opinion, it is not worth saving money.
Basically, these are syringes prefilled with a gel that is injected into certain places on the face to improve wrinkles, depressions, or increase volume in certain areas, such as the lips or cheekbones.
I have been performing these implants for many years, and the problems I have encountered in all that time with this substance can be counted on the tips of the fingers of one hand. But the greatest safety probably lies in the reabsorbability: even if a problem occurs, in time the substance will be reabsorbed, and with it, in the vast majority of cases also the problem!
It should also be emphasized that syringes are strictly “disposable” and cannot be used for more than one patient.
There are various types of hyaluronic acid and various manufacturers’ brands: a less concentrated type and a more concentrated type. In addition, there are biphasic and monophasic hyaluronic acids, the latter being the latest generation.
Some of the best-known trade names include: Restilane (in America this name is synonymous with hyaluronic acid), Juvederm, XHa3, regenial Idea, to name but a few.
They are used according to the depressions to be treated: the finer the wrinkles, the less concentrated the acid will be. The deeper the depressions, the more concentrated the acid will be.
The results are very good and especially immediate. The side effects rather few:
- Swelling can occur and is always due to water recall. It usually disappears within 24 hours and affects only about 5% of cases
- Hematoma due to puncture of capillaries or venules. Short-lived, a few days.
- Freshly made local erythema. They last a few hours.
- Intolerance reactions: reported in the literature. They disappear within a few days, and in rare cases within a few weeks. In this case, the only certainty is that the substance in a shorter or longer period will be completely reabsorbed.
- Asymmetries or swellings from exaggerated correction: if strict technique is used they remain difficult to find.
- In addition, ischemia of the treated tissues with possible, very rare tissue necrosis is possible. Using hyaluronic acid, hyaluronidase can be used to dissolve the hyaluronic acid that created the problem.
It remains to this day in Europe the most widely used substance in wrinkle correction.