Hyaluronic Acid (HA) is widely used to fill up lines and furrows in the aging face. While its properties have been well-studied, paying attention to where it’s being put in can also enhance and prolong its effects.


As we age, lines in the face not only appear but also deepen in severity. Particularly prominent are the nasolabial folds, the lines that form the jowls, the tear troughs, the depressions between the eyes and the sides of the nose (where tears would flow down); and the malar or upper cheek areas, which hollow out in older patients. Filling out these lines, depressions and hollows to reduce their prominence leads to a much younger appearance, and thus the search for the perfect filler substance.

Hyaluronic Acid (HA) is a naturally occurring substance in the human body, found in significant quantities in the eyeball and in the joints. HA is viscous, and has a propensity to keep its shape and quite resistant to friction. HA is also non-reactive; no foreign body reactions are triggered by its presence. And because commercial quantities can be made from different sources, HA has been extensively used in numerous clinical applications.

HA is used extensively by dermatologists and plastic surgeons as facial fillers. Those deep lines and furrows in the face are ‘plumped up’ by injections of HA. Its viscosity also makes it resistant to both constant movement (facial expression, chewing) and friction (scratching, pillow contact) that faces go through. The problems related to foreign body reactions –which can be indeed catastrophic in the face—are also non-existent; it is simply resorbed by the body over a period of time.

In a novel South Korean study, published in Dermatologic Surgery, five patients were given injections of HA at these identified sites of ‘facial aging. The patients were then followed up for a period of 40 months and periodically assessed using an objective scoring system. What was observed was that the areas of the face that were subject to more movement (the nasolabial fold), HA re-absorption happened much earlier. Conversely, HA was seen to be more persistent in the less dynamic facial areas, like the tear troughs or the malar areas.

What the research shows is that the efficacy of hyaluronic acid as a filler is dependent on not just its inherent properties, but also an understanding of anatomic differences in the different regions of the face. Being aware of these differences can enable doctors –and patients—to plan injection intervals to fully maximize and prolong the beneficial effects of hyaluronic acid.


Written By: Jay Martin, M.D.

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