The natural aging process leading to noticeable creases on the face is often treated by a variety of non-invasive methods such as fillers or fat injections. A new lead study revealed that hyaluronic acid (HA) was effective for treatment of a severe form of nasolabial folds (NLFs) with the least side-effects and downtime.


Naturally, nasolabial folds are the two prominent facial skin folds occurring on each side of the nose running to the corners of the mouth. Generally, dermal fillers may be used for restoring the lost buccal fat pads and collagen on the facial area. Currently, hyaluronic acid (HA) dermal fillers are the most popular fillers employed for different purposes, especially in aesthetic procedures as well as facial tissue augmentation. The HA products that vary in gel characteristics such as firmness, degree of cross-linking and particle size can be adapted to different injection depths, treatment sites, and tissue quality. Therefore, HA products with effectiveness and safety outcomes up to a longer duration of 12 months are available for different facial folds. The most common HA fillers are Emervel Deep (HAED) and Restylane Perlane (HAPER) which are intended for deep injection into the dermis for correcting facial wrinkles, especially nasolabial folds (NLFs).  A multicentric long-term study was carried out by scientists in France and Germany on HA effect and safety on the treatment of severe NLFs. The findings of the study in this direction were published in the journal of Dermatologic Surgery, 2016.

In order to understand the effect of HA fillers on NSFLs, Ascher, along with his colleagues, carried out a randomized, controlled, subject and evaluator-blinded, split-face, and multicenter study. Researchers considered adults above 18 years with severe NLFs for study subjects while those suffering from active skin disease or inflammation near or in the NLFs, those with certain medical histories (e.g., sensitivity to HA, bleeding disorder, impaired coagulation, severe keloids, or hypertrophic scars), tissue augmentation or any aesthetic or dermatologic treatment in the face in the previous 12 or 18 months and those who were pregnant were excluded from the study. Researchers subjected randomization of treatment either to left or right side of the face and the follow-up period was for 12 months. A comparison of the effectiveness and safety of HAED with HAPER for the treatment of severe NLFs was done by wrinkle severity rating scale (WSRS), as well, safety and symptoms were recorded for 3 weeks after treatment. Interestingly, the study results at 6 months, based on mean change from baseline in WSRS score, showed that HAED was almost similar to HAPER for the treatment of severe NLFs. The effect lasted for at least 12 months in approximately 80% of subjects after the first treatment. Moreover, the effectiveness results reported in the study was similar to results reported previously.

Therefore, both HA gel products were well tolerated and effective for treating NFLs with minimum adverse events. To summarize, the effectiveness and therapeutic aspects of HAED used in severe NFLs is similar to that of HAPER. One main drawback of the HA fillers used in this study is that they did not have lidocaine, which is beneficial for those who are allergic to this class of local anesthetic, but this results in pain and reduced treatment comfort. Further corroborated studies are needed in confirming the minor differences and clinical relevance in the different types of HA fillers used for treating NFLs.

Written By: Manche Santoshi, PhD

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