Hyaluronic Acid

The midface is gradually flattened, the bones in the area of ​​the eyebrows are reduced, as well as the subcutaneous fat below them on the upper eyelid, grooves appear under the eyes, rhinozoic crests become less visible, while the nasolabial folds deepen and form vertical peripheral lines, the lips atrophy and the corners of the mouth (puppet lines) go down significantly, giving the image of a face fixed down and turning its triangular shape that characterizes youth into a table that is a sign of gradual development of aging.

With the proper use of fillers either on the skin or under it in the subcutaneous fat and, even deeper, around the bone, all the above changes are improved or completely corrected, thus avoiding larger-scale surgeries. If the treatment of wrinkles, variegation and firmness of the skin is added, then the end result is much more natural than any combination of surgeries. Similar results with implants on the face are achieved on the dorsal surface of the hands.

Most fillers are available in pre-filled syringes for injection deep into the skin and subcutaneous tissue, depending on the filler being injected and the indication for which it is used. Lines and wrinkles require the filler to be deposited at various heights of the dermis (part of the skin below the epidermis), while the “filling” of the grooves and the provision of volume and contour require deeper deposition in the subcutaneous tissue, or just above the underlying bone.

There are different implants depending on their source, which act temporarily, ie they are absorbed after a few months by the body and their infusion must be repeated if we want to maintain the good result. These are the most commonly used and consist of hyaluronic acid produced mainly by bacteria. There are also long-acting implants, such as hydroxyapatite, which are synthetically prepared in the laboratory, and permanent ones, such as polyacrylamides, also synthetic, which are rarely used today.

Hyaluronic acid used almost universally is a natural polysaccharide that is normally found in the skin of all humans and all mammals. This acid is a hygroscopic substance and, in fact, has the ability to hold 1000 times its weight more water. In its natural form, non-cross-linked hyaluronic acid is characterized by a half-life of approximately 24 hours before being broken down by hyaluronidases and oxygen free radicals into the skin. However, different types of hyaluronic acids are prepared and marketed, which differ in their source, the concentration of acid in the syringe, the agent used to cross the acid polymers, the degree of differentiation due to crosslinking in combination with the amount of free hyaluronic acid, as well as whether the product is single-phase (solid gel) or biphasic (particulate). In fact, depending on the product, the depth of injection, the location and the purpose of use, various injection techniques are applied, such as intermittent administration, in small quantities, or continuous outflow, during the slow removal of the syringe. The best results are usually achieved with a combination of products and infusion techniques.