TAKE-HOME POINTS■ Hyaluronic acid fillers are the gold standard of dermal fillers.
■ Hyaluronic acid occurs naturally in the human body.
■ In the case of an undesirable outcome or complications, the effects of hyaluronic acid fillers can be fully reversed with hyaluronidase injection.
■ Juvéderm is the only filler approved by the FDA for use in patients with darker skin tones.
Juvéderm is the newest hyaluronic acid dermal filler used to shape and restore volume to facial wrinkles and folds.1 Two versions are available in the United States: Juvéderm Ultra and Juvéderm Ultra Plus. Juvéderm is the only hyaluronic acid dermal filler shown to be safe and effective in persons with a darker complexion. In early 2010, new versions of both formulas that include lidocaine were introduced (Ultra XC and Ultra Plus XC).2
Hyaluronic acid is a component of collagen, which occurs naturally in the body. Found in various anatomic regions, including the dermis, joint fluid, and vitreous of the eye,3 hyaluronic acid hydrates the skin and adds volume.2 The amount of hyaluronic acid decreases with age, causing dehydration and wrinkle formation.3 Fillers made from hyaluronic acid can be used to correct the resulting wrinkles, nasolabial folds, and oral commissures. These fillers are also used to restore volume to the lips, cheeks, and chin. The ideal use for hyaluronic acid fillers is to correct deeper wrinkles and folds.3
The structure of hyaluronic acid is a linear polysaccharide that is identical in all vertebrates. Thus hyaluronic acid fillers have a much smaller risk for immunogenic or allergic reactions, especially when compared to fillers such as bovine collagen. Hyaluronic acid fillers can be derived from animal or bacterial sources and differ by the amount of cross-linking and non-cross-linking they contain. The concentration of each type determines the filler's consistency and longevity. The more cross-linking, the longer the filler will continue to restore volume.3
ABOUT SOFT TISSUE AUGMENTATION
Skin changes and facial aging go hand in hand. Sun damage, changes in skin tone, gravity, and migration and loss of fat all contribute to facial aging.3 As a person ages, the changes in the structure of the face may not be aesthetically appealing.4 Fat relocation results in volume loss, which shows itself as a flat forehead and brow, temporal concavity, flat cheeks, jowls, and a decrease in lip fullness.3
Facial rejuvenation no longer requires surgery in the form of a facelift. Temporary, reversible injectable fillers can restore facial volume and correct wrinkles safely with minimal downtime.5 Dermal fillers help to recontour, shape, and retexturize aged skin.4
The idea of soft tissue augmentation dates back to the 1800s, when a German physician, Franz Neuber, performed the first autologous fat transplant. Over the next 2 centuries, paraffin and silicone were introduced to the market as fillers used to achieve soft tissue augmentation. In the 1980s, animal-derived collagen fillers were introduced.3,6 Along with bovine collagen, acellular human dermis and cultured fibroblasts were used as filler substances.3 In 2006, the FDA approved a new hyaluronic acid gel to rectify wrinkles and folds of the face.1,6 Among the dermal fillers, hyaluronic acid gels are the gold standard.1 Hyaluronic acid fillers are available in several formulas, including Restalyne and Juvéderm.6