Current Practices in Hyaluronic Acid Dermal Filler Treatment in Asia Pacific and Practical Approaches to Achieving Safe and Natural-Looking Results

Abstract

Complications such as delayed inflammatory reactions (DIRs) and unnatural outcomes can sometimes arise from hyaluronic acid (HA) dermal filler treatments and can be challenging to address. Given the popularity of HA dermal fillers for aesthetic procedures, there is a need for preventive strategies to minimize these complications. Two hundred practitioners from 10 regions in Asia Pacific who administer HA fillers completed a survey on prevention of DIRs and unnatural outcomes. Thirteen global experts convened to evaluate the current practices and propose practical approaches for safe and appropriate use of HA dermal fillers. From the survey, the top three measures used to reduce the risk of DIRs included choosing an appropriate HA filler, aseptic technique, and patient selection. Key strategies employed to achieve natural-looking outcomes were treatment customization, understanding the rheological properties and behavior of different HA fillers, and being conservative in treatment approach. The panel developed a concise reference guide aimed at minimizing the risk of DIRs while achieving natural aesthetic outcomes. Five practical considerations were recommended: patient assessment and individualization of treatment plan, choice of an appropriate HA filler, adequate knowledge of facial anatomy, strict adherence to aseptic methods, and proper injection technique. The panel highlighted the need for education efforts to increase awareness of differential immunogenicity between HA fillers and to improve understanding on the importance of preserving aesthetic individuality for optimal results. These practical insights from the global experts support practitioners in optimizing safety and quality of aesthetic treatment with HA fillers.

Etiology of Delayed Inflammatory Reaction Induced by Hyaluronic Acid Filler

“…Hyaluronic acid fragments below 1000 kDa are proinflammatory and can initiate an inflammatory response by activating Tolllike receptors 2 and 4 [31]. Some studies have suggested that the Vycross technology hyaluronic acid filler may have a higher risk of delayed inflammatory reactions because of its low-molecular-weight hyaluronic acid composition [32]. However, although hyaluronic acid fillers usually contain a high-molecule hyaluronic acid, it is degraded by hyaluronidase and reactive oxygen into 20-kDa fragmants [7].…”

“… 30 Some studies have suggested that the Vycross technology hyaluronic acid filler may have a higher risk of delayed inflammatory reactions because of its low-MW hyaluronic acid composition. 31 However, although hyaluronic acid fillers usually contain a high-MW hyaluronic acid, it is degraded by hyaluronidase and reactive oxygen into 20-kDa fragments. 7 Thus, it is reasonable to assume that the periphery of the implanted hyaluronic acid filler can be degraded by hyaluronidase and that low-MW fragments of hyaluronic acid could induce an inflammatory response.…”

Elevating Aesthetics: Patient-Specific Treatment with Hyaluronic Acid Fillers to Improve Appearance and Psychosocial Wellbeing

“…[10][11][12] Panels of experts have defined key strategies to achieve naturallooking results when injecting HA fillers: patient assessment and individualisation of treatment plan, adequate knowledge of facial anatomy, proper injection techniques, good knowledge of the rheological properties and behaviours of different HA fillers, and a conservative treatment approach. 13,14 Patients are not only looking to improve their appearance, but also their mental and emotional health, along with social wellbeing. 15 In a survey on patient motivations to undergo cosmetic procedures, psychosocial concerns were mentioned more than other identified themes, specifically the appeal for improved confidence, feeling depressed and anxious with current appearance, and feeling consumed by efforts to conceal undesirable physical features.…”