Safety and effectiveness of combining different hyaluronic acid fillers for treatment of facial soft tissue defects: randomized trial, multilayer (“sandwich”) approach

Abstract

Hyaluronic acid (HA) has been used as a gold standard for aesthetic facial treatments. Many different HA gels are available, and they differ in their HA concentration and rheological aspects. Treating patients with more than one HA gel in the same session or throughout the patient's life is a common practice. We want to show that a combination of different HA is safe and can have a better outcome regarding results, duration, and patient satisfaction. We have treated 30 patients, split into four groups. Patients were treated with three different HA products selected by their G’ to target different facial layers. All products were from the same brand and were injected through a cannula with one point of entry. Patients were evaluated with the WSRS and GAIS scales, showing no difference between groups. A statistically significant difference was seen when compared with basal photos. The follow-up was 12 months. No relevant side effects were detected in all groups. Considering that aging is a transversal process that implicates every facial layer, we conclude that combining different G' HA (multifiller approach) targeting precisecly different layers appears to be well tolerated and increases the average duration of aesthetic effects. More studies should be performed to confirm these preliminary results.