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Reconstituted Injectable Hyaluronic Acid: Expanded Applications in Facial Aesthetics and Additional Thoughts on the Mechanism of Action in Cosmetic Medicine

Fagien, Steven M.D.; Cassuto, Daniel M.D.

Plastic and Reconstructive Surgery: July 2012 - Volume 130 - Issue 1 - p 208–217
doi: 10.1097/PRS.0b013e318254b3f6
Cosmetic: Original Articles

Background: As we currently have a better understanding of the components of facial aging, injectable filling agents have a larger role in nonsurgical facial rejuvenation. Many products are now available worldwide as options for treating the spectrum of indications that include particular agents used for the treatment of various facial rhytides and in larger quantities for regional or panfacial volumization. The latter indication has been most popularly treated with a host of agents classified as hyaluronans or injectable hyaluronic acid gels. The former had been traditionally and more successfully treated with injectable collagen or dermal matrix agents. Attempts to confuse these generalized approaches have often led to unsatisfactory results. With the precipitous disappearance of the availability of most injectable collagen substances, other methods of treating finer facial rhytides have been explored.

Methods: Of the many options available for the treatment of facial fine lines, the authors describe a novel technique of formulating reduced concentrations of existing hyaluronic acid gels by variable dilution/reconstitution.

Results: Over 350 of the authors' collective patients have been treated with this approach. The results have been highly satisfactory, with greater persistence, and have challenged traditional concepts of mechanism of action and biodegradation and suggest alternative options in formulations of currently available products.

Conclusions: Reconstituted injectable hyaluronic acid is a highly effective and viable alternative for the aesthetic treatment of facial fine lines and other components of aging. Observations, treatment guidelines, and a rationale for this novel use and concepts to explain these finding are contained in this article.

Boca Raton, Fla.; and Milan, Italy

From private practice.

Received for publication December 7, 2011; accepted January 24, 2012.

Disclosure: Dr. Fagien is a clinical investigator and consultant for Allergan Medical, Medicis, Inc., Galderma, Inc., and Merz Aesthetics. Dr. Cassuto is a consultant for Allergan Medical.

Steven Fagien, M.D.; Aesthetic Eyelid Plastic Surgery, 660 Glades Road, Suite 210, Boca Raton, Fla. 33431,

©2012American Society of Plastic Surgeons