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Long-term follow-up of longevity and diffusion pattern of hyaluronic acid in nasolabial folds correction through high-frequency ultrasound

Qiao, Ju M.D.1; Jia, Qian-Nan M.S.1; Jin, Hong-Zhong M.D.1; Li, Feng M.D.1; He, Chun-Xia M.D.1; Yang, Jun M.D.2; Zuo, Ya-Gang M.D.1; Fu, Lan-Qin M.D.1

Plastic and Reconstructive Surgery: May 6, 2019 - Volume PRS Online First - Issue - p
doi: 10.1097/PRS.0000000000005848
Original Article: PDF Only

Background: Injectable hyaluronic acid (HA) fillers have been widely applied in the clinical treatment for facial wrinkle. However, further information with clinical evidences concerning dermal changes and HA filler longevity post injection as well as diffusion pattern are limited.

Methods: We evaluated the longevity and diffusion pattern of two HA fillers generated by different crosslinking technologies in the nasolabial folds treatment using high-frequency ultrasound. 41 subjects were treated with Restylane 2 and the remaining 41 with Dermalax DEEP. Wrinkle severity rating scale score and high-frequency ultrasound evaluation of nasolabial folds were performed before and after the injection of HA filler. The ultrasound images were acquired and analyzed to determine dermal thickness and the shape and distribution of HA filler.

Results: At two and 24 weeks from baseline, increased dermal thickness induced by HA filler treatment did not display significantly different between groups. At 48 weeks after injection, increased dermal thicknesses of Restylane 2 group (0.14mm±0.12) were much lower than that of Dermalax DEEP group (0.20mm±0.13). Ultrasound examination revealed that HA materials form well-demarcated and hypoechogenic areas. Restylane 2 tended to form a more diffused pattern with multiple smaller bubbles, while Dermalax DEEP developed into more localized configuration with bigger clumps.

Conclusions: Our current study is the first long-term assessment of nasolabial folds correction which reveals the performance of different HA materials in vivo and validates high-frequency ultrasound as a simple and rapid modality. HA fillers generated by different crosslinking technologies display differential diffusion patterns in the skin tissues.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

1.Department of Dermatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

2. Institute of Biomedical Engineering, Chinese Academy of Medical Science and Peking Union Medical College, Tianjin, China

Funding sources: CAMS Initiative for Innovative Medicine (2017-I2M-B&R-01)

Conflicts of interest: ACROSS Co., Ltd provided investigational and reference devices, the cost of patients’ physical examination and follow-up. All authors except Jun Yang received payment for participation in the study from ACROSS Co., Ltd. The company had no role in the design and conduct of the study, data collection and analysis, preparation and approval of the manuscript, or the decision to submit the manuscript for publication.

Acknowledgments: JQ, QNJ and HZJ did the study design; JQ analyzed the clinical data and drafted the first version of manuscript; JQ, QNJ, FL, CXH, JY, YGZ and LQF performed the study; HZJ revised the final version of the manuscript and all authors approved the final version of the manuscript for submission. This study has been approved by the institutional review board.

Corresponding author: Hong-Zhong Jin, M.D., No.1, Shuaifuyuan, Dongcheng District, Beijing, China Telephone& Fax: +86 10 69151502, E-mail:

©2019American Society of Plastic Surgeons