A comparative study assessed the longevity of different Hyaluronic acid (HA) fillers used in facial rejuvenation over a period of six months to find the best filler for your skin.


Hyaluronic acid (HA) is an important naturally-occurring compound found in the connective tissue, and 50% of it is located under the skin. It serves an important part in biological functions such as cell adhesion and motility regulation, but degrades over a period of time. Hormonal changes, environmental factors like smoking and sun exposure can contribute to this damage. Restoring HA results in facial rejuvenation with the restoration of facial volume and reduction of fine lines and wrinkles. Dermal filler injections are a popular technique for such facial rejuvenation.

There are different dermal fillers available in the market, depending on the chemical structure of the HA compound used. HA-based fillers are either cross-linked or non-cross-linked. Cross-linking are inter-molecular bonds that enhance durability and stability of the fillers. In turn, cross-linked fillers are classified as monophasic and biphasic. Monophasic HA fillers are a combination of low and high molecular weight HA. They are further classified as monodensified and polydensified, depending on when the cross-linking occurs. Biphasic HA fillers have cross-linked HA molecules suspended in non-cross-linked HA.

Fig 1. Classification of HA fillers

The clinical performance of fillers is dependent on their chemical structure and properties. Hence, to evaluate the durability of different dermal fillers, researchers carried out a clinical trial over a period of six months. Findings of the study can be reviewed in the Aesthetic Surgery Journal.

The study, conducted on 24 female subjects, evaluates the long-term durability of three different types of manufactured HA fillers, i.e. biphasic, monophasic monodensified and monophasic polydensified fillers. The products used were Perfectha Derm (biphasic), Teosyal Global Action (monophasic monodensified), and Esthelis Basic (monophasic polydensified). The subjects were injected with three skin fillers at three different positions on their back, making a matrix of nine application points. On days 2, 92 and 182 of the trial, skin biopsies were conducted and a tiny skin fragment was collected from the subjects. These skin specimens were subjected to an evaluation to determine the presence or absence of HA.

The results indicate that the biphasic fillers had the highest durability among the three tested products. Over the course of 182 days, it only reduced by 12.5% as compared to day 1. In comparison, the products with monophasic monodensified and monophasic polydensified HA reduced by 25% and 62.5% respectively. The samples collected on day 92 show a similar presence of both monophasic products. However, the monophasic polydensified filler deteriorates rapidly over the next three months. Other features like diffusion and resistance to oxidation were also observed to be better in the biphasic fillers.

The trial aims to bring clarity for patients and clinicians to choose dermal fillers according to their needs. Facial rejuvenation using dermal fillers is an aesthetic procedure that is becoming a trend for looking younger and attaining softer and smoother skin. The researchers have attempted to make the choices of dermal fillers easier for the client base.




Written By: Anuja Galagali, Biomedical Engineer

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