HYALURONIC ACID YEAR 2023
Adrián Ríos, Unilaser medical director
Today, hyaluronic acid has the magic of achieving immediate results that last without the need for overcorrection. So when you feel the need to apply it in a palpable way, it is often because the impact of hyaluronic acid has been discerned in someone close to you, even if they rarely admit it. This has led us to a new approach towards defining facial contours more precisely with much less volume.
Upper Facial Contour (Including Forehead)
It covers the forehead, temples and infraorbital area, as well as the malar prominences and temporal processes. Its objective is to define the upper part of the face.
Lower Facial Contour (Including Lips)
In this case, the lower jaw, cheeks, and perioral area are involved, as well as the lips. The goal is to provide contour and definition to the lower part of the face, including a fullness effect on the lips.
The Upper Facial Contour (Temporal, Malar and Upper Maxilla)
The upper facial contour establishes an upper frame for the face, consisting of the forehead, eyes, and upper cheeks. A well-defined contour is recognized as a sign of beauty.
Upper Facial Contour Bone Structure
The upper facial contour is based on 4 bones: frontal, zygomatic, maxilla and temporal. As we age, these bones take on particular shapes, while the soft structures surrounding them give rise to a heterogeneous aging phenomenon, resulting in the formation of folds that should not be ignored in the natural reconstruction of the appearance of the upper facial contour.
It is not enough to simply “inflate” all the tissues; this could lead to an excessively pronounced contour that reveals a cosmetic intervention.
Objectives of Hyaluronic Acid
Hyaluronic acid aims to correct the retraction of the facial center, adjust the variable angles of the underlying bones and restore the displacement of fatty tissue present in youth.
Delineation of the orbits, forehead and cheekbones | Amount | Hyaluronic Acid Prices (in millions of pesos) |
Hydration and light outline | 1-4 cc. | 1.5 – 6 |
Profiling and filling of sinkholes | 2-8 cc. | 3 – 10 |
The Lower Facial Contour
The jaw plays a key aesthetic role by breaking the continuity between the neck and the face and providing strength and definition to the features. A well-defined, angular jaw is a trait we associate with physical attraction in both sexes.
Importance of the Mandibular Angle
When the angle of the jaw is not very pronounced, certain facial defects such as the formation of “chunky cheeks” may become more evident. In these cases, it is essential to consider a more comprehensive intervention that strengthens the entire mandibular structure, including the chin, which is an inseparable element of the whole.
Restoration Strategies
Complete restoration of the jawline may require a combination of fillers that increase volume and also define the entire jawline. This includes Volux®, Voluma ®, and HarmoniCa®.
Amount of Hyaluronic Acid Used
The amount of material needed may vary, generally ranging from 2 to 8 vials, depending on the specific needs of the patient and the technique used.
Lower facial contouring | Amount | Hyaluronic Acid Prices (in millions of pesos) |
Light outline | 1,2-4 cc. | 1.8 – 7.4 |
Profiling and filling of sinkholes | 2-7.4 cc. | 3 – 10 |
Types of Hyaluronic Acid and Calcium Hydroxyapatite
Volite®
It is a very low-density cross-linked hyaluronic acid filler. Its main function is to restore slight skin depressions and provide hydration at the subdermal level.
Sunekos 200®
It is a non-cross-linked hyaluronic acid filler that specializes in superficial skin hydration, as well as correcting small grooves.
Sunekos 1200®
This is a subdermal hyaluronic acid activator, created to stimulate tissue regeneration.
Volift®
It is a medium-density hyaluronic acid filler, specially formulated to address the presence of medium-depth grooves in the skin.
Volbella®
This low-density cross-linked hyaluronic acid filler, although with a higher density than Volite® and lower than Volift®.
Voluma®
Voluma® is a high-density cross-linked hyaluronic acid filler, designed for deep tissue integration.
Volux®
It is a hyaluronic acid filler with greater volumizing capacity and good deep integration.
Radiesse®
Radiesse® is a calcium hydroxyapatite used for subdermal restorations, especially when used in hyperdilutions.
HarmoniCa®
It is a facial contour filler that combines Volift® with calcium hydroxyapatite.
What is Hyaluronic Acid Used For in Cheeks?
They are the center between the two contours, they are the transition that instead of hiding should be made uniform between its upper and lower support bones.
Anatomical Features and Challenges
Some people may present hypertrophy of the central fat pads while others show the opposite, accentuated by deeper wrinkles. Almost always the fat on the cheeks gives the appearance of a gravitational descent, exposing the malar and maxilla bones that support the eye socket and also the lateral support, the temporal bone apophysis. In the lower and central part they clearly define the entire jaw and the lips with particular changes.
The cheeks are a tissue that is “loose” in its center and does not accept heavy fillers, much less reticulated ones, because nodulations are easily formed. Trying to correct them with fillers that overcorrect the upper facial contour can result in hiding them.
Implementation strategy
In principle, all of the above leads us to look for fillers with cross-linked hyaluronic acid in the contours and non-cross-linked in the “center”.
Amount:
The delimitation of the upper and lower contours may require between 2 and 8 vials. Sometimes a little more.
Components of the upper facial contour:
- Forehead
- Temples
- Infraorbital contour (region below the eyes)
- Frown
- Upper contour of the cheeks
What is Hyaluronic Acid for the Forehead?
A beautiful forehead enhances the other features of the face.
The forehead may show various signs of aging, thinning, more pronounced furrows, accentuation of the depression in the center, greater visibility of the superciliary bony prominences and the frontal suture.
Average Amount Applied
The average amount of hyaluronic acid applied to the forehead is approximately 2 milliliters. Filling in the temples can add an additional 1 to 2 milliliters to the total amount of hyaluronic acid applied.
Forehead Delineation
Action | Amount | Hyaluronic Acid Prices (in millions of pesos) |
Hydration and light outline | 1-2 cc. | 1.5 – 3 |
Projection or filling of sinkholes | 1-4 cc. | 1.5 – 6 |
What is Hyaluronic Acid for Temples?
Beautiful temples are distinguished by their fullness and soft contour, complementing the bone structure of the face without adding visual tension.
Filling only the cheekbones and not the temples can result in an unbalanced facial appearance.
To soften the hollowing of the temples, hyaluronic acid of the Voluma® type is used. However, this may not be sufficient for the lower part of the temples, specifically in the area above the malar and temporal process. Supplementing this area with another type of filler, such as Volbella®, will help to soften the part that covers both the temporal process and the malar bone.
Average Amount Applied to Temples
The recommended volume for outlining the temples can vary between 1 and 4 milliliters, with the average being approximately 2 milliliters.
Outlined on the temples | Amount | Hyaluronic Acid Prices (in millions of pesos) |
Filling and light malar-temporal contouring | 1-2 cc. | 1.5 – 3 |
Filling of sinkholes | 1-2 cc. | 1.5 – 3 |
What is Hyaluronic Acid used for in the Infraorbital Contour?
Hyaluronic acid applied to the infraorbital contour must take into account several aspects, such as thinning of the eyelid skin, increased visibility of the folds of the orbicularis muscle, decreased fat pads on the maxilla and malar bones, the presence of palpebral bags and fatty denudation of the upper infraorbital grooves.
Amount and Time of Application in the Periorbital Region:
The amount of non-cross-linked hyaluronic acid in the periorbital tissue should not exceed 1 milliliter in total. One or two sessions can be performed after 21 days. Since we use Sunekos 200®, it is replaced in a vial of 2.5 milliliters in total, the excess, the 1.5 milliliters, are applied to other areas such as the neck.
In the malar grooves and maxillary depression, between 1 and 2 milliliters of Volift®, Volbella® and Voluma® may be needed.
The average in the initial session is usually 2 milliliters between cross-linked and non-cross-linked fillers.
Delineation of the orbits | Amount | Hyaluronic Acid Prices (in millions of pesos) |
Hydration and light outline | 1-2 cc. | 1.5 – 3 |
Projection and filling of sinkholes | 1-4 cc. | 1.5 – 6 |
What is Hyaluronic Acid used for in the eyebrows?
The area between the eyebrows is an area that generally responds to botulinum toxin, since it is the contraction of the muscles that ends up defining a furrow. When the folds are already permanent, hyaluronic acid fillers are especially useful.
Application Techniques
- Puncture : When the defect to be corrected is small, a “template” puncture technique is required to avoid complications.
- Cannula : In cases where the sinking is more pronounced, a cannula is used to create a ‘bed’ through which injection is made without pressure.
Choosing the Type of Hyaluronic Acid
The choice between Volbella® and Volift® may depend on the depth of the depression in the area between the eyebrows. Integrating these fillers into smaller wrinkles may not be effective and non-cross-linked hyaluronic acid may be necessary.
Average Amount Applied
The average amount can range between 0.5 and 1.5 milliliters.
Filling between the eyebrows | Amount | Hyaluronic Acid Prices (in millions of pesos) |
Superficial | 0.25 –0.5 cc | 1 |
Deep | 0.5-1 cc. | 1.5 |
Components of the lower facial contour:
- Lips
- Body and mandibular branches
What is Hyaluronic Acid Used For in Lips?
The lips in women are perhaps the first area where signs of aging appear.
The phenomenon is deflationary or “constriction.” This means that the entire anatomical area is affected, including the vermilion.
Likewise, forward projections of all the skin covering the lip should be adjusted, since, as far as possible, the entire anatomical unit should be treated, avoiding accentuating the vermilion with hyaluronic acid in an unnatural way by not treating the perioral region, or the opposite, which hides the vermilion even more.
Anatomical and aesthetic considerations
It is important to note that the skin of the lips does not have a large amount of fat in the limits just beyond the vermilion.
Additionally, the fat is not distributed evenly which can result in natural bulges in some people.
Marionette lines and nasolabial folds begin to become more noticeable, not only due to the sagging of the cheeks or the increase in their fatty deposits, but also due to the reduction of the delicate fatty packets in the lips.
The vermilions also undergo these constrictive changes, making them smaller and wrinkled.
Finally, we have the corners of the lips, which, when sunken, give the impression of a “sad mouth” and deserve direct correction as soon as they take on this appearance.
Therefore, any defect in the placement of cross-linked hyaluronic acid can be very evident.
In doubtful cases, it is preferable to use dense, non-cross-linked hyaluronic acid, such as Sunekos 1200®. This product provides adequate short-term volume and improves the structure of the subdermal tissue. It also allows for more accurate evaluation of future interventions with cross-linked hyaluronic acid fillers. Sunken corners of the mouth respond better to Volift ® than to Volbella®, and vermilion can be treated with both Volite® and Volbella®.
Amount:
Generally, the amount of hyaluronic acid to be used in this area will range from 2 to 6 milliliters, depending on the individual needs of the patient.
Outlining the lips and perioral area | Amount | Hyaluronic Acid Prices (in millions of pesos) |
Hydration and light outline | 1-4 cc. | 1.5 – 6 |
Profiling and filling of sinkholes | 2-6 cc. | 3 – 7.2 |
What is Hyaluronic Acid for in the mandibular contour including the chin?
In the description of the lower facial contour we describe mainly the mandibular part attached to the chin, which is another area of the face that can show obvious signs of lack of definition.
Anatomical Features and Challenges
The chin is home to several very specific fatty deposits that have very different consistency properties. This is why different types of hyaluronic acid are used depending on whether it is used on the chin, the supramental area, the lateral branches of the chin, both upper and lower.
Hyaluronic acid offers an effective solution to these problems, allowing the chin to be projected and contoured. Hyaluronic acid fillers used in this area are preferably Volux ® which gives volume and smoothness and thus corrects deeper depressions, Voluma ® or Volift® which can be used to compensate for marionette lines and HarmoniCa® to complete the definition.
Amount:
As a general rule, the amount of hyaluronic acid in the chin is rarely used less than 2 cubic centimeters (cc) and it is common to easily reach 4 cc, depending on the specific needs of the patient.
Outlining the lips and perioral area | Amount | Hyaluronic Acid Prices (in millions of pesos) |
Light outline | 1-4 cc. | 1.5 – 6 |
Profiling and filling of sinkholes | 2-6 cc. | 3 – 7.2 |
Other areas of application of hyaluronic acid and calcium hydroxyapatite:
What are earlobe fillers for?
Earlobes are one of the most overlooked areas when it comes to facial rejuvenation, but treating them can make a huge difference in your overall appearance and how your earrings hold up.
Common Problems
Over time, earlobes can lose volume and firmness, and this can lead to unwanted dilation of the earring holes. In addition, this loss of volume can make the lobes appear disproportionate to the rest of the ear.
Amount of Filling Needed
Although the amount of hyaluronic acid needed for earlobe filling may vary depending on the individual and the severity of volume loss, the amount is generally between 0.5 and 1 ml per earlobe.
Hyaluronic Acid and Calcium Hydroxyapatite Fillers in the Neck
Treatment Approach
For those seeking a less invasive solution, hyperdilutions of calcium hydroxyapatite and hyaluronic acid offer an attractive option. These treatments aim to provide “direct nutrition” to the skin, improving its appearance and texture.
Calcium Hydroxyapatite and Hyaluronic Acid
Using hyperdilutions of calcium hydroxyapatite (commonly known as Radiesse®) together with non-cross-linked hyaluronic acid can be effective in addressing these issues. These compounds work together to restore volume and stimulate collagen production, thereby improving skin quality.
Quantity and Dilution
In terms of quantity and dilution, two 1.5 cc ampoules of Radiesse® can be used, diluted with saline solution. In addition, one or two doses of low cross-linking hyaluronic acid and more saline solution can be added for longer-lasting effects.
Treatment with Hyaluronic Acid and Hydroxyapatite on Arms, Elbows, Hands, Knees and Thighs
Hydroxyapatite Hyperdilution Technique
The hydroxyapatite hyperdilution technique is used not only on the neck but also on other areas such as arms, elbows, hands, knees and thighs. This treatment combines calcium hydroxyapatite with hyaluronic acid to address various aesthetic problems in these parts of the body.
Aesthetic Problems Addressed
Volume loss, sagging and wrinkles are common aesthetic concerns in these areas. The application of hyperdilutions of hydroxyapatite in combination with hyaluronic acid seeks to improve these problems by stimulating collagen production and providing additional hydration to the skin.
Advantages of Treatment
- Natural Results : The combination of these ingredients provides a natural effect, avoiding a “done” or “exaggerated” appearance.
- Personalization : The technique can be adapted to the individual needs of each patient, allowing for a more coherent aesthetic approach.
- Collagen Stimulation : In addition to providing volume and hydration, the treatment also stimulates collagen production, which can improve skin quality in the long term.