Hyaluronan (also called hyaluronic acid or hyaluronate) is an anionic, nonsulfated glycosaminoglycan distributed widely throughout connective, epithelial, and neural tissues. It is unique among glycosaminoglycans in that it is nonsulfated, forms in the plasma membrane instead of the Golgi, and can be very large, with its molecular weight often reaching the millions.^[2] One of the chief components of the extracellular matrix, hyaluronan contributes significantly to cell proliferation and migration, and may also be involved in the progression of some malignant tumors.

The average 70 kg (154 lbs) person has roughly 15 grams of hyaluronan in the body, one-third of which is turned over (degraded and synthesized) every day.^[3] Hyaluronic acid is also a component of the group A streptococcal extracellular capsule,^[4] and is believed to play a role in virulence.

What is Hyaluronic Acid Therapy?

Hyaluronic acid therapy is a cosmetic surgery technique that is used for facial augmentation. The therapy involves injections in the face to mask/remove facial flaws. It is administered through a needle and bears the important distinction of being a substance that is very well tolerated by the human body. This means that you do not have to have to be tested for an allergic reaction before being injected with it. This is good news for those who do not want to wait eight weeks for the results of an allergy test.

What is Hyaluronic Acid?

Hyaluronic acid is compatible with the human body because it is a substance that is found in every single organic living thing. Its main purpose in the human body is to act as a network that transfers essential nutrients from the bloodstream to skin cells.

It is most present in the human body in fluids around the eye area and in the joints. In fact, aside from its applications to cosmetic surgery, it is also often injected into joints to relieve rheumatism and other kinds of joint pain. However, the names of the products that are associated with hyaluronic acid’s use for cosmetic surgery are Hylaform, Restylane, Perlane and Esthelis. Of them all, Hylaform and Restylane are the two most popular injectibles that are used to fill lines and wrinkles.

In its purest essence, hyaluronic acid is a gel like substance that sits between the skin and connective tissues supporting the skin. When injected, it acts like an inflated cushion to support facial structures and tissues that may have lost volume and elasticity due to aging and other causes. It is also hydrates the skin by bringing water to the surface which helps give it a refreshed and more youthful appearance.

Hyaluronic Acid Injections

Hyaluronic acid injections are termed dermal fillers by plastic surgeons. It is used to add volume to deflated or depressed areas in the skin. Dermal filler is a substance that can be used to improve the facial contour as well as reduce the depressions in the skin due to scars, injury or lines.

Hyaluronic Acid Injections - Procedure

The procedure itself is very non invasive and does not require anything but a topical anesthetic administered to the site of injection (to deal with any pain caused by the insertion of the needle). The needles used for this procedure are very fine and tiny and depending on how many problems are being treated the treatment takes between fifteen minutes and an hour. It is considered to be an outpatient procedure and many people return to their normal activities the same day.

The augmentation usually lasts from between three and five months depending on your life style, body chemistry and the rate at which you are naturally aging. It is important to realize that this is a temporary solution and not a permanent cure for facial problems. To maintain their youthful appearance most people have new hyaloronic injections two to three times a year.

Before you consider having hyaloronic acid treatment, be aware that you might not achieve the results you want with just one treatment. Depending on how your body reacts to the injections you might have to return to the doctor’s office to get a touch up on your injection. On average, most people need at least three visits before they are completely satisfied with the results.

Functions

Until the late 1970s, hyaluronan was described as a "goo" molecule, a ubiquitous carbohydrate polymer that is part of the extracellular matrix. For example, hyaluronan is a major component of the synovial fluid, and was found to increase the viscosity of the fluid. Along with lubricin, it is one of the fluid's main lubricating components.
Hyaluronan is an important component of articular cartilage, where it is present as a coat around each cell (chondrocyte). When aggrecan monomers bind to hyaluronan in the presence of link protein, large highly negatively-charged aggregates form. These aggregates imbibe water and are responsible for the resilience of cartilage (its resistance to compression). The molecular weight (size) of hyaluronan in cartilage decreases with age, but the amount increases.
Hyaluronan is also a major component of skin, where it is involved in tissue repair. When skin is exposed to excessive UVB rays, it becomes inflamed (sunburn) and the cells in the dermis stop producing as much hyaluronan, and increase the rate of its degradation. Hyaluronan degradation products also accumulate in the skin after UV exposure.
While it is abundant in extracellular matrices, hyaluronan also contributes to tissue hydrodynamics, movement and proliferation of cells, and participates in a number of cell surface receptor interactions, notably those including its primary receptors, CD44 and RHAMM. Upregulation of CD44 itself is widely accepted as a marker of cell activation in lymphocytes. Hyaluronan's contribution to tumor growth may be due to its interaction with CD44. Receptor CD44 participates in cell adhesion interactions required by tumor cells.
Although hyaluronan binds to receptor CD44, there is evidence hyaluronan degradation products transduce their inflammatory signal through toll-like receptor 2 (TLR2), TLR4 or both TLR2, and TLR4 in macrophages and dendritic cells. TLR and hyaluronan play a role in innate immunity.
High concentrations of hyaluronan in the brains of young rats, and reduced concentrations in the brains of adult rats suggest hyaluronan plays an important role in brain development.

The longest lasting hyaluronic acid dermal filler?

Like some other hyaluronic acid dermal fillersCaptique and Restylane, Juvederm Ultra and Juvederm Ultra Plus are made from bacteria. Because of that similarity, many patients find it difficult to choose between fillers. As long as the dermal filler works, few patients care about the details. Sadly this can be an expensive mistake. While the hyaluronic acid dermal fillers are made from bacteria, they are not all created equal. including

Juvederm Ultra and Juvederm Ultra Plus are made from a certain type of Strep bacteria similar to, but certainly not exactly like, the bug that causes Strep throat. We have advanced genetic engineering to such a degree that we can now change the genes in bacteria to do our bidding. This is what the manufacturers of Juvederm Ultra and Juvederm Ultra Plus have done. They have created bacteria with just the right genes to pump out loads and loads of hyaluronic acid. What the makers of Juvederm have also managed to do is make that hyaluronic acid highly cross-linked.

Why is cross linking of hyaluronic acid good?

…Because the more cross-linked the hyaluronic acid, the longer it lasts in the skin. Consider that hyaluronic acid is a natural component of every person’s skin. That means that the human body has a way of producing hyaluronic acid and a way of breaking it down and clearing it from the body. This building up and breaking down is a theme throughout biology to keep tissues fresh and healthy. A simple hyaluronic acid molecule is easy for the body to break down. An enzyme snaps it in two or tags it for removal and away it goes. However, if that hyaluronic acid is attached to a number of other hyaluronic acid molecules, it cannot be broken down so easily. The result is a long lasting effect of the hyaluronic acid dermal filler in the skin.

Juvederm is highly cross-linked

Every patient will break down hyaluronic acid at different rates. In other words, one person injected with a filler may get six months of cosmetic benefit while another patient may enjoy a full year. However the amount of cross linking of hyaluronic acid will increase any person’s duration of benefit from the treatment.
In fact, Juvederm Ultra Plus has just about the highest amount of cross-linking available in a hyaluronic acid dermal filler. Patients that received Juvederm Ultra Plus injections into wrinkles and lines of the face can expect positive effects to last for nine to twelve months on average. This effect is about twice as long as most other hyaluronic acid dermal fillers.

Juvederm may be the right choice financially

If you are considering a hyaluronic acid dermal filler, the duration of the beneficial effect is something to take into account. The longer that a dermal filler lasts, the fewer treatments are needed to maintain the facial filling effect. Fewer treatments mean fewer injections and less expense over the long term. While Juvederm Ultra Plus may cost slightly more than other hyaluronic acid fillers, fewer treatments may mean a cost savings ultimately.

Here's how it works

If you want to reduce facial wrinkles and lines, hyaluronic acid may be a good choice as a dermal filler because of its compatibility with the human body.
In fact, this substance is found in almost every single living thing. In humans, it acts as a network that transfers essential nutrients from the bloodstream to skin cells.

Hyaluronic acid is a natural substance found in your body. High concentrations are found in soft connective tissues and in the fluid surrounding your eyes. It's also in some cartilage and joint fluids, as well as skin tissue. It is extracted and reformulated and now has become one of the most popular kinds of injectable fillers. If the term sounds familiar, it's because the same substance is often injected into the aching joints of people with arthritis to ease pain and provide extra cushioning. Brand names include Captique, Esthélis, Elevess, Hylaform, Juvéderm, Perlane, Prevelle, Puragen and Restylane. Hyaluronic acid is not derived from animal sources.
When this gel is injected, it acts like an inflated cushion to support facial structures and tissues that may have lost volume or elasticity due to normal aging. It also brings water to the surface of skin to keep it looking fresh and supple.
In the last few decades, various synthetic forms of hyaluronic acid have been developed and used to correct disorders in the fields of rheumatology, ophthalmology, and wound repair. More recently, synthetic forms of hyaluronic acid are being manufactured for use in face augmentation.

What Are the Different Types of Lip Injections?

There are three main types of lip injections in use, fat, collagen, and hyaluronic acid based. Each type has advantages and drawbacks. None of these substances will provide permanent lip plumping. The results from lip injections typically last between four and six months. The substances used in injections gradually break down and are absorbed over time.
Fat transfer is a process where fat is removed from the individual's body, through liposuction or with an incision, and then is injected into the lips. Because the fat comes from the person receiving the injection, it is unlikely that rejection will develop. Fat creates a natural-looking lip. Fat injections do not typically last as long as collagen or hyaluronic acid based injections. Hyaluronic acid based injections use a clear gel that is similar to the hyaluronic acid naturally present in the body. Hyaluronic acid is responsible for lubricating joints and is also present in the skin. Hyaluronic acid based lip injections bind with water in the body, accenting the plumping effect of the injection. These products typically last about six months.
Collagen is the most common product used for lip injections around the world. The collagen can come either from cows or humans. Bovine-based collagen comes from cows that are raised in a closed herd to prevent contamination. Some individuals are allergic to bovine collagen, so the healthcare provider will perform a skin test prior to injecting the lips. Human based collagen is removed from cadavers or excess skin removed during surgery. No allergy testing is required during this procedure. Lip injections create fuller lips, which are equated with youth. As people age, it is normal for the lips to become thinner. The procedure is quick and relatively painless. Although the skin around the lips is extremely thin and sensitive, the needles used for injections have a very small diameter, and the patient receives topical anesthesia before the injections.

Hyaluronic Acid Procedure
Injectable fillers are one of the most popular facial rejuvenation techniques. As we age, the underlying tissues that keep our skin looking youthful and firm begin to break down due to the effects of gravity, sun exposure, diet, genetic factors, and years of facial muscle movement. Over time these factors contribute to the development of lines, wrinkles, and folds in the face.

Your skin consists of two layers known as the epidermis and the dermis. The epidermis, or outer layer of the skin, acts as the skin’s primary defense against the environment. The dermis, or innermost layer of the skin, is composed primarily of connective tissue and provides the skin with a support network. Most facial wrinkles and deeper folds occur within the dermal layer of the skin.
Within the connective tissue of the dermis, collagen and elastin fibers form a network that provides the skin with structure, support, and elasticity. Furthermore, fat cells and other molecules, such as hyaluronic acid, help to create volume beneath facial skin. With time, this network of collagen and elastin fibers breaks down, and hyaluronic acid molecules and fat cells that create volume are depleted. Together breakdown and depletion of these molecules result in wrinkles and other changes to facial skin.
When used as standalone treatments or with other procedures, injectable fillers can reduce or eliminate wrinkles and scars, create fuller lips, and treat lipoatrophy, or fat loss beneath the skin. With little downtime and almost immediate results, injectable fillers offer a safe, effective method of restoring a smoother, more youthful appearance.
H
yaluronic acid is a naturally occurring complex sugar molecule that forms large matrices in the connective tissue of the body, such as skin and cartilage. Much like a sponge, its primary function is to bind and absorb water molecules, which creates volume in the face. Hyaluronic acid fillers are generally used to treat facial wrinkles and folds and to enhance the appearance of the lips. One of the fastest growing dermal filler treatments available, hyaluronic acid fillers work by replacing the hyaluronic acid in the body that has depleted over time, which restores the volume beneath the skin’s surface.
While there are a variety of hyaluronic acid fillers, some of the most common are Hylaform®, Restylane®, and Juvederm®. Hylaform®, marketed by INAMED Aesthetics, consists of avian, or bird-derived, hyaluronic acid. Restylane®, marketed by Medicis, and Juvederm®, marketed by Allergan, are both non-animal derived forms of hyaluronic acid produced in the laboratory. Hyaluronic acid fillers are generally biocompatible, which means allergy skin testing is not required prior to treatment.
Depending on the extent of treatment, hyaluronic acid injection procedures typically last between fifteen and sixty minutes. Prior to the start of your procedure, the treatment areas will be cleansed, usually using an alcohol based cleaner. Unlike collagen injections, hyaluronic acid injections do not include an anesthetic agent. Therefore, a local or topical anesthetic may be used to numb the treatment area during the procedure.
Using an ultra fine needle, hyaluronic acid is injected into the dermis at several points along the edge of the treatment area. After approximately two to three injections, the physician will massage the treatment area. The physician will continue injecting the filler along the length of the wrinkle or fold until maximum correction has been achieved. If a local anesthesia has not been used, you may feel some minor stinging from the injections. As the injected hyaluronic acid molecules attract and bind water molecules, the volume beneath the skin will increase, restoring a smoother, more youthful appearance.
Immediately following the injections, you may experience some redness, slight stinging, minor swelling, or bruising in the treatment area. Tiny scabs may also form at the injection sites. These symptoms typically disappear within two to three days. No bandaging is necessary and most patients are able to resume normal activities immediately.
The body will eventually metabolize and absorb the injected hyaluronic acid over time. Therefore, while the effects are immediate, hyaluronic acid injections do not provide the same long-lasting results that may be gained from cosmetic surgery. Although the longevity of results varies by patient, results from hyaluronic acid injections are typically maintained for six to twelve months.

Injectables and Skin Fillers – From A to Z

Injectable skin fillers have added new dimensions to the field of cosmetic dermatology, allowing new forms of facial rejuvenation and wrinkle treatment without surgery. Injectable skin and wrinkle fillers are used to increase tissue volume (as with lip augmentation), reduce wrinkles, and improve skin’s overall contour.

Artefill®/Artecoll®

Artefill®, known as Artecoll® outside the United States, is an injectable skin filler that promises long-lasting wrinkle treatment thanks to its unique composition. Artefill® is a combination of polymethylmethacrylate (PMMA) microspheres suspended in bovine collagen. The microspheres act as a near-permanent support structure for the skin because, unlike most other wrinkle fillers, they are not naturally absorbed by the body over time.

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BOTOX® Cosmetic

BOTOX® Cosmetic temporarily diminishes or eliminates lines and wrinkles on the face, and it has become a popular wrinkle treatment among patients who want to address moderate signs of aging. BOTOX® Cosmetic works by relaxing the facial muscles that contract and cause lines and wrinkles to form. The treatment is usually quick, taking about 10 minutes in most cases. Because the results of a BOTOX® treatment last an average of three to six months, touchup treatments are usually necessary.

Captique™

In recent years, many exciting new products have been introduced for use in cosmetic dermatology. Captique™ is a new wrinkle filler made of non-animal hyaluronic acid. Captique™ provides outstanding aesthetic enhancement by filling facial wrinkles and smoothing skin, and it has a lower incidence of adverse side effects than animal-based hyaluronic acid fillers, which may cause allergic reactions in some people. Even when minor redness or swelling around the injection site of a Captique™ wrinkle treatment does occur, in most cases it dissipates in a matter of hours.

Collagen

Collagen has been used since 1976 as a wrinkle filler to treat hundreds of thousands of patients. Collagen is natural protein in the human body that supports the joints, bones, ligaments, and skin. Because injectable collagen is often derived from cows, a small percentage of people are allergic to the treatment. A doctor who provides collagen treatments should perform a skin test prior to treatment to determine if a patient will have an adverse reaction. There are also newer types of collagen wrinkle treatment which make use of human collagen, such as Cosmoderm™ and Cosmoplast™, which reduce the potential for allergic reaction.

Cosmoderm™ and Cosmoplast™

Cosmoderm™ and Cosmoplast™ are the first FDA-approved human collagen skin fillers, and they offer patients the benefits of collagen without the risk of allergic reaction that is associated with bovine-derived collagen. Cosmoderm™ is used to treat finer facial wrinkles; Cosmoplast™ is used to treat deeper wrinkles and creases. Both injectable wrinkle fillers contain a small amount of lidocaine, an anesthetic, so patients feel minimal pain during the procedure.

Fascian™

Fascian™ is a long-lasting injectable wrinkle filler that some studies indicate may actually stimulate the production of natural collagen in the body. It is made from fascia, a connective tissue composed of collagen, and found naturally in human bodies. As with other injectable fillers, Fascian™ is injected under the skin, in the area of the winkle. Because it is thicker than normal collagen, Fascian™ is absorbed more slowly into the body and results are longer lasting.

Fat Transfer (Microlipoinjection)

Autologous fat transfer, also called microlipoinjection, is one of the safest wrinkle treatment methods available because it uses the patients own fat. In the procedure, the doctor draws a small amount of fat from the thigh or buttocks with low-power liposuction. The doctor then injects the fat into the targeted facial areas. The procedure can provide very long-lasting results. While a large amount of the fat may be reabsorbed by the body within several months of the procedure, as much as a third of the total injected volume can remain in the body for years.

Hylaform®

Hylaform® is an injectable skin filler made of highly purified avian hyaluronic acid that mimics the effects of the natural hyaluronic acid found in the body. Hyaluronic acid is a natural moisturizer that attracts and binds water, helping to support and lubricate the skin. Over time, hyaluronic acid in the skin diminishes, leaving the skin loose and less elastic. Hylaform® replenishes your body's natural hyaluronic acid to help restore a more youthful appearance to your skin.

Juvedérm®

Hyaluronic acid has become accepted—and even preferred—for use in wrinkle treatment. However, some people have allergic reactions to hyaluronic acid products synthesized from bovine or avian tissue. Juvéderm® is made of biosynthesized, non-animal hyaluronic acid, so it is free of allergens that may cause adverse reactions in some patients. Juvéderm® offers the same cosmetic benefits provided by animal-based hyaluronic acid skin fillers, but without the risk of allergic reaction. Juvéderm® comes in several concentrations for treatment of different types of wrinkles and creases.

Perlane

Perlane is another of the hyaluronic acid–based injectable fillers that provide an excellent way to reduce or eliminate the lines and wrinkles that accompany aging. Unlike some skin fillers, however, Perlane also provides exceptional lip enhancement for fuller, more sensual lips.

Radiesse™ (Formerly Radiance™)

Radiesse™ is an injectable skin filler that contains microspheres comprised mainly of calcium and phosphate ions, which occur naturally in the human body. After Radiesse™ is injected, thin tissue forms around the microspheres, filling wrinkles and creating a semi-permanent support structure for the skin. Results may last up to two years or more, though touchup procedures may be needed.

Restylane®

Made from biodegradable hyaluronic acid, Restylane® is very similar to Perlane, but is used more for facial wrinkles and contouring than for lip augmentation. The effects of Restylane® can be expected to last about six months. Thanks to its safety and the potential longevity of its effects, Restylane® has become one of the most popular non-surgical treatments in the world of cosmetic surgery today.

Sculptra®

Sculptra® is the brand name of Poly-L-Lactic Acid (PLLA). It is a skin filler that is diluted in sterile water and injected beneath the skin. A very effective wrinkle treatment, Sculptra® works unlike most other skin fillers. After Sculptra® is injected into the body, it stimulates the formation of new collagen, which increases skin volume and fills wrinkles. Sculptra® is often used in cosmetic dermatology for patients suffering from facial lipoatrophy, the loss of facial fat. Sculptra® treatment has been described as a “liquid face lift” for this reason.

Zyderm®/Zyplast®

Two of the most time-tested injectable skin fillers in the world of cosmetic dermatology, Zyderm® and Zyplast® have been used since 1981 and 1985, respectively. More than 1.5 million people have been treated with Zyderm® and Zyplast® since their introduction to the market.