Hyaluronic acid (HA) is a natural substance each of us has in the body. It is a polysaccharide, a type of sugar with a very large molecule. On average, a human body contains approx. 15g of hyaluronic acid, half of which is locatedin the skin. This acid is also found in connective tissue, joints and eyeballs. Its most valuable property is hygroscopicity, i.e. the ability to bind water. One molecule of acid can bind about 250 water molecules, which is about a thousand times the mass of that single molecule. In other words, one gram of acid can bind about 6 liters of water.
Hyaluronic acid was discovered in 1934 by two American scientists, Karl Meyer and John Palmers. They isolated it from the vitreous body of the bovine eye. Initially, it was used in the baking industry as a replacement for chicken eggs. It debuted in medicine in 1980 (orthopedics and ophthalmology), and 16 years later in aesthetic medicine. Initially, it was obtained from rooster combs, but now hyaluronic acid used in aesthetic medicine is produced by genetically modified bacteria. Such acid, before becoming an ingredient of preparations used in clinics, undergoes a process of purification and cross-linking.
Hyaluronic acid is produced by fibroblasts deep in the dermis. Its most important role is to maintain the proper level of skin hydration and firmness. Unfortunately, with age, the amount of the acid gradually decreases and the skin dries: cheeks and lips lose their volume. In addition to moisturizing, hyaluronic acid plays a number of functions: it is an antioxidant, anti-inflammatory, anti-swelling and bacteriostatic agent supporting healing and regeneration. These HA properties mean that it can be used for injecting injuries, hard to heal wounds or diabetic foot. Hyaluronic acid creates a microenvironment in the places where cells migrate to work better, close the wound or restore the skin.
In aesthetic medicine, pure hyaluronic acid in never used, only preparations with 20 milligrams of HA per 1 gram of preparation, i.e. 2%. The remainder constitute saline and excipients, including stabilizers and cross-linking agents. Cross-linking, which thickens HA, i.e. combines its molecules into larger conglomerates, is needed to make the hyaluronic acid preparation more durable. If it wasn’t for that, its pure particles would disintegrate within 1-2 days without a trace. Cross-linking is the addition of a special preparation that creates bonds between the chains, as if making a dense three-dimensional mesh from a thread. This creates a lump of acid that will dissolve more slowly. The advantage of cross-linking is that the acid will last longer. The downside is that it is cross-linked with chemicals not indifferent to the body. The most popular cross-linking compounds are BDDE and DVS.
As a result of cross-linking, we get hyaluronic acid preparations of different density. How long the acid will last depends on the degree of crosslinking. The more compact it is (the harder and denser it will be), the slower it will dissolve,i.e. the longer it will stay in the tissue. The persistence of HA ranges generally 6-12 months for denser acids and 3-6 for thinner and merely 1-2 days for non-crosslinked ones. The length of the HA decomposition process depends on the patients’ personal predispositions, age and lifestyle.
It should be remembered that despite all its biocompatibility, hyaluronic acid is a foreign body and not everyone can use it. Therefore, it is important to carefully qualify the patient for the procedure, choose the right preparation and its appropriate application.
What are our guidelines when choosing hyaluronic acid for patients at Triclinium?
- When choosing hyaluronic acid, the rule that the more expensive hyaluronic acid the better (safer)always works. Of course, this is quite a simplification, but it can be assumed that the more expensive acids have undergone a better purification and cross-linking process. At Triclinium we work only on the best preparations, such as Restylane or Juvéderm.
- The division of HA into non-crosslinked, slightly crosslinked and strongly crosslinked is quite sufficient. Coming up with additional categories, “mouth” or “under the eyes” is just a marketing trick that allows companies to sell the “mouth” acid more expensively.
- Each acid preparation must be certified -it is a medical device, such as a tooth implant, knee joint or breast implant.
- An important indicator of the quality of the acid are the parameters indicating the degree of its purification,i.e. the degree to which the cell walls of the acid-producing bacteria have been removed. This is vital because they can bring about allergic reactions. For concrete parameters indicating how much bacterial debris remains in the acid you usually need to ask the producers directly. Somehow they themselves do not brag about it… And the differences between the low and good qualityacids are tenfold. The general rule is to choose preparations that feature a level of bacterial residue below 10E.
- The amount of cross-linking agent in the preparation is also fundamental. This information is hard to find, but with a little bit of trouble, it is available. Some preparations contain up to 10% BDDE (a cross-linking preparation) while other acids have a lot less (upto several times in some cases). Therefore, it is possible that the complications after hyaluronic acid treatments do not result from its “fake” form, but because the procedure was performed using an excessively chemical preparation.
The effects of the treatment with hyaluronic acid
- increasing the volume of sunken tissues
- correction of skin depressions such as wrinkles, furrows, scars, skin folds
- correction of the nose, chin, jaw line shapelifting, highlighting the cheeks
- smoothing, highlighting the temples
- volumetry or modeling of the face shape
- enlargement, modeling of the mouth
- compensation of asymmetry of the lips, nose, face
- facial rejuvenation
- drooping of the face / loss of volume / face contour
- asymmetrical facial features and distorted proportions/ face shape
- asymmetrical, disproportionate, crooked nose
- small, asymmetrical lips
- volumetry -the desire to naturally shape the face, e.g. lengthening the chin
- desire to enlarge, highlight the cheeks
- upper and middle face aging
- flaccid skin
- deep furrows e.g. on the forehead
- “puppet lines”, “hamster cheeks”, “valley of tears”
- known hypersensitivity to any component of the preparation, e.g. hyaluronic acid
- pregnancy / breast-feeding
- active viral, bacterial, fungal skin infectionsactive skin lesions (e.g. psoriasis, lichen planus, seborrheic dermatitis)
- local skin allergies
- severe allergies in the past characterized by, among others, diagnosed anaphylactic shock
- tendency to form hypertrophic scars or keloids
- open wounds in the treatment area
- steroid therapy, incl. cortisone treatment
- autoimmune diseases
Frequency and number of treatments
The frequency and number of treatments depends on the type of skin, the severity of the problem to be corrected and the expected effect by the patient. The exact therapy scheme is determined individually for each patient during consultation with a specialist. Treatments using fillers are very precise therapies usually requiring several visits. It should also be remembered that hyaluronic acid treatments give immediate results, but these are not treatments that we perform once and for all. After 3-12 months, the preparations gradually undergo degradation and are completely absorbed. The procedure should then be repeated. On the one hand, it can be considered a disadvantage, and on the other hand -an advantage: thanks to this the procedures are completely safe. We have a guarantee that the effect of the intervention will pass after some time not causing a permanent change in the appearance of the face.
Advantages of the procedure
- safe method if performed by an experienced specialist
- short recovery period
- safe preparation with a European safety certificate
- immediate results
- it is not recommended to take medicines that reduce blood clotting, e.g. acetylsalicylic acid, one week before the procedure
- up to 7 days after the procedure, avoid warming the skin (using the sauna, solarium) or swimming pool
- massage the postoperative area every day
Expected postoperative symptoms
- temporary soreness
- temporary burning sensation, spreading at the application site
- skin redness
Undesirable postoperative symptoms
- allergy to any of the ingredients
- prolonged redness
- tissue hardness / papules / granulomas
Recommended treatments giving similar effect
Duration of the procedure
- 30 minutes; anesthesia, about 30-45 minutes should be added to the time of treatment