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Hyaluronic Acid

Among the non-permanent fillers, Hyaluronic Acid has taken the lead in terms of results and comfort. It works wonders on fine and deep facial wrinkles. There is no down time after the injection, you can return to your active life immediately. Expression wrinkles such as naso-labial/genian folds, frown lines, wrinkles created by certain positions (i.e. pillow wrinkle) will be significantly reduced with Hyaluronic Acid. Manufacturers have adapted its viscosity based on the area to be treated. The higher the viscosity the deeper the product can go meaning it can reduce deep wrinkles better. 

Hyaluronic Acid is synthetically produced consequently, there is no animal protein in it which makes it extremely pure and effective. There is no need to perform an allergy test before an injection. Your session can be scheduled as soon as you decide, it will last about 30 minutes. Depending on your area, a session should cost between 350€ and 500€. An expensive session doesn’t mean it’s going to be better. In Centers of Excellence, once your session has occurred, you should be offered to come back within 8-15 days to finalize and give your correction a perfect look. Overcorrecting during the first session is a bit extreme, because you will endure the consequences. Since our hyaluronidase enzymes eat up the newly installed hyaluronic acid first (rather the one we already have in our skin) it is possible that your initial session needs to be followed up with a finalization session. In these centers, this final injection is included in your original fee. Please ask your center how they manage injections and if they have a finalization session program in place.

What is Hyaluronic Acid?

Discovered about 60 years ago in the eye, it was then called glycosaminoglycane (GAG). It is gel like and transparent. Our skin is organized in layers supported by callagen and elastin fibers. Hyaluronic acid holds this system in place, as the connective tissue also made of water and protein complex. This specific environment is used for nutrients transport from the blood to our skin cells through our capillary system.

Hyaluronic Acid is found in large quantities in the body of young beings. Unfortunately, with aging and exposure to free radicals (sun, pollution, etc..) our hyaluronic acid is destroyed or consumed. At 50 years of age, it is estimated that only 50% of the original hyaluronic acid is left in the body. This will have a direct impact on our skin appearance, getting thinner and thinner as we age.

In its aesthetic indication, Hyaluronic Acid comes either reticulated or non-reticulated. The reticulation process allows the product to be more compact and more water absorbant. Its stability is increased over time, that’s why some highly reticulated products such as PerlaneÒ (RestylaneÒ) can produce results up to 14-16 months.

How do we use Hyaluronic Acid?

Each manufacturer provided a loaded syringe. Usually it comes in 0.5ml or 1ml syringes. Some do produce a 0.8 ml syringes. It comes with 2 extremely fine needles. One for the initial injection, the second for the final or touch up session 1 or 2 weeks after the initial one. The gel is injected beneath the wrinkle in the upper layer of the dermis to provide support under the targeted wrinkle. It creates volume giving a fresher look and smoother skin. The bottom of the treated wrinkle lifts up and stretches the skin on each side.

The use of Hyaluronic Acid is, in general, quite easy. Tangible results are visible right away with some local redness for up to 3 days. Sometimes the skin may present a little edema or bruise if a small capillary vein was touched during the injection. These minor side effects are easily hidden under make-up. Inflammatory granulomas have rarely been reported with non-permanent Hyaluronic Acid products. If that happens, our hyaluronidase enzymes eat up these granulomas over a couple of months.

Finally, Hyaluronic Acid works by mixing with water in our dermis (hydrophyllic) to bring back volume and fullness. It is often associated with vitamin C helping it better penetrate our connective tissue.

Depending on the area to be treated, a small local anesthesia could be performed to increase your comfort. It is preferable to do so when areas around the mouth/lips or the nose are involved.

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The method used is similar as the one used at the dentist’s. Your skin will stay numb for about one hour. Sometimes, crème à la lidocaïne cream is used when naso-labial/genian folds are treated. It should be applied 30 to 45 minutes prior to your session. Its effect varies among individuals.

Injection Methods : identical as those used for Collagen:

a) Tracing or retro-tracing: the injection follows the path of the targeted wrinkle. As the product is injected, the needle moves toward the entry point. Sometimes, the same entry point is used to inject in several different directions within the same horizontal axis, to promote skin retraction so it looks smoother. The product is now set right under that wrinkle so its bottom is now flush with the rest of the skin. The result is a fuller skin. The epidermis is now laying on a filled up dermis.

b) multi-puncture: several entry points are made in which a drop of product is injected ; If this method is not well managed, some little nodules could be felt throughout the injected area. It would be seen with side lighting and would not be a satisfiying result. In case of an over-correction, massaging the area would be the only hope of making it smoother.
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What happens after a Hyaluronic Acid Injection?

Local and temporary redness could be seen for about 2 to 4 days. They disappear without problems but be aware that you should not expose your skin to the sun during that time frame. If you have a slightly pigmented skin, that could yield to little brown spots like after a mosquito bite. A local and usually small temporary oedema could occur. It could be minimized if, right after the injection, some ice is placed on the injection site.


Other side effect have been reported such as : injection point pain, itching, discoloration at injection point and injection point sensitivity. They usually last a few days. In very rare cases, less than 1/ 2000, hypersensitivity reactions were reported with local edema expanding on surrounding area with redness and some acne like spots.

Is there any danger with Hyaluronic Acid Injections?

In fact, this one of the safest fillers on the market today. Side effects are usually minimal but it is always possible to run into an hypersensitivity reaction as described above.

Most common areas treated with Restylane®or Perlane®

- Naso genian/labial folds = wrinkles going from corner of our nose down to corner of our mouth

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- Wrinkles around the mouth and on the chin (vertical and/or horizontal)

- Peri-oral lines (sadness lines on each side of the mouth)

- Lips

- Glabella = Lion’s frown (Unibrow space)

- Periorbital region =Crow’s feet (external side of eye)

- Horizontal wrinkles on forehead 

These last three areas are now preferably treated with Botulinum Toxin also known as botulique toxin. In some cases, combining both botulique toxin and Hyaluronic acid will give a superb result.


Finally, some specific scars (acne or post-trauma) may respond well to Hyalorinic Acid injections.
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Where can I go to get my Hyaluronic Acid Injections done?

a) In a Center of Excellence in Aesthetic Medicine, to your Dermatologist or to a Cosmetic Surgeon. It is preferable to use the services of someone who has acquired a large experience in wrinkle filling and shows a good artistic touch. Balance and taste are two qualities your operator must possess. It is best when your operator has followed key workshops or course on this topic. Usually, these credentials are displayed by the professional eager to show that he/she has been trained in wrinkle filling.

b) Call ahead and ask if Hyaluronic Acid injections are frequently done in that office/center or clinic. It is not standard practice to give prices over the telephone but some centers with helpful personnel will courteously provide you that information.

In an Aesthetic Medicine Center of Excellence, a vial of 1ml of Restylane or Perlane enough to fill both naso-genian/labial folds will run between 400 € and 600 €. If your session requires 2 vials it could almost double that price. Usually, prices are provided if you made an appointment.

c) Ask if that office/center or clinic is dedicated to Aesthetic Care only. In fact, these places do not see any “sick” people, so they tend to have fewer issues with pathogens or germs. It’s always better.

d) Request an estimate and consent forms for your session.
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How long does it last?

On average about 12 to 14 months, depending on the product reticulation. A low or non-reticulated product could last between 8 and 10 months.

An annual maintenance visit is best to use the cumulative effect from the previous injection. This way, after 9-12 months, you might need fewer Hyaluronic Acid to fill the same wrinkle. Many people prefer coming back at 9 months after the initial injection, just to keep looking good.

Contra-Indications :

- Skin diseases, like psoriasis or cold sores. (Have them treated first)
- Hyaluronic Acid hypersensitivity
- Autoimmune disease such as diabetes
- Cheloid type scars

Practical recommendations:

-Avoid sun exposure for about 3-4 days after injections, use 30 SPF sunscreen
-Do not massage the treated area

Before-After Photos

Mouth/chin area : « sadness folds »

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Naso-genian/labial folds

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Lips

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