Hyaluronic Acid Fillers: Codifying the Face for Foundation, Reconstruction, and Refinement

  • Silvia ZimbresEmail author
Living reference work entry

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Part of the Clinical Approaches and Procedures in Cosmetic Dermatology book series (CAPCD)


Techniques for facial aesthetic rejuvenation and enhancement are continuously evolving. The use of hyaluronic acid injectable fillers for rejuvenation is the second leading facial aesthetic procedure, after the use of injectable neuromodulator. The first step to achieve an optimal outcome in facial aesthetics is to understand the whole process of aging, such as bone reabsorption, atrophy of the fat compartments, muscle contraction, dental loss, and thinning of the skin. Hyaluronic acid filler is an important tool to achieve a global treatment of the face, since it is capable to restructure, to contour smoothly and to treat delicate areas as well. In this chapter we are going to describe facial assessment, indications, treatment planning, and procedures according to the anatomic area. Authors will explain the best technique and preferable hyaluronic acid to treat the forehead, temples, eyebrows, zygomatic and malar area, periocular region, chin, mandible, and perioral region.


Face aging Volume loss Fat compartments Hyaluronic acid Fillers Rejuvenation 


  1. Andre P. Hyaluronic acid and its use as a rejuvenation agent in cosmetic dermatology. Semin Cutan Med Surg. 2004;23(4):218–22.PubMedCrossRefGoogle Scholar
  2. Bertucci V, Lynde CB. Current concepts in the use of small-particle hyaluronic acid. Plast Reconstr Surg. 2015;136(5 Suppl):132S–8S.PubMedCrossRefGoogle Scholar
  3. Borrell M, Leslie DB, Tezel A. Lift capabilities of hyaluronic acid fillers. J Cosmet Laser Ther. 2011;13(1):21–7.PubMedCrossRefGoogle Scholar
  4. Bosset S, Barre P, Chalon A, et al. Skin ageing clinical and histopathologic study of permanent and reducible wrinkles. Eur J Dermatol. 2002;23:247–52.Google Scholar
  5. Braz AV, Aquino BO. Preenchimento do sulco nasojugal e da depressao infraorbital lateral com microcanula 30G. Surg Cosmet Dermatol. 2012;4(2):178–81.Google Scholar
  6. Braz AV, Mukamal LV. Preenchimento labial com microcanula. Surg Cosmet Dermatol. 2011;3(3):257–60.Google Scholar
  7. Braz AV, Sakuma TH. Midface rejuvenation an innovative technique to restore cheek volume. Dermatol Surg. 2012;38(1):118–20.PubMedCrossRefGoogle Scholar
  8. Braz AV, Mukamal LV, Costa DLM. Manejo cosmetico del tercio medio e inferior de la cara. In: Atamoros FP, Merino JE, editors. Dermatologia cosmetica. Cidade do Mexico: Elsevier Masson Doyma; 2011.Google Scholar
  9. Braz AV, Louvain D, Mukamal LV. Combined treatment with botulinum toxin and hyaluronic acid to correct unsightly lateral chin depression. An Bras Dermatol. 2013;88(1):138–40.PubMedPubMedCentralCrossRefGoogle Scholar
  10. Callan P, Goodman GJ, Liew S, et al. Efficacy and safety of a hyaluronic acid filler in subjects treated for correction of midface volume deficiency a 24 month study. Clin Cosmet Investig Dermatol. 2013;6:81–9.PubMedPubMedCentralCrossRefGoogle Scholar
  11. Carruthers A, Carruthers J, Hardas B, et al. A validated lip fullness grading scale. Dermatol Surg. 2008;34(Suppl2):161–6.Google Scholar
  12. Coleman SR. Structural fat grafting. St. Louis: Quality Medical Publishing; 2004.Google Scholar
  13. Coleman SR, Grover R. The anatomy of the aging face volume loss and changes in 3-dimensional topography. Aesthet Surg J. 2006;26(S):S4–9.PubMedCrossRefGoogle Scholar
  14. de Maio M, Swift A, Signorini M, et al. Facial assessment and injection guide for botulinum toxin and injectable hyaluronic acid fillers focus on the upper face. Plast Reconstr Surg. 2017;140(2):265–76.CrossRefGoogle Scholar
  15. Donofrio LM. Fat distribution a morphologic study of the aging face. Dermatol Surg. 2000;26:1107–12.PubMedCrossRefGoogle Scholar
  16. El-Doyati M, Attia S, Saleh F, et al. Intrinsic aging vs. photoaging a comparative histopathological, immunohistochemical, and ultrastructural study of skin. Exp Dermatol. 2002;11:398–405.CrossRefGoogle Scholar
  17. Ellebogen R, Youn A, Yamini D, Svehlak S. The volumetric face lift. Aesthet Surg J. 2004;24:514–22.CrossRefGoogle Scholar
  18. Fenske NA, Lober CW. Structural and functional changes of normal aging skin. J Am Acad Dermatol. 1986;15:571–85.PubMedCrossRefGoogle Scholar
  19. Fulton JE Jr, Rahimi AD, Helton P, et al. Lip rejuvenation. Dermatol Surg. 2000;26:470–4.PubMedCrossRefGoogle Scholar
  20. Ghavami A, Pessa JE, Janis J, et al. The orbicularis retaining ligament of the medial orbit: closing the circle. Plast Reconstr Surg. 2008;121(3):994–1101.PubMedCrossRefGoogle Scholar
  21. Guyuron B. The aging nose. Dermatol Clin. 1997;15:659–64.PubMedCrossRefGoogle Scholar
  22. Hirmand H. Anatomy and nonsurgical correction of the tear through deformity. Plast Reconstr Surg. 2010;125(2):699–708.PubMedCrossRefGoogle Scholar
  23. Hwang K, Nam YS, Kim DJ, et al. Surgical anatomy of retaining ligaments in the periorbital area. J Craniofac Surg. 2008;19(3):800–4.PubMedCrossRefGoogle Scholar
  24. Jones D, Murphy DK. Volumizing hyaluronic acid filler for midface volume deficit 2-year results from a pivotal single-blind randomized controlled study. Dermatol Surg. 2013;39(11):1602–12.PubMedCrossRefGoogle Scholar
  25. Klein AW. In search of the perfect lip. Dermatol Surg. 2005;31(11 Pt 2):1599–603.PubMedCrossRefGoogle Scholar
  26. Landau M, Fagien S. Science of hyaluronic acid beyond filling fibroblasts and their response to the extracellular matrix. Plast Reconstr Surg. 2015;136(5 Suppl):188S–95S.PubMedCrossRefGoogle Scholar
  27. Medelson BC, Muzaffar AR, Adams WP Jr. Surgical anatomy of the midcheek and malar mounds. Plast Reconstr Surg. 2002;110:885–911.CrossRefGoogle Scholar
  28. Moss CJ, Medelson BC, Taylor GI. Surgical anatomy of the ligamentous attachments in the temple and periorbital regions. Plast Reconstr Surg. 2000;105:1475–98.PubMedCrossRefGoogle Scholar
  29. Ozdemir R, Kilinc H, Unlu E, et al. Anatomicohistologic study of the retaining ligaments of the face and use in face lift retaining ligament correction and SMAS placation. Plast Reconstr Surg. 2002;110:1134–47.PubMedCrossRefGoogle Scholar
  30. Pessa JE. An algorithm of facial aging verification of Lambros’s theory by three-dimensional stereolithography, with reference to the pathogenesis of midfacial aging, scleral show, and the lateral suborbital through deformity. Plast Reconstr Surg. 2000;106:479–87.PubMedCrossRefGoogle Scholar
  31. Pessa JE, Zadoo VP, Mutimer KL, et al. Relative maxillary retrusion as a natural consequence of aging: combining skeletal and soft tissue changes into an integrated model of midfacial aging. Plast Reconstr Surg. 1998;102:205–12.PubMedCrossRefGoogle Scholar
  32. Pierre S, Liew S, Bernadin A. Basics of dermal filler rheology. Dermatol Surg. 2015;41(Suppl 1):S120–6.PubMedCrossRefGoogle Scholar
  33. Price RD, Berry MG, Navsaria HA. Hyaluronic acid the scientific and clinical evidence. J Plast Reconstr Aesthet Surg. 2007;60(10):1110–9.PubMedCrossRefGoogle Scholar
  34. Raspaldo H. Temporal rejuvenation with fillers global faceculpture approach. Dermatol Surg. 2012;38:261–5.PubMedCrossRefGoogle Scholar
  35. Raspaldo H, Gassia V, Niforos FR, et al. Global, 3-dimensional approach to natural rejuvenation part 1. Recommendation for volume restoration and the periocular area. J Cosmet Dermatol. 2012;11:279–89.PubMedCrossRefGoogle Scholar
  36. Reece EM, Pessa JE, Rohrich RJ. The mandibular septum anatomical observations of the jowls in aging-implications for facila rejuvenation. Plast Reconstr Surg. 2008;121(4):1414–20.PubMedCrossRefGoogle Scholar
  37. Rohrich RJ, Pessa JE, Ristow B. The youthful cheek and the deep medial fat compartment. Plast Reconstr Surg. 2008;121:2107–12.PubMedCrossRefGoogle Scholar
  38. Sarnoff DS, Saini R, Gotkin RH. Comparison of filling agents for for lip augmentation. Aesthet Surg J. 2008;28:556–63.PubMedCrossRefGoogle Scholar
  39. Shaw RB Jr, Kahn DM. Aging of the midface bony elements a three dimensional CT study. Plast Reconstr Surg. 2007;119:675–81.PubMedCrossRefGoogle Scholar
  40. Shaw RB, Katzel EB, Koltz PF, et al. Aging of the facial skeleton aesthetic implications and rejuvenation strategies. Plast Reconstr Surg. 2011;127:374–83.PubMedCrossRefGoogle Scholar
  41. Sherris DA, Larrabee WF. Anatomic considerations in rhytidectomy. Facial Plast Surg. 1996;12:215–22.PubMedCrossRefGoogle Scholar
  42. Swift A, Remington K. Beauthiphication a global approach to facial beauty. Clin Plast Surg. 2011;38:347–77.PubMedCrossRefGoogle Scholar
  43. Wang F, Garza LA, Kang S, et al. In vivo stimulation of de novo collagen production caused by cross-linked hyaluronic acid dermal filler injections in photodamaged human skin. Arch Dermatol. 2007;143(2):155–63.PubMedCrossRefGoogle Scholar
  44. Weinkle S. Injection techniques for revolumization of the perioral region with hyaluronic acid. J Drugs Dermatol. 2010;9(4):367071.Google Scholar
  45. Yang HM, Lee JG, Hu KS, et al. New anatomical insights on the course and branching patterns of the facial artery clinical implications of injectable treatments to the nasolabial fold and nasojugal groove. Plast Reconstr Surg. 2014;133(5):1077–82.PubMedCrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Dermatology Specialist by University of São Paulo, Titular Member of the Brazilian Dermatology SocietySão PauloBrazil

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