Hyaluronic acid (HA) is a natural occurring substance in the skin. It is a polysaccharide and found throughout the body and in the extracellular matrix of the skin . It’s versatile, non-toxic and not inflammatory. It plays a role in cushioning, shock absorption, and tissue viscosity. It is found as an injectable and in topical formulations.
It is most often used medically and cosmetically for a number of reasons as an injectable. For dermatology, I use it for soft tissue augmentation on the face, backs of hands, scars and chest lines. It has been used by ophthalmology (cataract surgery), Orthopaedics (joints), ENT (vocal cords), urology ( interstitial cystitis) , etc. It is biocompatible and very well tolerated with very few adverse effects noted. It has lubricating properties, hydration, cushioning, and wound healing effects.
Topical formulations of HA are seen for anti- wrinkle creams and skin hydration. The question here is how much HA can get through the skin to actually have an effect as it is a fairly large molecule. The goal of HA topically is to increase improve skin hydration, elasticity and decrease wrinkle depth. HA can attract and retain moisture in the skin. The reality here is that it’s not really an ‘anti aging’ product- it’s action is misunderstood by people who opt to use it. HA in fillers is injected directly into the dermis of the skin to get to work. HA topically can’t get there- the molecules are too big. It may get into the very superficial layer of the epidermis to retain some moisture to make the skin look less wrinkled because it’s more hydrated. In this sense it’s an effective moisturizer.
For the skin as an injectable we use it predominantly for tissue augmentation. It provides fast, safe and effective results for patients looking to restore loss of volume or augment. It is wonderful to work with because as a bioimplant, when injected correctly, does not have a firm or bumpy feel.
I inject either directly into the area of concern or carefully place product to restore contours to the face.
Topically, it’s a moisturizer. It’s not necessarily the greatest moisturizer ingredient ever made- but it’s good.
HA is very well tolerated as an injectable- Occasionally will see bruising that may last about a week. Redness and swelling can occur as well. Overall very well tolerated.
Topically, it hydrates. Not likely to cause allergic reactions. It’s actually not an acid, by the way, (even though it’s called Hyaluronic ACID:) so it won’t exfoliate or cause dryness.
I break down cosmetic procedures into 3 categories: restorative, enhancing and transformative. Restorative is focusing on restoring volume loss that results in deep lines and wrinkles. Commonly this is the under eye area, nasolabial folds, jowls, etc. Enhancing procedures take a feature we have and augment or enhance the feature to draw attention to it. Examples of this would be lip enhancing or cheek bone augmentation. Transformative procedures are when I have a patient that comes in with a photo of a feature they do not have and wish to transform their look to include it. Most commonly this would be significant lip augmentation.
All areas can use HA fillers.
The key to note here is understanding the anatomy of a wrinkle. I break this down as three features: loss of volume/fat, thinning of skin, and muscle contraction. Loss of volume is where HA fillers work. Thinning of skin can be enhanced by topical retinoids and alpha hydroxy acids or radio frequency devices. And muscle contraction is addressed through botulinum toxins.
Topically, if you are looking for a moisturizer and would like to try it out then go for it! One caution- the HA molecule looks for and loves water. If you live in a humid environment it will draw moisture from there. If you live in a dry environment it may pull moisture out of your skin up towards the product and paradoxically make you feel dryer. (Remember those osmosis diagrams in your middle school science textbook with the salt water solutions:)
Just about anyone can use these products as long as they are not allergic.
Topically, oily skin types fair better than dry. Dry skin unfortunately may not have the moisture HA topical products need to work.
Injectables are up to your dermatologist- these vary not in concentration but more so in particle size)
Topically, most products are 1-2% HA. I don’t know how it could be much more in the liquid state (most come as serums). If a product is claiming to be more than that please let me know- I’d be happy to evaluate it and give you the run down on what the label actually means. Technically you really shouldn’t go above 1-2 % because your skin will not have the moisture the HA is looking for. It will deplete the natural moisture deep inside your skin as the moisture gets absorbed by the HA molecules!