The science and art of hyaluronic acid dermal filler use in esthetic applications

Background The number of dermal fillers has expanded dramatically; clinicians can benefit from practical information on their optimal use. Aims To review key determinants of dermal filler performance, to discuss technical considerations, and to illustrate these factors based on the author's clinical experience. Methods Current literature pertaining to the physicochemical properties of hyaluronic acid (HA) dermal fillers and implications for clinical use was reviewed. The author provides clinical guidelines for optimizing outcomes, illustrated with three case examples. Results Hyaluronic acids are nonimmunogenic, versatile, reversible, and have excellent benefit-risk profiles, making them near-ideal filling agents. They differ in their manufacturing processes, viscosity, hardness, cohesivity, ease of injection, and ideal uses. Patient counseling and education with individualized selection of the appropriate agent is critical to provide satisfactory outcomes. Conclusions Clinicians must be technically proficient, balance esthetic need with facial anatomy, and consider HA properties to provide optimal outcomes.