Hyaluronic acid implant

Author: Vanessa Ngan, Staff Writer, 2002.

Hyaluronic acid implant — codes and concepts

What is a hyaluronic acid implant?

Hyaluronic acid implants are popular as temporary fillers for facial augmentation. Hyaluronic acid is a safe, non-surgical procedure that conveniently softens facial lines and furrows. It also has the added benefit of not requiring skin testing before use. Products available include Hylaform®, Restylane®, Perlane®, Juvéderm™, Esthélis®. Captique™, Prevelle™, Puragen™, and Elevess™.

How is hyaluronic acid used as a filler?

Tiny quantities of hyaluronic acid are injected through very fine needles, boosting the skin's own hyaluronic acid. Depending on how many lines are treated, the treatment takes 20 minutes to an hour, with minimal discomfort (especially with products that contain local anaesthetic agents).

The effects can be maintained by small ‘top-up’ treatments as required, generally about twice a year.

What is hyaluronic acid?

Hyaluronic acid is a natural substance that is found in all living organisms. High concentrations are found in soft connective tissue and in the fluid surrounding the eye. It is also present in some cartilage and joint fluids, and in skin tissue.

In skin tissue, hyaluronic acid is a jelly-like substance that fills the space between collagen and elastin fibres. The role of hyaluronic acid in the skin is to:

  • provide a mechanism of transport of essential nutrients from the bloodstream to living skin cells
  • hydrate the skin by holding in water
  • act as a cushioning and lubricating agent against mechanical and chemical damage.

Over time, either through the natural process of skin ageing or through exposure to environmental factors such as pollutants and sunlight, the body's natural store of hyaluronic acid is degraded and destroyed.

In the last 30 years, synthetic forms of hyaluronic acid have been developed and used to correct disorders in the fields of rheumatology, ophthalmology, and wound repair. More recently, synthetic forms of hyaluronic acid are being manufactured for use in facial augmentation. Brand names of manufactured hyaluronic gels for this purpose include Hylaform® (includes Hylaform Fine Line and Hylaform Plus – Hylan B), Restylane® (non-animal stabilised hyaluronic acid), Perlane®, Juvederm®, Rofilan Hylan® and AcHyal®.

Where can hyaluronic acid injections be used?

Hyaluronic acid injections can be used as a dermal filler to improve the skin's contour and reduce depressions in the skin due to scars, injury or lines.

Facial lines and features that can be corrected using hyaluronic acid implantation include:

  • Frown lines that run between the eyebrows (glabellar lines)
  • Smoker's lines which are vertical lines on the mouth (perioral lines)
  • Marionette lines at the corner of the mouth (oral commissures)
  • Worry lines that run across the forehead (forehead lines)
  • Crow's feet at the corner of the eyes (periorbital lines)
  • Deep smile lines that run from the side of the nose to the corners of the mouth (nasolabial furrows)
  • Cheek depressions
  • Redefining lip border
  • Acne scars
  • Some facial scars

Am I suitable for hyaluronic acid therapy?

Almost all people are suitable for hyaluronic acid therapy. Because hyaluronic acid is chemically identical within and between species, allergy to it is very rare. Thus, unlike bovine collagen implants, manufacturers claim there is not the need to perform a skin allergy test and wait up to 8 weeks for results before commencing treatments. You should discuss with your doctor about whether or not you require a skin allergy test with hyaluronic acid before commencing therapy.

Hyaluronic acid therapy is suitable for patients allergic to bovine collagen.

How is hyaluronic acid treatment given?

Treatments are carried out at a medical centre by a trained doctor or supervised nurse.

Procedure for hyaluronic acid treatments:

  1. Wash your face thoroughly.
  2. The treatment area is wiped with an antiseptic.
  3. A local anaesthetic may be used to numb the treatment area.
  4. Injection method used depends on the doctor but will be either the serial intradermal puncture technique (series of small injections with a very fine needle) or tunnel or threading technique (the needle is withdrawn as the hyaluronic acid is injected).
  5. Depending on the area treated, the skin may be lightly massaged.
  6. Immediately or within a few hours after injection, the site may be red and swollen. This usually disappears within a week.
  7. Another one or two treatments (at least a week apart) may be necessary to achieve the desired correction.

How long does a hyaluronic acid implant last?

Hyaluronic acid implantation is not permanent. Like natural hyaluronic acid, manufactured hyaluronic acid once injected into the skin will gradually break down and be absorbed by the body. In most cases, the augmentation usually lasts anywhere between 3-9 months. To maintain the initial results, repeat treatments or top-up treatments will be necessary. Most people have 2 to 3 treatments per year.

Are there any side effects of hyaluronic acid therapy?

Hyaluronic acid therapy is generally very well tolerated. At the time of treatments, most patients report minor discomfort. This is minimized by the use of a local anaesthetic. Immediately after treatment, the area may be red, swollen and tender, this usually improves within a few days. Rarely, allergic reactions to hyaluronic acid have been reported. These are generally red and/or thickened nodules arising in the injected sites and may persist for several weeks or months.

Hyaluronic acid fillers injected around the eye have rarely been reported to cause blindness due to accidental occlusion of the retinal artery. Vision loss can also be due to muscle weakness causing ptosis or ophthalmoplegia. 

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Related information



  • Myung Y, Yim S, Jeong JH, Kim BK, Heo CY, Baek RM, Pak CS. The Classification and Prognosis of Periocular Complications Related to Blindness following Cosmetic
    Filler Injection. Plast Reconstr Surg. 2017 Jul;140(1):61-64. doi:10.1097/PRS.0000000000003471. PubMed PMID: 28654591.

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