This is a continuation of the Science of Aging in PRS January 2021. This article is about using Hyaluronic Acid, “Rejuvenation of Aged Human Skin by Injection of Cross linked Hyaluronic Acid.”
Cross inked hyaluronic acid is used all the time in the face. Juvederm, Restylane, Voluma, Refyne, Defyne. These are common HA dermal fillers we inject every day in our office. We use these fillers to add volume to the face. When adding volume, it helps lift and fill out the face.
But does it do more?
It is thought that it can exert force on the skin, which can change fibroblast morphology and function in aged and photodamaged skin.
Study:
- 53 subjects, age 70 and older
- single injection of saline (control) and HA filler (.5cc) in separate adjacent skin sites on a photodamaged forearm or the sun protected buttock skin.
- full thickness biopsies were done at various times
- examination was done to look for molecular and cellular changes.
Findings?
- HA forms discreet pockets that localize to areas of the dermis that have fragmented loosely organized collagen
- These pockets fill the space and apply mechanical forces, which induced stretching of fibroblasts. Stretching of fibroblasts is GOOD.
- The stretched fibroblasts causes increased collagen gene expression and deposition of mature collagen bundles, which resembles those of young skin.
- Increased expression of type 1 procollagen was detectable at 4 weeks post injection, showing a 10x increase in expression when compared to the saline injected skin.
- The collagen producing fibroblasts were still seen at 3 months after injection.
- At 6 months it was still seen, but diminishing in its effectiveness, though some was still seen up to 12 months out.
Conclusion: HA fillers cause deposition of mature collagen, which remains in the skin for decades, likely giving long term benefits.
NOTE: They looked at hydroxyapetite fillers (like Radiesse). These caused a foreign body reaction- this was NOT seen in HA fillers. So all “fillers” are not the same.
My thoughts?
I didn’t know all of this. The HA filler companies had mentioned it causes collagen growth, but I didn’t really believe it. I do NOT like other types of fillers because your body recognizes them as foreign. That is a big deal- your body doesn’t like foreign objects, so it causes scar and inflammation. That is very different than the HA fillers.
It is interesting the HA filler is helping the collagen production because of the mechanical forces it is putting on the skin. Would more filler (and therefore more pressure) do better?
They talk about how the age related decline in fibroblast function seems to be reversible, and is not irreversible senescence of the cell. That is good news. Any aging of the cells we can reverse will help us look younger, longer.
Love love love. I love Juvederm and Restylane. They are easy, have great results, and if they are reversing the aging of your fibroblasts, all the better. This just reinforces my love of these fillers over other ones, except for fat of course. If you are in the OR fat grafting is the best.