Aesthetic interventions continue to enjoy great popularity in Germany, and the trend is rising. The most common procedures for men and women in 2019 are wrinkle injections with botulinum, which are the leaders with 19,922 treatments, closely followed by 18,269 hyaluronic treatments.
Hyaluronic acid injections are one of the most popular techniques of non-surgical rejuvenation and elimination of facial and body defects. By using these “beauty shots”, you can enlarge lips, change the shape of the nose and cheekbones, remove wrinkles, improve the overall state of the skin, and even enlarge the breast.
For normal functioning and regular renewal, our skin needs a sufficiently large amount of water. To accumulate and retain it, the body produces its own (“native”) hyaluronic acid. However, after the age of 25-30 years old, its amount begins to steadily decrease, which leads to unpleasant consequences ‒ the skin dries out and becomes flabby, wrinkles and folds appear everywhere.
Beauticians found a solution to this problem as far back as in the middle of the last century ‒ artificial hyaluronic acid which is introduced into the desired dermal layers through injections. Once in the body, it immediately begins to accumulate and firmly retain moisture (it is estimated that 1 molecule of hyaluronate can attract an average of about 500 water molecules).
The resulting gel fills the previously hollow subcutaneous areas. At the same time, the upper layers of the skin are lifted, due to which wrinkles are smoothed out and a regular contour of the face is formed. Additionally, in the problem area, the natural synthesis of fibroblasts is activated, and the production of elastin and collagen, the proteins necessary to create a strong and elastic intercellular matrix (skin framework), is stimulated.
For injection procedures, the following types of hyaluronic acid are used:
According to the internal molecular structure, two types of hyaluronic acid are distinguished:
According to molecular weight (the length of an individual molecule of the substance), there can be:
According to the concentration of the active substance, hyaluronic acid preparations are divided into:
Hyaluronic acid injections are used in cosmetology and therapeutic medicine to solve a wide variety of tasks. Depending on the main problem, a suitable procedure, gels with the desired characteristics and optimal techniques for performing injections are selected:
It is the most popular and multipurpose procedure. Its main task is to increase the volume, whether these are lips or subcutaneous cavities responsible for the appearance of wrinkles. It is ideal for patients over the age of 30, since it is during this period that the natural reserves of hyaluronic acid begin to deplete in the body. It can be performed on almost any area of the face and body. The main potentialities are:
True, most experts do not consider contouring an adequate procedure for working with large parts of the body, such as breasts, buttocks, etc.: in order to noticeably enlarge them it will take more than 100 ml of the preparation, which will cost the patient a considerable sum of money (for comparison, when working with the face, volumes of 1-2 ml are used). At the same time, the result will remain only for half a year or a year ‒ unlike the installation of implants, which in the end will cost less and will last at least 10-15 years.
Therefore, the main area of application of hyaluronic acid injections is, after all, the face. Manufacturers of hyaluronic acid preparations, that offer the widest range of products specifically for this area, agree with this. As a rule, within the same brand there are the following products:
This procedure is an injection of multicomponent preparations (“cocktails”) based on low molecular weight unstitched low-density hyaluronic acid. The other active ingredients are collagen, elastin, vitamins, micronutrients, peptides, growth factors, amino acids, coenzymes, etc. Most often, experts use ready-made complex preparations from manufacturers, but in some cases and with the doctor’s high qualification the cocktail is “mixed” individually for the patient. It has a more therapeutic effect than a rejuvenating one, therefore it can be indicated both at a very young age (from the age of 18) and at a more mature age.
Mesotherapy is used to eliminate many problems:
Mesotherapy is performed in courses of 4-8 procedures at intervals of 7-10 days. During each session, a kind of “depot” is created in the skin, from which the preparation is gradually released, which prolongs the work of the active ingredients. The effect is noticeable after a few days and it continues to grow by the end of the course. The result lasts 6-9 months.
First, the dosage of therapeutic mesococktail which can be introduced within one series of injections is limited ‒ it is usually not more than 15-20 ml. It is useless to increase it: the surplus preparations are simply removed from the body. With the successive course, a cumulative effect is achieved ‒ the effect of mesotherapy increases with each procedure.
Secondly, when working with more or less large areas, especially with the body, in one session you can perform injections on an area of no more than 20–25% of the problem area. When this indicator is exceeded, regeneration slows down considerably, since the neighbouring, intact tissues do not have time to supply a sufficient amount of “building material”.
The frequency of injections is determined by the composition of the drug ‒ on average from 7 to 20 days. During this time, the dose of the cocktail has time to do its job and you can introduce a new one. It is important not to break the interval between sessions recommended by the cosmetologist; otherwise the final result will worsen appreciably.
It makes it possible to eliminate such problems as:
The standard course is 6-8 intensive care procedures with an interval of 7 to 10 days on average. Then maintaining sessions are recommended ‒ once every 4 weeks. Cosmetologists advise to repeat the treatment with mesococktails annually. This is a general recommendation, the treatment scheme with injections can vary considerably depending on the doctor and the patient, as well as on the preparation used.
This type of procedure helps to correct minor defects of the figure. It is recommended in the presence of such indications as:
The course is chosen individually: to fight cellulite 10-15 procedures are usually prescribed, for weight loss ‒ up to 10. The intervals between them range from 2 to 3 weeks. During this time, the preparations have time to complete their action, and the body has time to remove the breakdown products of fat cells. After 3-5 months, several maintaining procedures should be performed to consolidate the result.
The main indications for this variant of the procedure are:
The main active ingredients of cocktails are flavonoids, venotonic agents, amino acids, vitamin complexes, antioxidants. The duration of the course depends on the problems that are to be solved: 8-10 sessions are enough to improve the condition of the hair; fighting alopecia takes much longer ‒ shock therapy of 10-12 procedures, then maintaining treatment for 4–7 months and a repetition of the course.
The main objective of this procedure is to maintain the water balance of the skin, its moistening, stimulation of the production of its own collagen and elastin. In addition to hyaluronic acid, preparations sometimes include such ingredients as vitamins, minerals, short protein chains peptides and coenzymes. Biorevitalization is intended for:
Cosmetologists recommend prophylactic procedures starting from ~ 25 years old, in order to keep the skin in a perfectly hydrated state as long as possible. Injection techniques are almost the same as for mesotherapy. However, the depth of drug introduction is less, which makes it possible to achieve a noticeable result within a few days after the first session. The course consists of 3-5 procedures with an interval of 10-14 days. The effect lasts 3-6 months.
These are anti-aging injections for aged skin, which cosmetologists recommend after 35-40 years old. Bioreparant preparations usually contain a “mix” of unstabilized and partially stabilized hyaluronic acid (to prolong its effect and provide a more pronounced lifting effect), as well as peptides, vitamins, minerals, antioxidants, growth factors and other active substances. The main indications for bioreparation are:
Due to the content of partially stitched hyaluronic acid and other active components, bioreparants have a pronounced rejuvenating effect on the aged skin, stimulate the production of collagen and elastin, activate fibroblasts, have an antioxidant effect and inhibit age-mediated melanogenesis. The procedure is performed in courses of 3-4 procedures with an interval of 1 month. The effect lasts more than 6 months.
The procedure aims at strengthening the subcutaneous framework of the connective tissue, lifting the contours of the face and eliminating age and gravitational ptosis. It is ideal for patients from 35 to 50 years old. At a younger age, it is enough to perform mesotherapy or biorevitalization to improve the condition of the skin, and at an older age such injections will not give the desired stable result and can only be used as an addition to plastic surgery.
During the session, the specialist injects a high-density preparation in the selected area ‒ as a rule, these are the face, the neck, the décolleté and the hands ‒ by using a special technique, in the form of long “tunnels” intersecting like a lattice. Hyaluronic acid stimulates the production of collagen and elastin, which are the basis for the extracellular matrix. As a result, even after its complete decay, a renovated framework of connective tissue remains in the treated area, which continues to keep the skin in a tightened position. The basic indications for bioreinforcement are:
To obtain a stable result, it may take several sessions with an interval of ~ 2 months to correct or cover a large area. The duration of the rejuvenation effect is up to 2-3 years.
Only a cosmetologist or a plastic surgeon should work with hyaluronic acid. It is desirable that they have general training in this type of procedure and have completed specialized courses in working with the selected filler, where manufacturers talk about all the nuances and features of the use of their product. The general scheme of the injections is as follows:
The average procedure takes from 30 to 90 minutes, depending on the size of the target area. The result in most cases will be noticeable immediately, but in the final form it can be assessed only after a few days, when the side effects of the injections will disappear (oedema, redness, small hematomas) and the hyaluronic acid will begin to work at full capacity.
To achieve the desired effect, as a rule, one single session is enough ‒ with the exception of mesotherapy and biorevitalization, which are performed in courses of 2-10 procedures. In addition, a slight asymmetry may remain on the face after volumetric contour plasty (most often this happens when working with the lip contour) and an additional corrective session is performed to eliminate it ‒ this is a normal practice, which is caused by the individual characteristics of the body and is not related to the doctor’s professional skills.
The overall effect of the injection therapy lasts 6-12 months, and sometimes even longer ‒ it all depends on the type of the preparation, the technique and area of introduction, as well as metabolic rate in the patient’s body. After this time, the procedure will need to be repeated in full. To consolidate and prolong the effect, you can undergo maintaining injections (with a smaller amount of the drug) every 2-3 months.
Injection therapy is considered to be a “weekend” procedure, all of which visible traces disappear on their own in just a few days. In part, this is the case: the healing of punctures and the dissipation of oedema and redness takes no more than 2-4 days. However, the regenerative characteristics of the skin are very individual, for some patients, this process can be delayed for 7-10 days, which is still considered the norm.
To consolidate the results, patients should follow these recommendations:
Rejuvenation by using hyaluronic acid injections is perhaps one of the most “friendly” procedures for a person. This substance is not foreign to our body, so the risks of allergic reactions and irritations are minimized. The main contraindications are of a general nature, i.e. those in which it is undesirable to perform both these and any other injections:
The most common side effects include skin soreness, hematomas, and oedema in the treated area. Typically, these effects pass on their own in a few days. But in some cases, the oedema can last for weeks or even months ‒ this is due to the peculiarities of hyaluronic acid itself, which actively attracts and holds water molecules (for details, see the article “How to remove oedema after fillers”).
Possible complications, as a rule, are associated with the cosmetologist’s violation of the injection technique or the patient’s non-observance of post-procedure recommendations. These can be:
Allergy to hyaluronic acid is an extremely rare complication, usually not posing a threat to health and, especially, life. Moreover, in most cases, the “culprit” is not hyaluronic acid itself, but foreign impurities in the composition of the filler or external agent.
Undesirable reactions of our body, associated with this natural for it substance, really happen, albeit infrequently. The main reasons are:
Does it hurt to get an injection of hyaluronic acid ‒ put fillers, enlarge lips, do mesotherapy or biorevitalization? In short, yes. Not everyone is able to tolerate injections without the slightest discomfort, especially when a very sensitive and delicate skin of the face is under the eye of a beautician.
There are several factors that influence our sensations during cosmetic injections:
People usually know what pain threshold (low or high) they have, but in the case of “beauty shots” there are nuances that are difficult to foresee and they can only be determined by experience. Thus, it is difficult for some patients to tolerate a point injection of large volumes of hyaluronic acid, as is the case with contour plasty. For others, this does not pose a problem, but it is extremely difficult for them to tolerate mesotherapy and biorevitalization procedures, during which a large number of superficial skin punctures are performed.
The emotional factor is no less important. A weakened, exhausted central nervous system can multiply the perception of pain and turn light discomfort into real torture.
Among the technical characteristics of injection gels, mesococktails and biorevitalizants the most important are:
The “gold standard” of anaesthesia for beauty injections is a mixture of lidocaine and prilocaine as a cream (the brand Emla is most often used). The product is applied to the skin, after which it is covered with a film of plastic for better absorption. In 20-30 minutes, you can start injections, which will be noticeably more comfortable ‒ although some of the unpleasant sensations will still remain.
This method is mandatory used for particularly painful procedures: lip augmentation, filling nasolabial folds with fillers, mesotherapy with vitamins B or C, etc. In other cases, the patient can choose ‒ even though most superficial injections will be uncomfortable, sometimes they can be tolerated without any aids. In particular:
Not so rarely after having “beauty shots” done, women remain extremely disappointed. Some consider the effect to be insufficiently pronounced, others suffer from the lack of professionalism on the part of cosmetologists and get an unnatural or unaesthetic result.
How to remove hyaluronic acid out of the lips? This is perhaps the most popular question with which dissatisfied patients come to the doctor or to Internet forums. Most complications after contour plasty are chargeable to the account of lip plasty, moreover, the lips are always in sight.
Errors or the doctor’s inexperience, wrong selection of the intradermal filler, non-compliance with the pre- and post-procedural recommendations sometimes lead to unsightly and even dangerous results ‒ uneven augmentation or hypercorrection of the lips, gel migration, inflammatory processes, etc.
Of course, most of these problems can be avoided if you choose a competent cosmetologist working with high-quality products of the latest generations, confirmed by certificates of quality and compliance. However, many defects occur due to individual body reactions to the gel injected: it is almost impossible to prevent the occurrence.
There is a fairly wide range of methods to correct the situation. In general, they all solve the same problem ‒ to boost the metabolic processes in the correction area, which ultimately leads to hyaluronic acid accelerated decay and removal from the body:
The main difference between all the above-listed methods is how quickly the desired effect will come. Most women who are dissatisfied with their lips do not want to wait until hyaluronic acid is absorbed by their body, albeit at an accelerated pace, so in order to remove it they turn to the most effective means ‒ injection of the enzyme hyaluronidase, which in 1-2 days destroys almost all of the previously administered hyaluronic acid.
This specific enzyme causes an accelerated biodegradation of hyaluronic acid, that is, its decomposition into low molecular weight fragments (hereinafter, they are immediately removed through the lymph and bloodstream). Small amounts of hyaluronidase are produced in our body in a natural way and enter into the chain of regulation of our own hyaluronic acid balance in the connective tissues.
In cosmetology and pharmacology, testicular hyaluronidase is used, which is obtained from bovine testes. It comes in the form of powder which is diluted with saline immediately before use. The drug is delivered to the problem area through injection or phonophoresis. A full result can be observed after 48 hours after the procedure.
How much time has passed between the introduction of hyaluronic acid in the lips and its removal by using the enzyme does not play any role. However, subsequent correction with fillers based on hyaluronic acid is possible not earlier than in 2-3 weeks, otherwise their effect will be minimal.
The use of this specific enzyme is not permitted in the following cases:
Hyaluronidase is prescribed with caution in combination with other drugs, as it activates the absorption and can cause an unpredictable increase in their action. In turn, many hormones and antihistamines greatly reduce the effectiveness of hyaluronidase.
Another important nuance of this technique is the relatively high risk of hypersensitivity to the drug and, as a result, the development of complications and side effects of an allergic nature. For most people, this can happen as early as the second injection of the enzyme. For the patient’s safety, a preliminary allergy test is usually done: the minimum amount of the drug is injected in the region of the forearm with subsequent observation for an hour.