Hyaluronic Acid Injections

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.

What Types of Hyaluronic Acid Are There?

For injection procedures, the following types of hyaluronic acid are used:

• Animal-based. It is produced from protein which is extracted directly from the tissues of animals (mainly cattle). It was used in first generation medications, but it proved to be not the best one: even with very good purification it caused allergic reactions and other complications and side effects in some patients.
• Synthetic. A more modern type of raw material which has become an absolute standard today. It is fermented from the cell walls of specially grown microorganisms. It does not contain animal proteins, therefore, it is absolutely hypoallergenic and incapable of becoming a source of infection.

According to the internal molecular structure, two types of hyaluronic acid are distinguished:

• Unstabilized or unstitched, native. It does not undergo additional processing, therefore, quickly degrades by the breakdown of large molecules into smaller ones. It is excreted from the body within 10-14 days. The main advantage of such gels is that they activate fibroblasts which, in turn, trigger the synthesis of the body’s own collagen. This hyaluronic acid is used for biorevitalization and skin restoration, that is, for its rapid rejuvenation, moisturizing and enhancing protective functions.
• Stabilized or stitched. It is produced by adding special substances to the raw materials that firmly bind the molecules to each other (most often it is BDDE ether). As a result, the speed of their decay considerably slows down, the resulting gel is kept in the body from several months to a year, but it becomes almost inert and does not interact with fibroblasts and therefore does not have a therapeutic effect. It is this hyaluronic acid that is used for volume correction and wrinkle repair.

According to molecular weight (the length of an individual molecule of the substance), there can be:

• Low molecular weight hyaluronic acid (~ 900-1000 kDa) which moisturizes the skin well and has a noticeable therapeutic effect. It is mainly used in the composition of cosmetics for external use, since small molecules better penetrate the skin barrier, as well as for mesotherapy, where it serves as a basis for even distribution of the active ingredients of the injected cocktail.
• High molecular weight hyaluronic acid (~ more than 900-1000 kDa) is just as good for moistening, but it affects other biological processes less actively. On the other hand, it lasts longer, gives a visible effect faster and costs less, therefore it is better suited for procedures whose purpose is to create volume, lifting and total skin rejuvenation (contour plasty, biorevitalization, etc.)

According to the concentration of the active substance, hyaluronic acid preparations are divided into:

• Low density (from 14 to 18 mg/ ml) ‒ are usually used for surface injections (biorevitalization, mesotherapy), when there is no need to enlarge something, but it is important that the gel is evenly distributed in the treated area without contouring under the skin.
• Medium density (from 18 to 22 mg/ ml) ‒ the “gold standard” for working with the face: filling wrinkles, lip augmentation, etc. It is introduced into the middle and (rarely) the deep layers of the dermis. Unlike the previous group, such preparations can considerably increase the volume, but they are still quite plastic.
• High density (from 22 to 25-30 mg/ ml) ‒ are used when you need to create the maximum volume (filling deep folds, correction of cheekbones, etc.). They should be introduced only into the deep layers of the dermis, otherwise they will be seen through the skin (characteristic bumps). With excessive administration, they are likely to cause allergic reactions and other side effects.

What for Are Hyaluronic Acid Injections Used?

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:

• Contour plasty. The introduction of a dense gel, with which the volume is formed on the desired area of ​​the face or body. The most popular options are lip augmentation, elimination of wrinkles and folds on the face.
• Mesotherapy. Injections of preparations consisting of low density hyaluronic acid and a large number of other active materials. The main task is the general improvement of the skin and the elimination of its defects (pigmentation, vascular mesh, etc.).
• Biorevitalization. Superficial introduction of hyaluronic acid to quickly and intensively moisten the target area.
• Bioreparation. A procedure for the rejuvenation of aged skin with obvious and multiple signs of chrono-aging, an enhanced and more multi-purpose variation of biorevitalization.
• Bio-reinforcement. A special technique of hyaluronic acid injections, aimed mainly at achieving the lifting effect (lift).

Contour Plasty

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:

• Complete elimination of small “mesh” wrinkles and partial smoothing of deeper folds;
• non-surgical correction of the shape of the nose, as well as the chin, cheekbones, etc.;
• lip augmentation;
• breast, buttocks, sural muscles augmentation;
• filling the retracted scars and stretch marks;
• intimate filler: labia majora, clitoris and point G augmentation, narrowing the opening to the vagina.

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:

• Lightweight fillers for correcting minor defects;
• medium and high density products for large-scale filling of wrinkles, eliminating the lack of soft tissue volume, changing the contours of the face and the body;
• preparations specifically designed to work in the delicate area of the lips and around the eyes;
• maintaining preparations which are most often used in mesotherapy or as an addition to contour plasty, when several months after the first one, another procedure is performed to consolidate and preserve the result.

Mesotherapy

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:

• Skin on the face, body and hands. It eliminates withering away, dryness, loss of tone, unhealthy colour, enlarged pores, small wrinkles, manifestations of hyperpigmentation, acne and post acne and couperosis. These preparations are also used for restoration of the protective functions of the skin before and after excessive insolation, preparation and rehabilitation after plastic surgery and aggressive peeling or laser procedures.
• Hair. They fight hair loss and their weakness, insufficient volume, dandruff, seborrhea, etc.
• Cellulite and fat deposits. Hyaluronic acid in this case is used as the basis for cocktails to improve metabolic processes and skin tightening after using active fat-burning components (lipolitics).
• Scars and stretch marks. Hyaluronic acid improves local metabolism, makes scar tissue softer and more elastic, brings its tint to the natural one.

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.

Why do I need to go through several procedures for a full result?

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.

Facial Mesotherapy

It makes it possible to eliminate such problems as:

• Tired skin (dryness, dull colour, desquamation);
• the first signs of withering (small wrinkles, reduced tone and elasticity);
• couperosis;
• acne;
• enlarged pores, etc.

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.

Body Mesotherapy

This type of procedure helps to correct minor defects of the figure. It is recommended in the presence of such indications as:

• Mild cellulite;
• excess fat deposits in certain areas of the body (knees, breeches, shoulders, chin, etc.);
• dehydration of the skin;
• puffiness;
• loss of skin tone;
• scars;
• striae, hyperpigmentation, etc.

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.

Scalp Mesotherapy

The main indications for this variant of the procedure are:

• Focal and diffuse alopecia;
• change in hair structure, severe dryness;
• slow hair growth, a weakening of the roots, as well as hair loss due to stressful situations, in the postpartum period, etc.

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.

Biorevitalization with Hyaluronic Acid

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:

• Providing a slight rejuvenating effect on the skin of the face, neck, décolleté, hands at the first manifestations of chronic aging;
• preventing and eliminating dehydration of the skin under intense sunlight (which is why it is recommended to perform it a few weeks before leaving for the sea and immediately after coming back);
• recovery after plastic surgeries, as well as aggressive chemical and laser rejuvenating procedures, mechanical peelings;
• eliminating hyperpigmentation;
• improving skin tone;
• providing a lifting effect, etc.

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.

Bioreparation

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:

• Dryness and dehydration of the skin;
• age ptosis of the lower third of the face;
• couperosis and spider veins;
• hyperkeratosis;
• photodegradation;
• hyperpigmentation, including age spots;
• scars and stretch marks, postacne;
• rehabilitation after chemical, laser and mechanical peelings;
• flabby skin;
• small and medium wrinkles, etc.

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.

Bio-reinforcement (Vector Lifting)

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:

• Overall soft tissue ptosis;
• displacement of the contours of the face;
• drooping eyes, eyebrows, lips;
• deep nasolabial folds;
• sagging of soft tissue in the lower third of the face and chin;
• sagging skin of the neck, décolleté and hands.

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.

How Are These Procedures Performed?

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 correction area is treated with antiseptic agents and a local anaesthetic is applied to the skin (most often, Emla ointment).
• The doctor in the presence of the patient opens the sealed package with the preparation and disposable needles.
• Then the actual injections are made, their types and techniques have already been discussed in detail above.
• After injections, antiseptic is applied again to the treated area, as well as anti-inflammatory agents and soothing masks.

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.

How Many Injections Will Be Required?

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.

How Should a Patient Behave After Injections With Hyaluronic Acid?

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:

• In the first 24 hours it is forbidden to wash, use decorative and care cosmetics, touch and rub the area of the correction so that the administered preparations will not shift. For better distribution of hyaluronic acid under the skin, there are special massage techniques, but only a beautician should perform such manipulations, and in no case patients themselves.
• Healing marks after getting injections will need to be treated with an antiseptic to prevent infection from getting inside.
• For 10-14 days you should refrain from visiting saunas, baths, gyms, solariums, beaches ‒ intensive warming dramatically accelerates the excretion of hyaluronic acid from the body and the effect of the procedure can eventually be reduced to zero.

Contraindications, Possible Complications and Side Effects

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:

• Individual intolerance to the drug;
• pregnancy and lactation;
• inflammatory processes and impairments in skin integrity in the area of correction;
• bleeding disorders or taking drugs that affect it;
• a recent (less than 1 month ago) laser face polishing or deep peeling;
• the presence of other non-absorbable fillers or implants in the correction area;
• propensity to form keloid scars;
• oncological diseases;
• diabetes;
• exacerbation of chronic diseases;
• acute fever;
• age up to 18 years old.

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:

• Inflammations of different intensity ‒ they occur when the injection site is infected because of insufficient antiseptic treatment of the skin;
• allergic reactions ‒ most often they indicate the use of a drug of low quality, counterfeit, fake, etc.
• migration (shifting) of the injected gel;
• formation of fibrous capsules at the injection site.

Allergy to Hyaluronic Acid

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:

• Individual intolerance to synthetic hyaluronic acid. An extremely rare situation ‒ for example, for the popular Restylane filler which is introduced annually to millions of patients, only 8 cases of such reactions have been recorded so far, and only one of them have been an anaphylactic shock of moderate severity.
• Allergy to hyaluronic acid of animal origin. The first-generation hyaluronic acid preparations were made from organic tissues ‒ rooster crowns and the hyaloids membrane of bovine eyes. Even with a very thorough purification, it was impossible to remove all protein and lipid compounds, as well as other impurities, from the resulting extract, so these drugs often caused undesirable reactions in patients. Modern hyaluronic acid used in cosmetology is synthesized from a wheat substrate using the bacteria Streptococcus Zooepidemicus or Streptococcus equi. Due to constant bacteriological and rheological control, a completely purified substance with a given molecular weight is obtained, which reduces the probability of an allergy to a minimum, although it does not exclude it completely.
• The patient’s general predisposition to allergic reactions. The real cause of the problem in this case are any foreign substances that enter the body with injections (if the proper level of antiseptics is not observed), as well as anaesthetics used before the injection session. This situation is much more common than individual intolerance to hyaluronic acid, and it can be anticipated and prevented.
• Response to other additional ingredients that are part of the filler or cream with hyaluronic acid. This could be, for example, ether which stitches molecules in dense fillers, vitamins, peptides and other active ingredients of mesococktails or drugs for external use, as well as a variety of foreign impurities in the preparations of poor quality and poor purification. It is they that in most cases become the real cause of allergic reactions to hyaluronic acid preparations.

How Painful It Is to Inject Hyaluronic Acid?

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.

What determines the degree of discomfort?

There are several factors that influence our sensations during cosmetic injections:

• Individual pain threshold;
• the person’s current emotional state, the stability of her or his nervous system;
• the area of the injection;
• the composition of the drug, as well as the density of hyaluronic acid;
• the depth of the injection and the total volume of the gel;
• the use of anaesthetics and what anaesthetics are used.

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.

The Composition of the Preparation, its Volume and Methods of Administration

Among the technical characteristics of injection gels, mesococktails and biorevitalizants the most important are:

• The presence of local anaesthetic in the composition. In some lines of fillers special preparations with lidocaine are presented. They are usually used for lip augmentation, since it is extremely difficult to endure the introduction of a large volume of tissue filler in the area of ​​the red border just with anaesthetic cream. It is believed that it is more comfortable to inject them than a pure HA; however, the effect will not be instantaneous, since the anaesthetic needs some time to begin to act.
• Separate “painful” components. These include, for example, vitamins of group B or C, often used in mesotherapy: it is known that during administration they cause much more problems than hyaluronic acid and preparations based on it.
• The density of the gel. Everything is simple here: the higher it is, the thicker the needle is and the more painful the injection will be.
• Total filler volume. The more drug is placed in the tissue, the more unpleasant the sensation during the procedure and the stronger the feeling of internal distention upon its completion are.
• What concerns the methods of introducing HA and mesococktails, each of them has its own characteristics:
• The papular technique is considered to be the most comfortable for patients. Linear retrograde (it is mainly used to fill wrinkles and reinforce the face) is much worse tolerated, even with anaesthetic. It is equally difficult to tolerate single deep injections during contour plasty, especially if the filler is placed at the level of the periosteum.
• Multiple superficial injections which are usually done during mesotherapy or biorevitalization, will be almost imperceptible at first, but over time the pain seems to accumulate and by the end of the procedure the discomfort can become quite severe. This effect is well known to those who have ever had eyebrow correction done: the second one is always more difficult to tolerate than the first one.

Local Anaesthesia for Hyaluronic Acid Injections: Pros and Cons

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:

• Some experts write that pain during mesotherapy and biorevitalization causes healing and rejuvenation of the skin, and they recommend not to use anaesthesia (there is even a “dry” injection technique, in which no drugs are drawn into the syringe).
• It is also extremely unpleasant to restore sensitivity when the action of the cream-anaesthetic is over. Sensations are comparable to tingling in a numb limb after the blood flow has been resumed, but it lasts much longer. Therefore, with less traumatic procedures, for example, biorevitalization in a papular manner, many patients are much more comfortable to do without anaesthesia.

How to Remove Hyaluronic Acid?

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.

Why may the necessity to remove hyaluronic acid arise?

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.

What should one do to quickly remove hyaluronic acid out of the lips?

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:

• Taking medications that accelerate metabolism.
• Physiotherapy.
• Intensified fitness classes and other active sports.
• Frequent visits to the sauna, warm compresses on the lips, hot drink.
• Also, practice shows that fillers are more quickly “utilized” by people who, due to their professional activities, actively talk and use facial expressions in the lips ‒ translators, teachers, announcers, singers, etc.

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.

What is hyaluronidase and how does it work?

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:

• Individual intolerance to the drug;
• acute inflammatory and infectious forms, exacerbations of chronic diseases;
• the presence of malignant tumours in the body;
• recent hemorrhages in the area of ​​correction;
• pregnancy and lactation.

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.