This Jama Facial and Plastic Surgery article looks at satisfaction, efficacy, longevity, and safety of hyaluronic acid filler for treatment of midface volume loss.

Even with a relatively low mean injection volume of 6.65 mL patients achieved satisfactory cosmetic results.  The study followed participants for 12 months.  The majority were female but 5% were male

The study found that even after up to  one year after treatment that 73% to 89% of the patients reported being very much or moderately improved.  At 12 months after the procedure, 84% reported satisfaction with their results. At all time points, most patients (68-100%) would elect to undergo the procedure again  Adverse events were minimal and all resolved without treatment in two weeks. At the 2-year follow-up, there were no reports of delayed adverse events.

Restoring the lost volume of the deep facial fat pads, especially that of the deep medial cheek, is critical to achieving an aesthetically appealing appearance. Although calcium hydroxylapatite and poly-l-lactic acid can both be used to replace lost facial volume, there are now several injectable hyaluronic acid (HA) fillers with high cohesivity that are specifically designed to provide the lift needed to restore midface volume.

The HA filler used in this study is a 20-mg/mL, smooth, highly cohesive, viscous HA filler (Juvéderm Voluma; Allergan Inc) composed of a proprietary mixture of low- and high-molecular-weight HA with low hydrophilicity. Since its initial approval by the US Food and Drug Administration, studies performed all over the world have found this filler to be a safe and effective means of restoring midface volume loss, with results lasting up to 24 months.

The pivotal US trial published in Dermatological Surgery was a multicenter randomized clinical study in which 235 individuals were injected with a total mean of 6.65 mL of product between the initial session and touch-up treatments, with a mean of 5.07 mL at the initial treatment and 1.93 mL for touch-up. With these volumes, 44.6% of patients continued to see clinical benefit at 2 years after the procedure.4


Another study in Clinical Cosmetic and Investigational Dermatology  found high post-treatment satisfaction, with 91.6% of patients satisfied or very satisfied.

A BMC Dermatology article reported that 88% of physicians and 76% of HA Filler patients rated the outcomes as much improved or very much improved.

The literature has clearly demonstrated that injection of large volumes of HA filler is a safe, efficacious method of addressing age-related volume loss. However, many, if not most, patients do not require such large volumes to achieve the desired correction. In addition, most patients cannot afford several syringes of a temporary filler, especially if they will require additional treatment several months later. It is also unclear whether the long duration of HA filler is related to these large treatment volumes or whether high patient satisfaction and clinical results can still be seen when small injection volumes are used. This study sought to assess the efficacy, longevity, and patient satisfaction associated with correction of age-related midface volume loss using the low volumes of HA filler more commonly used in day-to-day practice.

The most commonly treated site was the malar cheek, comprising 86% of patients. The next most common treatment sites were the temples  (7%), followed by the chin or nasolabial folds (7%). The mean price paid by the patients per syringe of HA filler was $749 (range, $0-$1000).

At follow-up, 48% received a touch-up treatment.  Patients represented a variety of ethnic groups and skin types.

No patient reported looking worse than at baseline at any time point.

At 1 month, 93% of patients indicated that they were very or somewhat satisfied with their aesthetic outcome. At 3 months, 87% of patients reported satisfaction. At 6 months, 86% were satisfied, and at 12 months, 84% were satisfied.

Pain associated with the procedure was rated on a scale of 0 (no pain) to 10 (extreme pain). The mean (SD) pain level reported by patients was 1.9 (1.8), with no significant difference among treatment volume groups. Four patients reported nodules, but these resolved spontaneously within 7 days. There were no reports of infection. Of note, there were no adverse events among the 10 patients who underwent off-label injection of HA filler into the temples and chin or nasolabial folds. At the 2-year follow-up, there have been no reports of delayed adverse events at either study site.



Source: Correction With Low-Volume Hyaluronic Acid Filler | Complementary and Alternative Medicine | JAMA Facial Plastic Surgery | The JAMA Network