Hyaluronic Acid Fillers May Cause Bone Resorption

There are several different types of dermal fillers and it is important to note the most common types of fillers. These examples include polylactic acid (brand name includes Sculptra), polyalkylimide (brand name includes Aquamid), calcium hydroxylapatite (brand name includes Radiesse), and hyaluronic acid (brand names include Captique, Elevess, Juvederm, and Restylane). Hyaluronic acid is a natural substance which is already readily found in our bodies, predominantly in the soft connective tissues and in the fluid surrounding a person’s eyes. It is administered as an injectable filler through extraction followed subsequently by reformulation. Albeit hyaluronic acid injections can be utilized as dermal fillers to improve one’s appearance, they can also be used as injections for treating the painful aching joints in the target areas for arthritis patients. Hyaluronic acid is typically deemed as a harder filler (versus a softer filler which is predominantly used in the lips) which is predominantly used to enhance a person’s cheekbones which are directly near the mandibular area.

It is important to note that injectable hyaluronic acid (HA) is a temporary dermal filler. As we inevitably age, the bone, fat, muscles, and skin in our face start to thin. This leads to our faces having a sagging or even a sunken appearance of the face, wrinkles, thin lips, and folds. The loss of volume in our faces can be treated with injectable HA to reduce the appearance of both these fine lines and wrinkles. The effects are seen immediately. If this sounds too good to be true, it is because injectable HA can have side effects and one must ask themself if the pros outweigh the cons for receiving these types of fillers. Most side effects are either immediate or short-term, categorized as occurring within the first one to two weeks after the original intervention. The majority of these side effects are inflammatory responses to tissue damage combined with the introduction of the foreign material of HA and include swelling, pain, tenderness and bruising. These reactions are very common. However, some, albeit rare, long-term effects are much more serious and need to be factored in consultations.

Hyaluronic acid fillers may cause bone resorption, specifically when these fillers are done in conjunction with jawline augmentation which is a common procedure. Bone resorption is, simply put, the breaking down and reabsorbing bones back into the body. Complications of bone resorption would include facial changes such as both the lips and cheeks sinking and/or shifting gradually over time and making it increasingly more difficult to get dentures and/or dental implants. In the article “Bone Resorption in Mentum Induced by Unexpected Soft-Tissue Filler”, a study demonstrated that there was evident bone resorption in the mentum following mandibular injection of 1 ml or more of hyaluronic acid (HA) filler. The authors of this study analyzed the impact of HA on bone resorption in the mentum as well as several other factors which included injection volume, injection interval, the number of injections, product and complications as well.

The study evaluated 80 patients and 160 cases from January 2014 to June 2019 and compared the computed tomographic scans of patients with or without mentum augmentation using HA. Patients who were injected with 1 ml or more per service of HA were more susceptible to bone erosion in comparison to the control group. The authors concluded that HA injection could induce bone resorption in the mentum, but the aesthetics were not impaired, and recommended that large-volume injection of HA should be performed with caution and patients should be informed about this potential complication preoperatively.

References-

What types of dermal fillers are available? American Society of Plastic Surgeons. https://www.plasticsurgery.org/cosmetic-procedures/dermal-fillers/types

Injectable Hyaluronic Acid. American Society for Dermatologic Surgery. https://www.asds.net/skin-experts/skin-treatments/injectables/injectable-hyaluronic-acid

Edwards, P, Fantasia, J. Clinical Interventions in Aging. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2686337/

What is Bone Resorption? Alaska Center for Oral + Facial Surgery. https://www.alaskaoralfacialsurgery.com/blog/what-is-bone-resorption/

Guo, X, Song, G, et al. Bone Resorption in Mentum Induced by Unexpected Soft-Tissue Filler. Aesthetic Surgery Journal. https://academic.oup.com/asj/article/38/10/NP147/5062983