Hyaluronic Acid Fillers and Potential Bone Resorption
Hyaluronic acid (HA) is a compound that is naturally occurring in the body but is most abundantly present in the skin. HA functions as a reservoir for moisture which maintains tissue structure, and aids in tissue repair by activating immune cells and mediating anti- inflammatory reactions. As we age, our skin loses moisture, thus causing our skin to show signs of aging like fine lines and wrinkles. Maintaining adequate skin moisture is key to maintaining youthful skin, of which hyaluronic acid is a key component (Papakonstantinou E).
Injectable hyaluronic acid (HA) is a dermal filler that is used to reduce the appearance of fine lines and wrinkles and create structure in the face. It is a popular cosmetic injection product for aesthetic improvements. There are various forms of HA fillers that vary in composition as well as suitable location to be used for injection. Popular brand names include Restylane, Juvederm, and Hylaform. HA fillers differ in concentration. Higher concentrations have greater tissue displacement and exert their effects for longer periods of time (Gold MH). Side effects associated with HA fillers include swelling, bruising, lumps and bumps, bleeding, and redness at the injection sites. Uncommon side effects include numbness, allergic reactions, blistering, and filler migration (ASDS).
There is anecdotal evidence that has prompted studies of the incidence of bone resorption after receiving HA fillers. A preliminary retrospective cohort study in China found that bone resorption can occur when fillers are injected into dermal layers located in areas close to facial bones, such as the chin or the cheekbones. Additionally, certain fillers have a higher propensity to form hard capsules, or granulomas, which can also cause bone resorption due to the pressure created from capsule formation (Lee W).
Based on available literature, there is no true causative relationship between HA fillers and bone resorption, and therefore this is not a true reaction that patients and providers should worry about when it comes to using HA fillers. If patients are worried about the safety of HA fillers, they should speak to a licensed and knowledgeable provider and if willing to receive the injections, to get them from a licensed and trained individual that uses proper technique and products that are suitable for patient- specific concerns.
Gold MH. Use of hyaluronic acid fillers for the treatment of the aging face.Clin Interv Aging. 2007;2(3):369-376. doi:10.2147/cia.s1244
Lee W, Yang, E. Unexpected Bone Resorption in Mentum Induced by the Soft-Tissue Filler Hyaluronic Acid: A Preliminary Retrospective Cohort Study of Asian Patients. Plastic and Reconstructive Surgery 147(6):p 1063e-1064e, June 2021. | DOI: 10.1097/PRS.0000000000007926
Papakonstantinou E, Roth M, Karakiulakis G. Hyaluronic acid: A key molecule in skin aging.Dermatoendocrinol. 2012;4(3):253-258. doi:10.4161/derm.21923
Hyaluronic Acid Fillers and Potential Bone Resorption
Hyaluronic acid (HA) is a compound that is naturally occurring in the body but is most abundantly present in the skin. HA functions as a reservoir for moisture which maintains tissue structure, and aids in tissue repair by activating immune cells and mediating anti- inflammatory reactions. As we age, our skin loses moisture, thus causing our skin to show signs of aging like fine lines and wrinkles. Maintaining adequate skin moisture is key to maintaining youthful skin, of which hyaluronic acid is a key component (Papakonstantinou E).
Injectable hyaluronic acid (HA) is a dermal filler that is used to reduce the appearance of fine lines and wrinkles and create structure in the face. It is a popular cosmetic injection product for aesthetic improvements. There are various forms of HA fillers that vary in composition as well as suitable location to be used for injection. Popular brand names include Restylane, Juvederm, and Hylaform. HA fillers differ in concentration. Higher concentrations have greater tissue displacement and exert their effects for longer periods of time (Gold MH). Side effects associated with HA fillers include swelling, bruising, lumps and bumps, bleeding, and redness at the injection sites. Uncommon side effects include numbness, allergic reactions, blistering, and filler migration (ASDS).
There is anecdotal evidence that has prompted studies of the incidence of bone resorption after receiving HA fillers. A preliminary retrospective cohort study in China found that bone resorption can occur when fillers are injected into dermal layers located in areas close to facial bones, such as the chin or the cheekbones. Additionally, certain fillers have a higher propensity to form hard capsules, or granulomas, which can also cause bone resorption due to the pressure created from capsule formation (Lee W).
Based on available literature, there is no true causative relationship between HA fillers and bone resorption, and therefore this is not a true reaction that patients and providers should worry about when it comes to using HA fillers. If patients are worried about the safety of HA fillers, they should speak to a licensed and knowledgeable provider and if willing to receive the injections, to get them from a licensed and trained individual that uses proper technique and products that are suitable for patient- specific concerns.
Citations:
ASDS. Injectable Hyaluronic Acid , American Society for Dermatologic Surgery, 2024, www.asds.net/skin-experts/skin-treatments/injectables/injectable-hyaluronic-acid.
Gold MH. Use of hyaluronic acid fillers for the treatment of the aging face. Clin Interv Aging. 2007;2(3):369-376. doi:10.2147/cia.s1244
Lee W, Yang, E. Unexpected Bone Resorption in Mentum Induced by the Soft-Tissue Filler Hyaluronic Acid: A Preliminary Retrospective Cohort Study of Asian Patients. Plastic and Reconstructive Surgery 147(6):p 1063e-1064e, June 2021. | DOI: 10.1097/PRS.0000000000007926
Papakonstantinou E, Roth M, Karakiulakis G. Hyaluronic acid: A key molecule in skin aging. Dermatoendocrinol. 2012;4(3):253-258. doi:10.4161/derm.21923