Why hyaluronic Acid is not just hyaluronic Acid

Tissue augmentation with dermal fillers is one of the most frequently practised cosmetic procedures. Also at LIPS and SKIN in Munich. For the success of the treatment as well as the health of the patient, the material used as filler is of utmost importance. I primarily use Juvéderm fillers in my treatments. Their excellent properties and high manufacturing quality allow for consistent achievement of treatment goals and utmost patient safety. Juvéderm fillers are made of a special kind of hyaluronic acid, that increases patient comfort during treatment and ensures long-lasting results. In this blog article, I want to elaborate on what role hyaluronic acid plays for a good treatment outcome. 

What is hyaluronIc acid?

Hyaluronic acid is a clear, viscous liquid and an important component of the human body. It is found in skin, bones, cartilage, connective tissue and especially wherever plenty of fluid needs to be bound, for example in the eyes or in the joints. The most significant property of hyaluronic acid is its ability to bind high amounts of water. It is mainly the hyaluronic acid that naturally provides to the skin moisture, elasticity, and tone.

Native, non-crosslinked and crosslinked hyaluronic acid

Different types of hyaluronic acid for cosmetic purposes exist. A distinction is made between native, non-crosslinked and crosslinked hyaluronic acid.

  • Native hyaluronic acid, which is very similar to the body’s own hyaluronic acid, primarily serves the anabolic metabolism of fibroblasts. It is water-soluble and can be easily degraded enzymatically, so it is not very durable. Native, non-crosslinked hyaluronic acid is often used in therapeutic mesotherapy and is also used for skin creams; it is less frequently used as filler-material in aesthetic medicine.
  • Cross-linked hyaluronic acid is mainly used to create volume. It is insoluble in water and resistant to enzymatic degradation. Therefore, it also retains its stability for much longer. Cross-linked hyaluronic acid is the essential ingredient of modern cosmetic dermal fillers.

The amount of cross-linked hyaluronic acid used in the filler and the technique of cross-linking determine key properties of the filler, including:

  • The capacity to bind water. It increases with the degree of crosslinking.
  • The durability of the filling effect after injection. It also increases with the degree of crosslinking.
  • The viscosity (viscosity) of the filler. It increases with the degree of crosslinking, but is also dependent on the crosslinking technique. The viscosity of a filler is a key property, as it determines the durability of treatment results, as well as patient comfort during treatment. Longevity of results is supported by a high degree of crosslinking. On the other hand, patient comfort is higher when viscosity is lower. And low viscosity is best achieved with a low degree of crosslinking. Clearly a conflict, that can only be resolved through innovative crosslinking techniques.

JUvederm’s Vycross crosslinking technique

For the dermal fillers that I prefer in my treatments, Juvéderm invented a new crosslinking technique called “Vycross”. In this process, the hyaluronic acid is first cross-linked and then broken down into particles of different sizes. The smaller particles are more easily degradable and have lower viscosity. The larger particles have a longer shelf life and greater viscosity. The trick is now to mix both particle types to obtain a filler with an ideal balance of properties. Juvéderm fillers made with Vycross technology combine thus the best of 2 worlds: long-lasting effect with easy application, hence patient comfort. In addition, Vycross fillers are characterized by particularly good tissue integration.

Tissue integration as ultimate quality factor

For both the visual success of a dermal filler treatment and continued patient comfort, the key factor is how well the injected hyaluronic acid bonds with the surrounding tissue. This is referred to as “tissue integration”. Optimal tissue integration creates a harmonious relationship between the gel and its surrounding tissue. The optical effect is thus perfect. The treated area looks absolutely natural. The patient’s comfort is also maximized: everything “sits” as it should, the gel is integrated seamlessly into the tissue, there are no irritating beads and no palpable lumps. Only when tissue integration is perfect, will the patient be happy.

The lips are particularly sensitive

This is particularly true for lip augmentation. The lips are a very sensitive area, and in relation to the available surrounding tissue, a relatively large amount of filler is injected in typical augmentations. It comes as no surprise, therefore, that reports of failed lip filler treatments are anything but rare. Perfect tissue integration of the filler material is thus a prerequisite for a good treatment outcome. For lip injections in particular, I therefore prefer Juvéderm Vycross fillers such as Volbella and Volift.

The following clip (unfortunately only available in German) illustrates the importance of tissue integration convincingly. And it emphasizes, once again, why the choice of a good filler is key for a good treatment outcome that the patient is still happy with months after the treatment. And for me, that’s the most important thing.


Attractive at every age

LIPS and SKIN Aesthetic Medicine

Eva Maria Strobl, MD
Herzog-Heinrich-Strasse 34
80336 Munich