The role of hyaluronic acid fillers (Restylane) in facial cosmetic surgery: Review and technical considerations

Background: Bioengineered hyaluronic acid derivatives are currently available that provide for safe and effective soft-tissue augmentation in the comprehensive approach to nonsurgical facial rejuvenation. Current hyaluronic acid fillers do not require preinjection skin testing and produce reproducible, longer-lasting, nonpermanent results compared with other fillers, such as collagen. Methods: A review of the authors' extensive experience at the University of Texas Southwestern Medical Center was conducted to formulate the salient requirements for successful utilization of hyaluronic acid fillers. Indications, technical refinements, and key components for optimized product administration categorized by anatomical location are described. The efficacy and longevity of results are also discussed. Results: Bioengineered hyaluronic acid fillers allow for safe and effective augmentation of selected anatomical regions of the face, when properly administered. Combined treatment with botulinum toxin type A can enhance the effects and longevity by as much as 50 percent. Key components to optimal filler administration include proper anatomical evaluation, changing or combining various fillers based on particle size, altering the depth of injection, using different injection techniques, and coadministration of botulinum toxin type A when indicated. Concomitant administration of hyaluronic acid fillers along with surgical methods of facial rejuvenation can serve as a powerful tool in maximizing a comprehensive treatment plan. Conclusions: Current techniques in nonsurgical facial rejuvenation and shaping with hyaluronic acid fillers are safe, effective, and long-lasting. Combination regimens that include surgical facial rejuvenation techniques and/or coadministration of botulinum toxin type A further optimize results, leading to greater patient satisfaction.