Injectable Hyaluronic Acid Filler

Hyaluronic acid is a highly sought-after ingredient for dermal fillers due to its natural occurrence in the body, which minimises the risks of negative reactions. However, the half-life of hyaluronic acid is notoriously short, with a normal filler degrading by half in just 48 hours. To address this issue, pharmaceutical companies created more durable formulations by chemically cross-linking the HA filler strands. These new formulations of hyaluronic acid filler can last from six months to two years based on the formula, the amount injected, and location.
It's important to note that there are two types of breakdown of HA filler that affect its durability; metabolic and mechanical. Metabolic breakdown refers to how quickly a patient’s body metabolizes or “breaks down” the hyaluronic acid filler. Mechanical breakdown of HA fillers is related to movement of the area and will differ depending on the individual’s unique movements (such as facial expressions) and habits (for example, massaging the skin too vigorously will break down injectable hyaluronic acid more quickly). Some areas of the face such as the smile lines and around the mouth, break down hyaluronic acid filler faster due to repetitive movement, which is why hyaluronic acid lip filler may need to be touched up every four to six months. Other areas, such as the under eye where there is little mechanical pressure due to the soft and thin nature of the skin, injectable hyaluronic acid may last up to several years.

The use of cosmetic lasers has grown significantly over the last decade with the global cosmetic laser market expected to reach 5.5 billion by 2026. The first cosmetic application of laser was in 1963, but it was the development of selective thermolysis in 1982 that gave physicians the ability to target specific tissue, thus spurring the rapid growth in the field that has continued to the current day.

There are many types of laser treatments available for nearly every aesthetic concern of the face and body, with new ways of applying non-ablative laser technology entering the market continuously. Although a bit simplistic, a helpful way to explore the world of non-ablative laser is by separating them into fractionated and non-fractionated lasers.

A fractionated laser divides the light into thousands of microscopic treatment zones without affecting the surrounding skin, allowing for shorter recovery times and decreased risk. Fractional, non-ablative laser is used to treat a wide range of skin irregularities and concerns of photoaging.

Some examples of fractional, non-ablative laser include:
Clear + Brilliant®
The Fraxel® suite of lasers
The M22™ module and ResurFX™ by Lumenis
The Icon™ by Cynosure

Non-fractionated and non-ablative laser creates uniform thermal damage to the dermis while sparing the epidermis. They are generally used for vascular lesions containing hemoglobin, mild-to-moderate photodamage and early signs of skin ageing. Some examples include:
Excel® V and XEO® by Cutera
VBeam® suite of pulsed dye lasers
ClearV™

The primary benefits of a non-ablative laser are minimal downtime and fast recovery. Although the skin may appear pink or flaky following laser resurfacing, because the non-ablative laser does not damage the top layer of skin, makeup may be applied immediately after treatment. Any edema or redness is generally resolved within three days, and the use of cold compresses may help alleviate discomfort after a skin rejuvenation laser treatment.

Although the skin begins to renew within 24 hours, patients are encouraged to keep the treated area well moisturised and apply sunscreen to avoid post-inflammatory hyperpigmentation. Darker skin types may be prescribed creams containing pigment inhibitors such as hydroquinone. Results of a laser skin resurfacing are generally seen very quickly but will continue to evolve over several months after a non-ablative laser treatment.

Both ablative and non-ablative lasers work on the principle of “controlled wounding,” whereby the induction of trauma within the skin initiates the natural healing response resulting in collagen remodeling, dermal repair and the production of new collagen. The energy produced by the non-ablative laser is absorbed by intradermal water at the target wavelength raising the intradermal temperature and delivering a thermal injury capable of denaturing collagen and initiating the wound response. The reduction in fine lines and wrinkles, overall improvement in skin texture, and skin tightening seen after skin rejuvenation with a non-ablative laser are due to this new collagen formation and subsequent dermal thickening.

Unlike the ablative laser which vaporizes or “ablates” a fraction or all of the epidermis, the non-ablative laser does not physically damage the epidermis. This difference accounts for the minimal downtime and reduced risks associated with non-ablative laser.

The light energy of a non-ablative laser may be delivered in a non-continuous pulse action or via a wave divided into a grid of microscopic columns, otherwise known as a fractional laser. The fractional non-ablative laser delivers heat into the skin through thousands of tiny, deep columns known as microthermal treatment zones. All of this occurs without affecting the surrounding skin, allowing for a much faster recovery after laser resurfacing and a reduced likelihood of post-procedure complications.

Because the non-ablative laser does not remove the top layer of the skin, it may not be as effective for skin resurfacing as an ablative laser. However, non-ablative lasers offer multiple approaches to skin rejuvenation without the downtime and complications associated with the more powerful ablative laser, making it the preferred method of skin rejuvenation for mild photoaging in patients 30 to 50 years of age.

Of all the types of laser treatment for the face, the non-ablative laser has more success in treating vascular conditions associated with aging such as rosacea, telangiectasia, and generalised erythema (redness). Non-ablative lasers may also improve acneic conditions by inhibiting sebum secretion, lessening post inflammatory hyperpigmentation and by improving the appearance of atrophic and hypertrophic scarring.

There are many options of non-ablative laser, each representing different wavelengths, pulse durations and fluence (the energy delivered per unit area) of the light beam. Each of these factors will affect the function of the non-ablative laser. The desired depth of a non-ablative laser is determined by the location of the target. In this way, deeper is not always better as some conditions, such as photo-induced pigment, may lie in higher levels of the skin. Conversely, a laser treatment for acne scars may require more intensity. Thankfully, non-ablative laser units offer adjustable depths by enabling the physician to change the pulse duration and fluence of the beam for customizable skin resurfacing and skin rejuvenation.

The discomfort during any types of laser treatment for face or body will vary depending on the area being treated, the type of laser used, the duration of exposure and the patient’s personal pain threshold. For some devices, a patient must communicate the sensations of discomfort to the provider to avoid unwanted epidermal injury. In these cases, the use of anesthesia during laser resurfacing is not advised.

In general, a non-fractional, non-ablative laser will include a topical anesthesia before the skin rejuvenation treatment. A device to blow cool air or the use of ice packs may also be used to relieve discomfort and minimize edema immediately following the non-ablative laser skin rejuvenation.

In general, a non-fractional non-ablative laser may create more discomfort than a fractional non-ablative laser. However, innovations within the field of laser skin resurfacing and skin rejuvenation have significantly improved the patient experience both during and after laser resurfacing and, in general, the procedure now includes only minimal discomfort.

The body represents a complete biological ecosystem that is constantly evolving and responding to external input. For this reason, lifestyle choices such as healthy eating, exercise and safe sun exposure can dramatically impact the longevity of results after non-ablative laser resurfacing. And while the most effective laser for skin rejuvenation is an ablative laser, repeated non-ablative laser treatments have been shown to produce equivalent results. This presents the broad versatility of non-ablative laser as, unlike the ablative laser, each treatment with a non-ablative laser may be without any significant downtime or patient discomfort. Once the desired outcome has been achieved, the results of a series of non-ablative laser skin rejuvenation treatments may last 3-5 years depending upon the factors discussed above.

Provided the patient is a good candidate for non-ablative laser (see “What You Need To Know”), the procedure is very safe and statistically represents fewer risks for post-treatment complications when compared with the stronger, and more effective, ablative lasers. In addition, because non-ablative laser may be performed in a series, wonderful results of skin rejuvenation can be achieved over time with little downtime and minimal risk.