Updated: Jun 9
Topical formulations of hyaluronic acid (HA) are seen for anti-wrinkle creams and skin hydration. Read more...
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What is Hyaluronic Acid (HA)?
Hyaluronic acid (HA) is a naturally occurring substance in the skin. It is a polysaccharide and is found throughout the body and in the extracellular matrix of the skin. It’s versatile, non-toxic, and not inflammatory. It plays a role in cushioning, shock absorption, and tissue viscosity. It is found as an injectable and in topical formulations. HA is most often used medically and cosmetically for a number of reasons as an injectable. For dermatology, I use it for soft tissue augmentation on the face, backs of hands, scars, and chest lines. It has been used in ophthalmology (cataract surgery), Orthopaedics (joints), ENT (vocal cords), urology (interstitial cystitis), etc.
What are the main benefits of hyaluronic acid?
The main benefits of hyaluronic acid are :
It is biocompatible and very well tolerated with very few adverse effects noted.
It has lubricating properties, hydration, cushioning, and wound-healing effects.
What is the difference between topical and injectable hyaluronic acid?
Topical formulations of HA are seen for anti-wrinkle creams and skin hydration. The question here is how much HA can get through the skin to actually have an effect as it is a fairly large molecule. The goal of HA topically is to increase and improve skin hydration, and elasticity and decrease wrinkle depth. HA can attract and retain moisture in the skin. The reality here is that it’s not truly an anti-aging product- its action is misunderstood by people who opt to use it. HA in fillers is injected directly into the dermis of the skin to get to work. HA topically can’t get there- the molecules are too big. It may get into the very superficial layer of the epidermis to retain some moisture to make the skin look less wrinkled because it’s more hydrated. In this sense, it’s an effective moisturizer.
For the skin as an injectable, we use hyaluronic acid predominantly for tissue augmentation. It provides fast, safe, and effective results for patients looking to restore loss of volume or augment. It is wonderful to work with because a bioimplant when injected correctly, does not have a firm or bumpy feel. I inject either directly into the area of concern or carefully place the product to restore contours to the face. Topically, it’s a moisturizer. HA is very well tolerated as an injectable. Occasionally bruising will be seen that may last about a week. Redness and swelling can occur as well. Overall very well tolerated.
Will hyaluronic acid injections make me look puffy or "overdone"?
The answer is basically not unless you want them to. The reality is that there are several techniques and levels of experience and expertise out there. The most important step to getting the outcome you are seeking is to be upfront and define the type of cosmetic procedure you want to be performed.
What types of cosmetic procedures are there?
I break down cosmetic procedures into 3 categories: restorative, enhancing, and transformative.
Restorative cosmetics focus on restoring lost volume. The lost volume gives the appearance of deep lines and wrinkles. Commonly this is the under-eye area, nasolabial folds, jowls, chin, jawline, and cheeks.
Enhancing cosmetic procedures take a feature we have and augment or enhances the feature to draw attention to it. Examples of this would be lip enhancement or cheekbone augmentation.
Transformative cosmetic procedures are when you are looking to truly alter your appearance. This would be when I have a patient that comes in with a photo of a feature they do not have and wish to transform their look to include it. Most commonly this would be significant lip augmentation, facial contour alteration, enhancing bony prominences, and/or changing the overall outline of the face.
How do I know if I need Botox, fillers, or laser?
The key to note here is understanding the anatomy of a wrinkle. I break this down into three features:
Loss of volume/fat: Addressed by fillers
Thinning of skin: Addressed by topical retinoids and alpha hydroxy acids or radiofrequency devices
Muscle contraction: Addressed by botox and other neurotoxins
Can you share some information about the different types and molecular sizes of hyaluronic acid, and how each one affects the skin differently?
In general, the molecular size of topical hyaluronic acid is too large to permeate the skin. Due to this fact, most topical formulations of hyaluronic acid stay on the surface of the skin and function as a moisturizer to retain hydration in the superficial layers of the skin. To get hyaluronic acid deeper into the skin, in general, it needs to be injected in the form of fillers. That being said, in topical formulations of hyaluronic acid, you may come across two different varieties- high molecular weight (HMW) and low molecular weight (LMW). The HMW hyaluronic acid is used as a moisturizer and stays on the surface of the skin to retain moisture. The quest to find a product that permeates the skin when applied topically to have a potentially higher likelihood to boost the cosmetic benefit from use led to LMW hyaluronic acid products. The thought is that if the molecule size is smaller, it can permeate the skin deeply and have a more significant effect on improving the depths of wrinkles. The concern here is that LMW hyaluronic acid can be more irritating to the skin than HMW, as well as more costly.
How does hyaluronic acid work as a topical agent?
Topically, it hydrates. Not likely to cause allergic reactions. It’s actually not an "acid" in that it will not exfoliate or cause dryness. The skin's natural pH is acidic. Just about anyone can use these products as long as they are not allergic.
Topically, oily skin types fair better than dry. Dry skin unfortunately may not have the moisture HA topical products need to work.
Is there a percentage of hyaluronic acid to look for?
Topically, most products are 1-2% HA. Technically you really shouldn’t go above 1-2 % because your skin will not have the moisture the HA is looking for. It will deplete the natural moisture deep inside your skin as the moisture gets absorbed by the HA molecules!
Is there a wrong way to use hyaluronic acid?
A word of caution on adding hyaluronic acid to your routine. The HA molecule looks for and loves water. If you live in a humid environment it will draw moisture from there. If you live in a dry environment it may pull moisture out of your skin up towards the product and paradoxically make you feel dryer. (Remember those osmosis diagrams in your middle school science textbook with the salt water solutions:) If this is a concern, the best way to use HA products is to consider applying the hyaluronic acid first followed by another moisturizer. This may help provide your HA product with a source of moisture to draw from.