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Hyaluronic Acid Gel in Skin Rejuvenation(2008/1/28 22:24:00)

Today hyaluronans have become the most popular agents used for soft tissue augmentation in the entire facial area. They are biodegradeable, nonpermanent and have a remarkable safety profile. Their natural biocompatibility means that no
pretreatment skin test is necessary. The soft pliable enhancement of natural tissue turgor and contour makes them very acceptable in the lips and perioral and periocular regions. The more viscous agents are very helpful in the treatment of facial lipoatrophy particularly in the region of the cheeks and chin.

During the aging process, loss of dermal elasticity and subcutaneous volume depletes skin of its youthful contours and gives rise to a number of lines, wrinkles, and other facial defects. Many products are available to restore aesthetic harmony; among the most popular are injectable hyaluronic acid derivatives, which are used to correct
wrinkles and folds, and add volume and structure. Hyaluronans have a long history of clinical use in facial rejuvenation and a number of advantages, including immediate clinical effects that can persist for up to a year, little downtime or recovery period, and minimal discomfort or inconvenience. Moreover, the wide variety of formulations and viscosities available target a range of imperfections from fine rhytides and lines to deeper grooves, folds, and depressions, and offer the experienced clinician a versatile product with which to sculpt, shape, and rejuvenate the face.

As key structural component that occurs naturally in the skin, hyaluronic acid is a long, dimeric, cross-linked sugar molecule consisting of N-acetyl glucosamine and glucuronic acid. In the dermis, hyaluronic acid functions as a space-filling, cell-protective molecule that provides structure and volume. During the aging process, the amount of natural hyaluronic acid decreases, leading to dermal dehydration and rhytide formation. Hyaluronic acid gels were developed for soft tissue augmentation by cross-linking hyaluronic acid chains and are injected into and below the dermis where they combine with the skin's naturally occurring hylauronic acid and bind to water, thereby contributing to skin turgor and elasticity, and create volume. After a period of 4 to 12 months, the injected filler is broken down and undergoes degradation and clearance by hepatic metabolism. Because hyaluronic acid occurs naturally and is a component of all connective tissue with no species or tissue specificity, there is no associated antigenicity. However, some clinicians initially reported positive skin tests after treatment and recommended skin testing prior to injection. Since 1999, when the manufacturer refined the product, the incidence of adverse reactions has been much less.

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