Ex vivo analysis evaluates how tissue plane and gel properties affect hyaluronic acid morphology, highlighting their adaptability based on technology.
BACKGROUND Hyaluronic acid (HA) gels are popular aesthetic treatments, but product selection remains challenged by limited in-tissue data linking gel properties to clinical outcomes. OBJECTIVE To evaluate how tissue plane, gel indication grouping, and crosslinking technologies influence in-tissue HA gel morphology. MATERIALS AND METHODS Eighteen crosslinked HA gels, representing 4 clinical indication groups and 5 crosslinking technologies, were injected into intradermal, subdermal, and deep planes of ex vivo human abdominal tissue under ultrasound. Bolus spread and height were quantified and mixed-effect regression models evaluated the effects of tissue plane, indication group, crosslinking technology, and their interactions. RESULTS Tissue plane significantly influenced gel spread and height; however, the magnitude and direction of these effects varied across gel indication grouping and crosslinking structure. Distinct crosslinking technologies demonstrated different patterns of plane-dependent adaptability; the cohesive polydensified matrix gels showed more pronounced changes in morphology across tissue planes, whereas noncohesive polydensified matrix gels tended to exhibit more plane-invariant behavior. CONCLUSION This ex vivo analysis demonstrates that HA gel morphology is influenced by the interaction between tissue plane of injection, gel subtype, and crosslinking technology and reveals that HA gels differ in the magnitude of these plane-dependent differences.
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Casabona et al. (2026) studied this question.
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