A Large Prospective Volumetric and Patient-Reported Outcome Analysis of Hyaluronic Acid Facial Fillers

BACKGROUND: Hyaluronic acid (HA) facial fillers are a nonsurgical treatment for age-related changes. Literature on long-term volumetric results and patient-reported outcomes (PROs) is limited. This prospective study aimed to precisely define and measure objective tissue metrics and PROs of HA fillers in different facial regions over 12 weeks. METHODS: Women 40 to 65 years of age received injections in facial regions using HA fillers: Restylane-L in nasolabial folds and marionette lines, Restylane-L Lyft in the malars, and Restylane Silk in the lip border. Patients completed the FACE-Q, and were photographed with 3-dimensional Vectra M3 imaging software before injection, immediately after injection, and at 2, 4, and 12 weeks after injection. Volumes were analyzed from 8 regions: left and right malars and extended midface, upper perioral, lower perioral and jawline, and lips. Tissue displacement factor (TDF) and effective volume (EV) were calculated. Statistical analyses included Mann-Whitney U tests and risk-adjusted linear regression. RESULTS: A total of 101 women participated. Restylane-L Lyft had the highest TDF (1.25), followed by Restylane-L (1.14) and Restylane Silk (0.56). EV for Restylane-L Lyft was highest (89.8%), followed by Restylane-L (89.7%) and Restylane Silk (70%). Volume maintenance was 65.5% (whole face), 79.2% (malars and extended midface), 62.7% (upper perioral), and 37.2% (lips) over 12 weeks. PROs demonstrated improvements in facial appearance, treated regions, and psychologic and social function. CONCLUSIONS: The authors defined novel tissue metrics-TDF and EV-relative to HA treatments, with greatest volume maintenance in the midface and greatest loss around the mimetic areas through 12 weeks. Significantly improved PROs were observed for patients undergoing large-volume HA filler injections. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.