Debunking myths on hyaluronic acid injectable gels in clinical practice

Abstract

Hyaluronic acid (HA)–based soft-tissue fillers are the most widely used injectables for nonsurgical facial rejuvenation, valued for their reversibility, versatility, and safety profile. Despite widespread use, misconceptions about HA gels have proliferated on social media and in clinical discourse, potentially affecting both healthcare professionals and patients. Methods: We conducted a narrative, nonsystematic review of the published literature, supplemented by clinical experience and expert opinion of 8 international specialists in aesthetic medicine. Published studies in English were retrieved from PubMed, with priority given to systematic reviews, meta-analyses, and controlled clinical trials. Evidence grading and quality assessment were applied where available. Results: Available evidence indicates that HA gels are biodegradable and temporary, with clinical effects generally lasting 4–18 months depending on product, technique, and patient factors. They are reversible through exogenous hyaluronidase injection. Current HA products cross-linked with 1,4-butanediol diglycidyl ether are not associated with toxicity at clinically used concentrations. The risk of gel migration or facial overfill syndrome is not inherent to the products but linked to inadequate anatomical knowledge, suboptimal injection technique, or inappropriate patient selection and counseling. HA gel treatment has also been associated with biostimulatory effects and improvements in patient quality of life. Conclusions: The weight of published evidence does not support common misconceptions about HA injectable gels. However, the evidence base is heterogeneous and includes studies of variable methodological quality. Practitioner education, thorough treatment planning, and shared decision-making between healthcare professionals and patients remain important for the safe and effective use of HA injectables.