Injectable Non-Animal Stabilized Hyaluronic Acid as a Skin Quality Booster: An Expert Panel Consensus

January 2018 | Volume 17 | Issue 1 | Original Article | 83 | Copyright © January 2018

Magda Belmontesi MD,a Francesca De Angelis MD PhD,b Carlo Di Gregorio MD PhD,c Ivano Iozzo MD,d Marina Romagnoli MD,e Giovanni Salti MD,f and Matteo Tretti Clementoni MDg

aStudio Medico Belmontesi, Vigevano, Italy bDe. A. Center Laser & Plastic Surgery Clinic, Naples, Italy cPlastic Surgeon, Palermo, Italy dCMIA Medical Center, Bologna, Italy eStudio Dermatologico Ligure, Genoa, Italy fAesthetic Plastic Surgery, Istituto Medlight, Florence, Italy gLaserplast, Milan, Italy

Hyaluronic acid (HA) is used extensively in aesthetic medicine thanks to its documented role in skin rejuvenation. The specific applications of HA-based products are not always fully acknowledged due to a lack of consistent recommendations. In this paper, the authors have summarized available published data on the range of applications of non-animal stabilized hyaluronic acid (NASHA®) gel skin boosters (NSBs) in several anatomical areas and types of patient, as well as their own recommendations. Overall, the panel agreed that a standard initial protocol treatment of up to 3 sessions, followed by a maintenance schedule, would allow patients to improve and then preserve skin quality over time. Indeed, distinct effects are evident after the first session, but a progressive enhancement of skin texture is detectable for up to 12 months after repeat treatment at 4 to 6 month intervals. Moreover, the authors agreed that the NASHA gel, reaching the dermis, is able to reestablish a greater degree of hydration and stimulate collagen that, in turn, restores the volume and density of the skin. Thus, a strong consensus was reached that NSB procedures are minimally invasive, safe, and effective, and designed to improve skin texture and maintain skin quality.

J Drugs Dermatol. 2018;17(1):83-88.


The increasing psychosocial importance of skin health is driving the development of new cosmetic treatments and approaches;1 and hyaluronic acid (HA) has a documented role in skin rejuvenation because, due to its viscoelastic properties, it develops a condensed network within the connective tissue to attract water into its own matrix and improve skin turgor.2-4 Recent data indicate also that HA promotes the release of cell growth factors, as well as increasing the production of collagen fibres and modulating their elongation.5-8 Mesotherapy injection procedures are based on native HA-based substances, with some formulations including collagen or a mixture of additional substances (vitamins, amino acids, and coenzymes) supposed to promote fibroblast stimulation.9 However, there is an ongoing debate about the factual efficacy of mesotherapy in inducing skin rejuvenation due to the controversial data on its in vivo efficacy and long-term change of collagen fibres.10-12Since the 1990s, different manufacturing processes have been used to prolong the persistence of HA into the tissue by creating a molecule resistant to degradation while preserving its natural entanglements.13-16 Non-animal stabilized hyaluronic acid (NASHA®) gels are based on a patented technology that uses a low degree of chemical cross-linking and preserves natural HA entanglements, and they have been among the most extensively documented and commonly used gels for soft tissue augmentation over the last 20 years.16-18 Restylane Skinboosters® Vital and Restylane Skinboosters® Vital Light (Q-Med AB / Galderma, Uppsala, Sweden) are NASHA gels specifically designed to progressively improve skin quality through intradermal or subdermal injection in very small aliquots. They have been used in Europe for more than 12 years and shown to be effective in the face, hands, neck, and décolletage.5, 19-22 Due to a lack of consistent recommendations on the approach to consultation, assessment, injection technique, and ways to optimize the treatment effect, there is misunderstanding regarding the use of such products. The authors here provide