Connections between cohesion and properties that related to safety and effectiveness of the hyaluronic acid dermal fillers: A comparative study of the cohesive and non‐cohesive gels

Abstract Background Although the importance of the cohesion of a hyaluronic acid (HA) filler has been recognized, the relationship between the cohesion and the other performance that related to safety and effectiveness, as well as the underlying mechanism is barely studied. Much efforts need to be made on this subject to provide guidance for clinical practice. Materials and methods Two types of the HA fillers (cohesive and particulate gels) were selected for the comparison of the cohesion and the other key physicochemical properties. Results Hyalumatrix, with significantly higher cohesion, was homogeneously smooth and showed a linearly oriented morphology, whereas Matrifill and Restylane were particulate and showed obvious boundaries between particles. The high cohesion of Hyalumatrix is beneficial to the properties that related to safety and effectiveness, including recovery under shear stress, injectability, tissue integration and in vitro resistance to enzymolysis. The underlying reason was that the strong internal interactions of the cohesive gel protect the network structure from collapse and keep the gel as an intact whole when the gel was subjected to the stress. The homogeneously smooth morphology further improved the tissue compliance and injectability. The G′ of Hyalumatrix is in the middle level of the commercially available HA fillers. Conclusion Hyalumatrix is a rare HA filler product to possess good cohesion and intermediate G′ simultaneously. More clinical practice is needed to verify the connection between the cohesion of Hyalumatrix and the clinical performance.