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.