Hyaluronic acid: what are the risks and contraindications – 05/30/2023 – Equilíbrio

In recent decades, the search for a face free of wrinkles and other signs of aging has gained a great ally: hyaluronic acid, a substance that can be applied to the inner layers of the skin to promote hydration, fill in and give the desired contours to the skin. chin, cheeks, lips and eyelids.

One of the stars of the popular “facial pairing”, the ingredient has become synonymous with beauty products and today appears on the labels of many creams and in advertisements for beauty clinics or offices.

But can it be used by everyone? Are there contraindications and side effects? And what is the difference between creams sold in stores and injections applied in offices?

Understand in five points the main issues related to this product.

What is hyaluronic acid?

Hyaluronic acid is a substance manufactured by our own body and that of many other animals.

It has the function of maintaining the natural hydration of the cells that make up the inner layers of the skin, in addition to helping to sustain and fill this tissue.

“As the years go by and the aging process, we lose the skin’s extracellular matrix, which becomes thinner and looser”, explains physician Alessandra Grassi Salles, coordinator of the Aesthetic Surgery, Cosmetics and Laser Group at Faculdade of Medicine at the University of São Paulo (USP).

This “extracellular matrix” that the specialist mentions corresponds precisely to all the substances that “fill” the skin and keep the skin cells together.

Over the years and the natural decrease of these compounds, it is normal for the surface layer of our body to become flaccid, gain wrinkles and end up becoming less thick.

That’s where hyaluronic acid applications come in: the goal is to replace or increase the amount of this substance, in order to maintain the skin with the desired thickness.

What is the difference between creams and injections?

“The big question is that the hyaluronic acid that we produce naturally has a very short half-life. It is absorbed by the body in less than 48 hours”, says doctor Daniel Boro, from the Brazilian Society of Plastic Surgery.

“The industry then developed versions of this substance that are much more resistant and remain in the body for months.”

Currently, hyaluronic acid injected in aesthetic procedures is obtained through a fermentation process of some microorganisms.

Creams already carry synthetic versions of this ingredient.

In addition to manufacturing, the two types of products have fundamental differences in the mechanism of action.

“The basic function of the cream is to promote a very superficial hydration of the skin. The injectable ones have the role of filling, supporting and rejuvenating parts of the face”, summarizes the doctor Alessandra Ribeiro Romiti, advisor of the Department of Dermatological Cosmiatry of the Brazilian Society of Dermatology.

Experts explain that the cream brings large molecules, which cannot overcome the first layers of the skin. With this, there is no possibility for the hyaluronic acid that is part of the formulation to go deeper and fill the extracellular matrix, mentioned earlier.

A similar hydration effect, incidentally, is observed in capsules that also contain this ingredient.

However, before starting to use any of these items, the ideal is to seek the guidance of an expert.

“If the person has oily skin and uses too much cream, there is a risk of this habit clogging the pores of the skin and causing acne”, explains Salles.

Who is hyaluronic acid indicated for?

In general, there is no “cake recipe”, or a general recommendation that works for everyone.

“We can apply hyaluronic acid as part of the skin aging management process,” points out Boro.

In Romiti’s view, everything will depend on what the patient is looking for and on his individual characteristics.

“There is no right age to start treatment. There are people who start working on dark circles at 25 years old, others seek to correct certain aspects of the face after bariatric surgery or want a more global approach when they reach 50 or 60 years old”, he says .

Salles adds that, in addition to the possibilities of modifying certain aspects of the face with new aesthetic technologies such as hyaluronic acid, health professionals need to understand each person’s motivations.

“It’s a big mistake to think that we need to have a 30-year-old face to be happy. If we don’t work on what’s happening inside the patient, he may even have a rejuvenated face, but he’ll never be truly satisfied”, he points out. .

Are the results of the application definitive?

No. The hyaluronic acid used in procedures even lasts longer, but gradually it is absorbed by the body. “It all depends on the type of gel and the part of the face where it will be applied”, answers Boro.

“In general terms, it stays in the skin layers for about a year, but this time usually varies between six and 18 months.”

It is worth explaining here that not all hyaluronic acid is the same: there are more consistent formulations and others that are more malleable.

The professional selects the appropriate type according to the part of the face and the desired effect – on the chin or jawline, for example, a firmer gel may be needed, while on the lips or eyelids, it is better to apply a flexible product and elastic, which will allow a more natural movement of the mouth or eyes.

In addition to consistency, another factor that interferes with the duration of hyaluronic acid is the movement of facial structures. The tendency is for it to run out quickly in areas that move a lot, like the lips and eyes, and linger extra time in parts that are less mobile, like the jaw.

But it’s clear that experts don’t wait for hyaluronic acid to completely end to indicate new applications.

“We carry out periodic follow-up and have protocols to make replacements, according to the need”, says Boro.

Is there a risk of side effects after the procedure?

Adverse events can happen, and it is important that both specialists and patients know how to identify them in order to act quickly and contain the damage.

One of the most feared dangers occurs when the product is injected into the wrong part of the face. With this, hyaluronic acid can stop inside the blood vessels that irrigate the face, where it will cause a blockage that leads to the death of tissues in parts of the nose, lips or even blindness.

“To minimize this risk, it is important to perform this procedure with professionals who have a lot of experience and years of training”, says Salles.

“This is not something you learn in a weekend course. It takes years of study to understand all the anatomical variations of the face and where the veins and arteries are likely to be. And even the most experienced specialists can make mistakes and inject without want the substance inside a vessel.”

To minimize damage, it is possible to use an enzyme called hyaluronidase, which has the function of absorbing hyaluronic acid applied improperly.

But this “antidote” cannot be used in any situation either: there are patients who are allergic to hyaluronidase and develop severe reactions.

In addition to the clogging of arteries and veins, other possible side effects are inflammatory reactions, marked by redness and swelling, and the formation of nodules at the application site.

The good news is that, as the product is absorbed by the body, these problems are usually temporary.

Finally, Salles considers that the excessive application of hyaluronic acid – and the unwanted aesthetic results of this – can also be seen as an adverse event in some situations.

“There are cases in which 10 to 20 milliliters of hyaluronic acid are injected and you see impressive transformations”, he observes.

“But this can affect the movement of the face and the person no longer has a smile or a natural expression. It is necessary to find a balance so that the person feels good and is able to recognize his own face in the mirror.”

– Text originally published here