title: Reconstituted injectable hyaluronic acid: expanded applications in facial aesthetics and additional thoughts on the mechanism of action in cosmetic medicine.
abstract: BACKGROUND
  As we currently have a better understanding of the components of facial aging, injectable filling agents have a larger role in nonsurgical facial rejuvenation. Many products are now available worldwide as options for treating the spectrum of indications that include particular agents used for the treatment of various facial rhytides and in larger quantities for regional or panfacial volumization. The latter indication has been most popularly treated with a host of agents classified as hyaluronans or injectable hyaluronic acid gels. The former had been traditionally and more successfully treated with injectable collagen or dermal matrix agents. Attempts to confuse these generalized approaches have often led to unsatisfactory results. With the precipitous disappearance of the availability of most injectable collagen substances, other methods of treating finer facial rhytides have been explored.
  
  
  METHODS
  Of the many options available for the treatment of facial fine lines, the authors describe a novel technique of formulating reduced concentrations of existing hyaluronic acid gels by variable dilution/reconstitution.
  
  
  RESULTS
  Over 350 of the authors' collective patients have been treated with this approach. The results have been highly satisfactory, with greater persistence, and have challenged traditional concepts of mechanism of action and biodegradation and suggest alternative options in formulations of currently available products.
  
  
  CONCLUSIONS
  Reconstituted injectable hyaluronic acid is a highly effective and viable alternative for the aesthetic treatment of facial fine lines and other components of aging. Observations, treatment guidelines, and a rationale for this novel use and concepts to explain these finding are contained in this article.
authors: Boca Raton, Fla.; and Milan, Italy From private practice.
authors: Steven
authors: S
authors: Fagien
authors: Daniel
authors: D
authors: Cassuto
mesh_terms: D003357:Cosmetic Techniques; D004954:Esthetics; D005145:Face; D005260:Female; D006801:Humans; D006820:Hyaluronic Acid / Q000008:administration & dosage*; D007267:Injections; D017060:Patient Satisfaction; D015595:Skin Aging; D055675:Viscosupplements / Q000008:administration & dosage*
chemical_list: D055675:Viscosupplements; D006820:Hyaluronic Acid