title: The Liquid Lift: Looking Natural Without Lumps.
abstract: BACKGROUND
  Hyaluronic acid (HA) is the most common filler used to rejuvenate. Today, a three-dimensional approach prevails over previous techniques in which this material was used in specific areas of the face such as the nasolabial fold, the marionette line, and the eye trough giving a strange appearance that does not look natural. Even with a volumizing purpose, the injection of HA can sometimes produce clinically detectable nodules or lumps where the filler is deposited.
  
  
  OBJECTIVE
  To develop a new technique of injecting HA that can provide more natural results and avoid the lumpiness and nodular appearance that sometimes occurs with the injection of HA. To detect whether mixing HA with diluted anesthetic agent modifies its behavior.
  
  
  METHODS
  Prospective, case control, single-center study on a private clinic setting.
  
  
  METHODS
  Eighty six patients were enrolled in this study. All of them had a previous treatment with nondiluted HA using a needle at least a year before. Patients were injected with 8 mL of reticulated HA (RHA) mixed with 6 mL of saline and 2 mL of anesthetic agent. The mixture was administered through a cannula inserted in the face, one at mid-cheek and another at frontal-temporal point of entry. Owing to the lifting effect of this mixture we called this procedure liquid lift (LL). Patients were evaluated 1 month, 6 months, and a year later and asked to compare the LL with previous experiences in terms of natural look, pain, and appearance of nodules.
  
  
  METHODS
  Student's t-test.
  
  
  RESULTS
  One month after the treatment, 83 out of 86 patients (96.5%) thought LL produced a more natural look than the previous treatment with the needle. Sixty two (72%) considered LL less painful than the previous treatment and only eight (9.3%) could detect lumps or nodules 1 month after LL was performed compared with 46 (53.5%) that described this problem with previous needle injections. The incidence of bruising was also clearly lower (7% with LL vs 17.4% with traditional needle).
  
  
  CONCLUSIONS
  Injection of diluted HA with saline and anesthetic agents through a cannula all over the face or LL can provide more natural results and less lumps or nodules, and is less painful than traditional treatments involving needle injection of nondiluted HA.
authors.affiliation: Clinica Dermatologica de Barcelona, Barcelona, Spain.
authors.forename: Iñigo
authors.initials: I
authors.lastname: de Felipe
authors.affiliation: Department of Dermatology, Clínica Universitaria, Universidad de Navarra, Pamplona, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Redondo
keywords: Face; filler; hyaluronic acid (HA); lifting; rejuvenation; wrinkles