Volumetric Study Shows Objective Effects of Hyaluronic Acid Filler Injections
Objective measures reflect patient-reported outcomes, reports Plastic and Reconstructive Surgery

Initial and follow-up 3D digital scans provide new insights into the effects of hyaluronic acid (HA) fillers in restoring facial volume and fullness, reports a study in the October issue of Plastic and Reconstructive Surgery®, the official medical journal of the American Society of Plastic Surgeons (ASPS). The journal is published in the Lippincott portfolio by Wolters Kluwer.

"Our study combines objective measurements of volumetric effects with patient satisfaction and other subjective outcomes to provide a deeper understanding of the immediate and long-term course of improvement after treatment with HA fillers," comments senior author and ASPS Member Surgeon Ivona Percec, MD, PhD, of the University of Pennsylvania, Philadelphia.

Facial volumes after HA filler injection: Immediate and follow-up measurements

Injectable dermal fillers are widely used for patients seeking a more youthful appearance, reducing facial lines and wrinkles and restoring aging-related loss of tissue volume. Hyaluronic acid products are the most popular fillers, with more than 5.3 million procedures performed in 2024, according to ASPS statistics.

Although studies have shown good improvement with HA fillers, there are limited data on long-term changes in facial volume or patient perceptions of treatment results. To address these gaps, Dr. Percec and colleagues evaluated objective and subjective outcomes of HA filler injection.

The researchers used advanced three-dimensional scanning technology (Vectra M3 imaging system) to measure immediate and long-term changes in tissue volumes. In addition, a wide range of patient-reported outcomes – including facial appearance and quality of life – were evaluated using the validated FACE-Q questionnaire.

The study included 101 women, aged 40 to 65 years, undergoing HA filler injections for facial rejuvenation. Three formulations of HA filler were used in different areas of the face. The 3D scans were performed immediately before and after treatment and at two to 12 weeks' follow-up to assess volumetric effects (increases in tissue volume) in eight areas of the face.

'HA fillers achieve patient satisfaction a minimum of 12 weeks following treatment'

Based on a measure called tissue displacement factor (TDF), the scans showed an immediate increase in facial volume after HA filler injection, ranging from 125% to 56%. These effects lessened as initial swelling and inflammation resolved. By two weeks, the effective volume (EV) was about 90% for HA injections in the lower and middle face and 70% in the lips.

At 12 weeks, volume maintenance was about 66% in the whole face, ranging from 79% in the midface, including the cheeks, to 63% in the upper perioral region, including the "marionette lines" between the nose and lips, and 37% in the lips.

Corresponding FACE-Q responses showed meaningful improvements in patient-reported outcomes. In addition to subjective improvements in overall appearance and in the specific facial areas treated, patients reported gains in psychological and social functioning.

Volume maintenance was affected by factors including age, history of smoking, and body mass index. "These and other patient-specific variables contribute significantly to outcomes of HA gel injections, requiring individual assessment." Dr. Percec notes.

The objective measurements provide new information on the immediate and long-term volumetric effects of HA filler injection. The two-week follow-up results seem to reflect "the final effective clinical volume," according to the authors. The differences between facial regions likely reflect the greater volume loss in areas with "greater animation," particularly the lips, as well as the physical properties of the smaller-particle HA filler product designed for use in the lips.

The FACE-Q data on patient-reported outcomes add to previous studies showing "HA fillers' capacity to achieve patient satisfaction a minimum of 12 weeks following treatment," Dr. Percec and coauthors conclude. They believe the objective data on volumetric effects – particularly the TDF and EV, reflecting initial and final changes in facial volumes – "should be consistently applied during treatment selection and patient counseling to optimize clinical outcomes and expectations."

Plastic and Reconstructive Surgery® is published by Wolters Kluwer.

Click here to read "A Large Prospective Volumetric and Patient-Reported Outcome Analysis of Hyaluronic Acid Facial Fillers"

Article: "A Large Prospective Volumetric and Patient-Reported Outcome Analysis of Hyaluronic Acid Facial Fillers" (doi: 10.1097/PRS.0000000000012135)