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Objectives: To understand that there is a disconnect between rheology of fillers and their behaviour in biological tissue.
Elastic modulus (G') and swelling/cohesion are at present the best parameters we have to characterise product performance.
Rheology of fillers along with deep understanding of individual anatomy will help to optimize aesthetic outcomes.

Introduction: Injectable hyaluronic acid fillers are routinely used for correction of soft-tissue volume loss and facial rejuvenation. Product differentiation has primarily been based on the rheologic parameters, the most widely recognised and used is the elastic modulus (G′), although other physicochemical properties like swelling and cohesion are being explored to characterize potential product performance. The author explores the advantages and disadvantages of using such rheological parameters which were based on the usage of petrochemicals in the automotive industry.

Conclusion: A discussion on the different hyaluronic acid technologies allows for the appropriate selection of products. Knowledge of the rheological properties of a gel, combined with proper selection of injection techniques and patient’s individual anatomy (skin quality, degree of correction, injection depth, and anatomical location) will help customize injection plans and contribute to an optimal aesthetic outcome.

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Objectives: Understand the key characteristics of a crosslinked HA filler gel driving safety and performance.

Introduction: HA fillers are the most successful and most described fillers. There are numerous brands on the market and to differentiate products, scientific publication or companies’ promotion give a strong focus on rheological properties of the crosslinked HA gels. This focus can lead to very technical concepts and product characteristics far from the expectation and needs of clinical practitioners.

Conclusion: In your clinical practice, rheology should not be seen as a stand-alone characteristic; it is intertwined with the other key characteristics of the crosslinked HA gel. Other key characteristics of an HA fillers are relevant to safety and performance: concentration, cohesivity/hydrophily, purity, gel particles size, and also the device. Those characteristics will drive what you can expect as clinical performance of a filler. Some will also play a key role with regards to hyaluronidase digestion and this is of particular importance when considering situation with accidental vascular occlusions.

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Objectives: The modulation of muscular activity after injections of hyaluronic acid has often been observed. One can define myomodulation as the regulation of muscular activity, the dynamic of the muscle, either by stimulation or through a pacifying effect.

Introduction: Long recognised as a product for volumising, it is clear that hyaluronic acid has an additional benefit: myomodulation. Over the last ten years, the author has spoken about it as well as presented and published their findings, on multiple occasions, at various conferences and symposia.

Materials / method: Injections of hyaluronic acid, a routine treatment in aesthetic medical practices, have been used for beautification, rejuvenation, and restoration in different areas of the face.

Results: Stimulation effect is observed in the midface due to Myotatic reflex of Orbicularis Oculi when injection is in the soof with mild elongation of the muscle. Pacifying effect when the hyaluronic acid is into or around the muscle with penetration of the gel Inside. So the gel calms down the tone at rest and the dynamic of the muscle.

Conclusion: Long recognised as a product for volumising, it is clear that hyaluronic acid has an additional benefit: myomodulation. So Hyaluronic acid and Botulinum toxin can interact in many areas ... "Et, ils n'ont pas livré tous leurs secrets"

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