Definition & Overview

An average adult has about 15 grams of natural hyaluronic acid (HA) in the body. About a third of this is replaced through natural body processes. It is a major component of the extra-cellular matrix and the articular cartilage. HA is also a chief component of the skin and is actively involved in the repair of damaged tissues. It serves as a network by which essential nutrients are transferred from the bloodstream into the skin cells. It is also found in the vitreous humor of the eye, where it provides cushioning and is a major factor in maintaining the shape of the eyeball.

Hyaluronic acid injections serve two major purposes - first, as a biomedical product used in eye surgery and as a treatment for osteoarthritis, and second, as a cosmetic procedure for anti-aging. Brand names for HA injections include Gel-One, Euflexxa, Juvederm, Hylaform, Puragen, Restylane, Captique, Orthovisc, Monovisc, Hyalgan, and Supartz.

In particular, the benefits of hyaluronic acid injections include:


  • Acts as a cushion to support facial tissues to add more volume and elasticity that have been lost due to aging
  • Adds water to the skin surface to keep it rejuvenated, fresh, and soft
  • Acts as lip filler to make the lip look more supple and full

  • When injected, it serves as a lubricant and cushions the joints to help ease pain caused by arthritis

  • As an ophthalmic surgical aid, it protects easily damaged cells in the eyes during cataract surgery, corneal transplantation, and repair of detached retina
  • Used as a post-operative procedure to hasten healing after a surgical procedure

Who Should Undergo and Expected Results

Anyone who wishes to enjoy the benefits mentioned above can take advantage of hyaluronic acid injections. Since the HA used is chemically identical to that of naturally present in humans (also among other species), there are hardly any harmful side effects. As a cosmetic procedure, hyaluronic acid therapy is usually administered on those who wish to improve their appearance, specifically to correct one or several of these problems:

  • Frown lines and worry lines running between the eyebrows and through the forehead
  • Marionette lines at the corners of the mouth
  • Crow's feet at the corner of the eyes
  • Unwanted cheek depressions
  • Acneand facial scars
  • Deep smile lines running laterally from the side of the nose to the mouth corners
    HA injections work instantly in temporarily correcting these problems. However, it is important to note that HA implantation does not have a permanent effect. Just like the hyaluronic acid naturally produced in the body, injected HA can gradually break down and get absorbed by the body. Effects of HA therapy usually last about 3 to up to 9 months. To maintain optimum results, repeated treatments will be necessary.

How is the Procedure Performed?

Hyaluronic acid injections are performed by trained doctors, supervised nurses or experienced skin care specialists. The treatment is done on an outpatient basis and lasts less than an hour.

The patient's face is first cleaned and dried thoroughly, and a local topical antiseptic is wiped onto the target treatment area. A local anesthetic can also be applied to minimise discomfort during the procedure. Once in effect, the hyaluronic acid is injected using any of these two methods:

  • Serial intra-dermal puncture, where a series of minute injections are administered using a very small needle
  • Tunnel or threading technique, where the injection is done into the deep dermis (subcutaneous space) and the needle is withdrawn as the hyaluronic acid is injected
    Depending on the treatment area, a massage may be performed to minimise pain or discomfort, and ensure the proper absorption of the hyaluronic acid.

Whether injected in the face or joint, a similar procedure is performed. As a treatment for arthritis, a series of shots is made about one week apart to complete a cycle of three or four injections.

Possible Risks and Complications

As mentioned earlier, hyaluronic acid therapy is usually well tolerated across all ages. During the treatment, light and minor discomfort may be felt, mostly due to the injection itself. There may be redness, swelling, and tenderness in the injected area, which normally go away after a few hours or a few days without treatment.

The worst complication ever reported is an allergic reaction. When allergy ensues, there are red, thickened or raised nodules that arise from the injected site that may persist for a few weeks. In this regard, many skin specialists may require skin allergy test depending on individual circumstance before HA therapy.

As a treatment for joint problems, strenuous activities such as jogging, tennis, soccer, and heavy lifting have to be avoided. Patients are closely monitored for progress and symptoms to determine if the medication is working properly.


  • H. Ralph Schumacher Jr., MD, professor of medicine, University of Pennsylvania Medical School; editor in chief, Journal of Clinical Rheumatology.

  • American Academy of Family Physicians Family Doctor: "Osteoarthritis of the Knee: Hyaluronic Acid Injections."

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