by Dr Shuyan (RJ CLINIC)
Hyaluronic acid (HA) has been a very popular ingredient used in the cosmetic industry for many years, and for good reason. Many skin care products in the market contain hyaluronic acid, and being advertised as a holy grail that can moisture and plump up your skin. The use of hyaluronic acid is not only limited to the cosmetic industry, but also used in fillers, skin boosters in aesthetic field, and in orthopedics to treat patients with osteoarthritis or rheumatoid arthritis.
(Of course, for therapeutic purposes in orthopedic, HA is not used for the skin. In individuals with osteoarthritis or rheumatoid arthritis, the synovial fluid can become thin and lose its ability to lubricate and cushion the joints. Injection of HA into the affected joint can help to increase viscosity and elasticity of the synovial fluid, improving its ability to cushion and lubricate the joint. This in turn leads to reduced pain, improved mobility, and a decrease in inflammation in individual with osteoarthritis or rheumatoid arthritis.)
What is hyaluronic acid (HA)?
HA is a naturally occurring substance that can be found in various tissue throughout the body, and richest in the skin, joints, vitreous body of the eyes and umbilical cord. For skin, its primary function is to retain moisture and keep the skin hydrated.
HA is highly soluble, and can hold up to one thousand times its weight in water molecules. The cosmetic and aesthetic industries utilize these properties of HA and incorporate HA into products like serums, moisturisers, masks, skin boosters and dermal fillers with some modifications.
Why do we need HA?
Let’s bust a myth before we talk about why we need HA.
Myth: Sebum prevents skin dryness.
Wrong! Dryness is due to decreased amount of natural moisturizing factors, glycosaminoglycan and impaired skin barrier causing water loss. HA is a glycosaminoglycan, hence its production is directly linked to skin hydration.
As we age, the production of key substances in our skin starts to decline, including HA, collagen and elastin. As a result, our skin become dry, lax and loses volume. Thanks to the advancement in technology, we have solutions to this problem. When it comes to achieving a youthful, refreshed appearance, skin boosters and dermal fillers are two popular options.
High molecular weight VS low molecular weight HA
Low molecular weight HA simply means a form of hyaluronic acid that has a smaller molecular size compared to high molecular weight HA. The smaller size allows it to penetrate deeper into the skin, which makes it more effective for certain skin care benefits. Some studies have suggested that low molecular weight HA promotes production of inflammatory mediators whereas high molecular weight HA inhibits production of pro-inflammatory mediators. In other words, there is possibility of causing inflammation with the use of low molecular weight HA. In some cases, people may experience skin irritation or redness after using skin care products or treatments that contain low molecular weight HA. However, these side effects are generally considered to be mild and temporary. It is also important to keep in mind that not everyone will react the same to it and that individual skin tolerance can vary.
High molecular weight HA has a larger molecular size with low skin permeability, meaning that it has difficulty penetrating the top layer of our skin. As a result, it only moisturizes the skin surface and acts more as a barrier to prevent moisture loss, rather than providing deep hydration.
Now that we have discussed about high molecular weight and low molecular weight HA, let’s move on to crosslinked and non-crosslinked HA.
In natural state, HA can break down rapidly, which is not suitable to be used for certain circumstances. In order to overcome this problem, they must be chemically engineered to create thicker gel in contrast to the usual liquid form. This can be achieved by crosslinking of polymer chains with chemical such as 1,4-BDDE. The more links created, the firmer the HA molecules and the more difficult it is to be broken down.
Both skin booster and dermal filler contain hyaluronic acid, but what makes the difference?
You may know about skin booster by “injection that gives you glowing or glass skin”. It has been around for a long time now but getting more popular because of the influence by KPOP and K dramas where all the Korean celebrities appear to have flawless, glass skin. If you are aiming for similar effect like them, skin booster is one of the treatments that you should try!
So, what is skin booster actually? It is a treatment designed to hydrate the skin from within, in which the primary ingredient is hyaluronic acid. Skin booster is typically delivered via a series of injections directly into your skin. Since it is made of non-crosslinked HA that does not stay at the site of injection but spread within your skin, its main function is to provide moisture but not volume.
On the contrary, dermal filler is injectable treatment that is designed to add volume to specific areas of the face. For example, to enhance the lips, cheekbones, jawline, fill up sunken areas caused by aging, or to reduce the appearance of fine lines and wrinkles. Dermal filler is able to achieve these because of the crosslinked HA that is firm enough to do so. But, not to say that all crosslinked HA dermal fillers are of the same, as there is a remarkable selection of fillers with unique properties in terms of particle size, degree of cross-linkage and concentration depending on the manufacturing methods. The choice of fillers will be made based on the treatment areas and the desired effect.
Effect of HA dermal fillers can also be seen immediately after the treatment, which makes them a great option if you have upcoming events and you want to look good. Result of HA fillers is also long-lasting for up to one to one and a half years, depending on the type of filler used, the area being treated, your skin type, skin condition, lifestyle and age. The effect is also reversible by hyaluronidase, which is an enzyme that breaks down hyaluronic acid into water and carbon dioxide.
In our clinic, we offer Belotero HA filler, which is a trusted brand manufactured by Merz Aesthetics. The range has won numerous industry awards a decade later and has expanded to include a series of options. Belotero range offers a choice of options specifically formulated to provide best possible effect depending on the treatment areas, including Belotero Volume, Belotero Balance, and Belotero Intense.
Of course, there are many more dermal fillers made of materials other than hyaluronic acid, for instance, Radiesse (calcium hydroxylapetite), Ellanse (polycaprolactone), Sculptra (PLLA), each with their own efficacy and safety profiles.
Radiesse is one of our favourite treatments, as it has the ability to help your body produce collagen and elastin naturally, which are the two important components that help keep facial lines and wrinkles at bay. As previously mentioned, these key substances decline as we age, and sun damage makes it harder for our body to produce them. Calcium hydroxylapatite, or CaHA, is what makes Radiesse unique as an injectable aesthetic treatment. Upon injection of Radiesse, CaHA particles integrate into your skin and create a “scaffold” that stimulates collagen and elastin. After a time, the CaHA microspheres are absorbed into your body and collagen continues to build in the skin for as long as two years.
There are many types of skin boosters available in the market. Every advertisement is so attractive that you are tempted to try but at the same time confused on which type is suitable for you.
Don’t worry, I’ve got you covered! Here, I have listed the types of skin boosters that we offer and given some brief explanations about them:
Profhilo is made of 100% pure hyaluronic acid, including high and low molecular weight HA. It uses patented thermal process NAHYCO Hybrid Technology which changes character and behavior of hyaluronic acid resulting in formation of co-operative hybrid complexes (HCC) which modulates the tissues. It is biocompatible and does not contain chemicals that are used as cross-linking agents such as BDDE. HCC reduce the degradation of high molecular weight HA, and low molecular weight HA is slowly released from HCC, thus has less risk of inflammation.
It is a powerful biostimulator and the only skin booster in the market that helps to stimulate all four types of collagen, elastin and fat stem cells that were lost through skin aging. With this, there will be improvement of skin laxity, fine lines, and skin hydration, tightening and lifting effect. Therefore, some do not consider Profhilo as a skin booster due to its lifting effect on tissues. Profhilo is one of the least painful procedures as it only needs 5 points of injection into each side of your face, which is known as BAP injection technique designed to avoid blood vessels and evenly distributes the product.
Typically, two to three sessions of treatment are recommended, spaced one month apart. Cycle can then be repeated every 6 months as needed to maintain the results.
As mentioned previously, non-crosslinked hyaluronic acid cannot last long under the skin, hence glowing result may only last less than a month. So, in addition to non-crosslinked hyaluronic acid, Belotero Revive included another ingredient known as Glycerol, which stays longer under the skin. Glycerol is mainly responsible for attracting and retaining water molecules, strengthening the hyaluronic acid matrix through hydrogen bonding and enhancing the potency of HA in promoting skin hydration. This results in glowing skin for up to 8 months after completing 3 treatments. Glycerol is also known to have anti-inflammatory and antioxidant properties.
Belotero Revive helps to improve skin elasticity, hydration, treat signs of aging like fine lines and sun damage such as uneven skin pigmentation and texture. It is suitable for people of all skin types and ages, and is particularly effective for those with dry, dehydrated, or aging skin.
Dermaheal skin booster contains non-crosslinked hyaluronic acid along with other natural ingredients such as amino acids that promote fibroblast formation, vitamins that provide additional nourishment to the skin, a complex of biomimetic peptides that restores skin’s vitality and minerals to support skin’s natural processes, improving skin’s ability to repair and regenerate itself. When injected into skin, Dermaheal Skin Booster results in brighter and more youthful-looking complexion, reduction of acne and enlarged pores and increased skin elasticity. Procedure involves injection of multiple small boluses over the whole face superficially into your skin. Numb cream will be applied first to ensure comfort during procedure and treatment with Dermaheal HSR can be repeated monthly to maintain the good result.
Skin booster is the type of treatment that gives subtle, smooth changes that occur continuously over time. So, it is an ideal choice for people who want to improve their skin’s appearance without drastic volume changes. Add this to your bucket list and you will no longer need to edit your photos because of your tired looking skin!
How about HA in skin care products?
If you read this post carefully, you should already have an answer to this.
When it comes to choosing a skin care product, look at the type of HA in the ingredient list. As mentioned previously, larger HA molecules cannot penetrate into skin despite being able to bind water better, whereas smaller HA molecule can penetrate deeper, but binds less water. So, for maximum effect, consider products that contain variety of HA sizes. However, not to forget that due to the proinflammatory properties of low molecular weight HA, there is tendency to cause skin redness. It is also undeniable that topical HA will never be as effective as injectable HA.
Now that you know the importance of HA, let’s talk about how to prevent the loss of HA. Hyaluronidase is an enzyme that breaks down HA. It can be activated by reactive oxygen species (ROS), which are the byproducts of cellular metabolism and generated from sources including pollution, cigarette smoke, radiation and UV rays. In other words, UV rays, pollution, smoking and radiation are factors that you should avoid in order to preserve healthy looking skin. Although it is impossible to completely avoid UV rays from sunlight, you can wear protective clothing or apply sunscreen to protect yourself from excessive sun exposure.
As solar UV rays and our body’s own metabolic pathways create ROS, constantly depleting our available antioxidants, supplementation becomes essential to replenish our body’s supply of antioxidants. Few examples of antioxidants include Vitamin C, Vitamin E, beta-carotene, curcumin, niacinamide, ubiquinone and grape seed extract. Antioxidants can be found in food, or in the form of supplement and topical skin care products.
In conclusion, HA is a naturally occurring substance that functions as a powerful hydrator, but due to external and internal factors that degrade HA, homo sapiens, who have been acknowledged as the most intelligent species on the planet have incorporated this brilliant substance into products like skin care, dermal fillers and skin boosters to benefit the skin, and HA gel injection into joints for orthopaedic use. With these, eventhough reversing the number of our age is impossible, at least we can slow down and reverse the signs of aging. Also, not to forget that on top of the availability of these luxury, it is our role and responsibility to practice healthy lifestyle to “protect” our HA.