[Paradigm shift in understanding hyaluronic acid filler effects]

Hyaluronic acid (hyaluron; HA) is an important constituent of the extracellular matrix and has an age-dependent decrease in tissue concentration. While natural HA is rapidly degraded, filler cross-linked HA achieve a half-life of 6-12 months. Such fillers enjoy increasing popularity in esthetic medicine and are versatile tools. Although HA fillers can activate fibroblasts it is of minor importance for long-term results. Fillers are injected into subcutaneous adipose tissue. Their interaction with somatic stem cells and mature adipocytes has gained increasing interest. Cross-linked HA can indeed support proliferation of pre-adipocytes, stimulate their differentiation into mature adipocytes and protect the mature cells from senescence, apoptosis and lipolysis. This view offers a new perspective on the development of future fillers for esthetic medicine.