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ASLS Guidebook for Aesthetic Medicine Practitioner

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ADSC expresses the well-known HA receptor CD44. It has been proven that almost exclusively the proliferation of pre-adipocytes in the body occurs in the CD44+ subpopulation. When high molecular weight HA is added to ADSC culture medium from outside, the proliferation and differentiation ability of ADSCs are improved. The HA-CD44 interaction has been proven to be involved in the chondrogenic differentiation of ADSC induced by HA. Furthermore, it has been proven that HA directly affects the development of adipocytes in vitro and in vivo. HA scaffold acts as a stable carrier for ADSCs. The volume lost due to the biodegradation of HA is compensated for by mature adipocytes. In addition, ADSCs in HA scaffold stimulate angiogenesis and reduce the apoptosis of adipocytes. Finally, cross-linked HA provides more sustainable results, which can induce better support for ADSCs, as well as resistance to enzymatic degradation, resulting in longer-lasting volumizing effects. Most hyaluronic acid fillers can be used for hydration injection. However, it is important to choose the right hyaluronic acid for the purpose of the procedure. Non-cross-linked hyaluronic acid has less volumizing effect and shorter duration than cross-linked hyaluronic acid. The persistence of hyaluronic acid depends on the degree of cross-linking, injection technique, injection site, and composition of hyaluronic acid. Therefore, products with higher hyaluronic acid concentration or larger particles provide more volumizing effect and longer duration. Products with lower hyaluronic acid concentration or smaller particles have the opposite effect. However, products with lower hyaluronic acid concentration or smaller particles, as well as non-cross-linked products, diffuse well into the peripheral tissue and cause less uneven skin surface after the procedure. Therefore, they are suitable for providing moisture supply to thin and dry skin around the eyes. On the other hand, cross-linked hyaluronic acid is useful in areas other than the eyes due to its volumizing effect and longer-lasting persistence.

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