Clinical Durability of Hyaluronic Acid-Based Dermal Fillers for Facial Application: A Systematic Review.

backgroundHyaluronic acid (HA) fillers are widely regarded as safe and effective for soft tissue augmentation, including correction of nasolabial folds, wrinkles, lips, and facial contouring. Despite favorable clinical outcomes, long-term durability remains under investigation.

objectiveTo systematically review the effects of facial HA fillers on durability, patient satisfaction, and adverse events, providing a comprehensive overview for clinical and aesthetic practice.

methodsA systematic search was conducted in Virtual Health Library (BVS), Embase, PubMed, Web of Science, and Scopus for clinical and observational studies, case reports, and series reporting quantitative data with ≥12 months follow-up. Studies included patients treated with various HA formulations and focused on filler longevity, subjective satisfaction, and adverse effects.

resultsTwenty-four studies from 13 countries including 1,410 patients (81.8% female, 21-76 years) were analyzed. Nineteen HA brands were reported, with Restylane most frequent (21.1%). 3D volumetric assessments (64%) showed HA persistence of 50-86% at 24 months and 60-86.4% at 12 months, with one study reporting 6-9 months. Ultrasound (20%) indicated 12-36 months persistence; MRI (8%) and profilometry (4%) reported presence up to 12 months. Patient-reported satisfaction, measured via subjective scales, aligned with objective findings, declining alongside quantitative HA volume over time. Adverse effects were evaluated, with the majority immediate (72.6%) and long-term events rare (4.8%).

conclusionHA filler longevity is influenced by manufacturing technology, tissue mobility, and anatomical factors. All technologies demonstrated good durability, though Vycross was associated with more long-term adverse events. Subjective satisfaction mirrored objective persistence, emphasizing the clinical relevance of both assessments. Individualized product selection remains essential to achieve safe, predictable, and satisfactory outcomes. LEVEL OF EVIDENCE I: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .