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

Abstract

Background: Hyaluronic 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.

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

Methods: A 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.

Results: Twenty-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%).

Conclusion: HA 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.

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Keywords: Aesthetics; Dermal fillers; Effectiveness; Hyaluronic acid; Longevity.