Application of Hyaluronic Acid in Reconstructive Surgery

Over the past two decades, HA has become the most extensively used material in plastic surgery, ophthalmology and orthopaedics. The use of HA in reconstructive surgery, as a dermal filler, dressing, or cream, centres on the restoration of soft tissue defects, and the treatment of wounds and burns. Typically, these defects are secondary to surgical or physical trauma, especially in subtractive surgeries, such as tumour removal. HA is used as a filler due to its ability not only to restore the lost volume, but to also improve the quality of the skin, namely its elasticity, plasticity and hydration. 

Skin exposure to excessive heat, chemicals, radiation, electric current, or even mechanical friction results in hums and skin lysis due to damage to the underlying tissues. The severity of the hum depends 

Facial characteristics are defined by the skin, muscles and bones. Over the years, the face loses its youthful appearance. Body weight, hormonal changes, ultraviolet radiation, smoking, and gravity lead to the appearance of depressions and wrinkles. In addition, the loss of the skin s elasticity becomes apparent after the age of 30. Areas of the face most affected are the periorbital, malar, forehead, temporal, glabellar, mandibular, mental and perioral zones [14-16]. 

HA injections can restore the natural and youthful appearance of the skin. This minimally invasive procedure restores tissue volume, reduces wrinkles, and fills the depressed areas by local absorption. The use of HA as a skin filler became popular in the mid-1980s and, according to the AS APS, it is considered to be the fastest growing, non-invasive, procedure in the United States [17]. Filler HA is a viscous, transparent gel, which can be injected through a small gauge (G) needle, typically of 23-27 G. It provides increased volume and skin hydration due to its hydrophilic nature. Deep wrinkles require a high concentration of HA (approximately 25 mg/ml), while shallow wrinkles are typically treated with a lower concentration (5 mg/ml). HA filler lasts approximately 

8-16 months in the skin, depending on the age, the type of skin, the muscle activity of the underlying tissue, the depth of the injection, and the density of the material. 

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