Key importance of compression properties in the biophysical characteristics of hyaluronic acid soft-tissue fillers.

Hyaluronic acid (HA) soft-tissue fillers are the most popular degradable injectable products used for correcting skin depressions and restoring facial volume loss. From a rheological perspective, HA fillers are commonly characterised through their viscoelastic properties under shear-stress. However, despite the continuous mechanical pressure that the skin applies on the fillers, compression properties in static and dynamic modes are rarely considered. In this article, three different rheological tests (shear-stress test and compression tests in static and dynamic mode) were carried out on nine CE-marked cross-linked HA fillers. Corresponding shear-stress (G', tanδ) and compression (E', tanδc, normal force FN) parameters were measured. We show here that the tested products behave differently under shear-stress and under compression even though they are used for the same indications. G' showed the expected influence on the tissue volumising capacity, and the same influence was also observed for the compression parameters E'. In conclusion, HA soft-tissue fillers exhibit widely different biophysical characteristics and many variables contribute to their overall performance. The elastic modulus G' is not the only critical parameter to consider amongst the rheological properties: the compression parameters E' and FN also provide key information, which should be taken into account for a better prediction of clinical outcomes, especially for predicting the volumising capacity and probably the ability to stimulate collagen production by fibroblasts.