Hyaluronic Acid: Benefits in the Skin, in Skin Care or in Injections

• In the skin: hyaluronic acid is a substance naturally present in the skin; it retains water and contributes to skin hydration.
• In skin care: a moisturizer can make some fine lines less noticeable by retaining water in the skin; hyaluronic acid serums do not all have the same effect.
• As an injection: filler targets contours and volume, while injectable skin hydration aims to hydrate the skin; neither replaces a skin care product applied to the surface.
• As a supplement: a lasting benefit for your skin has not been established; taking a supplement does not replace topical skin care or an injection.
• The risk to be aware of: an injection is a medical procedure; unusual pain, a change in vision or white, grey or blue skin near the injection site requires immediate care.

You want to hydrate your skin, and you find the same ingredient listed on a cream, a serum and a supplement, and in an injection. Yet their benefits for the skin and face are not the same. Hyaluronic acid is already present in your skin; applying it, swallowing it and injecting it are different uses. Before choosing, start with what you want to change: hydration, the appearance of some fine lines or a lack of volume. You can also decide to do nothing.

Hyaluronic acid is a long chain of sugars naturally present in the tissues of the skin. It is a biological substance, not the name of a single treatment. Three things share this name without being interchangeable: the natural substance in your skin, the ingredient in a cosmetic product and the gel prepared for injection.

In water, hyaluronic acid chains hold a large volume of liquid and give it a thick, gel-like consistency. In the skin, the water bound to this substance contributes to the hydration of the dermis and of the living part of the epidermis, below the surface. The skin also has to retain this water: a layer of the epidermis, called the granular layer, contributes to this barrier. Hyaluronic acid therefore does not maintain hydration on its own.

Its ability to retain water explains its role in hydration. This is not enough to predict a visible change from a product, or to establish that a serum reaches the layers where the natural substance is found.

A moisturizer retains water in the skin. Some fine lines may then be less visible and the complexion may look brighter. Hyaluronic acid serums do not all have the same effect, however: their formulation matters, not only the name of the ingredient.

A serum can improve hydration and the appearance of some fine lines. With sun protection, these changes can appear within a few weeks, but not every serum produces them, and they are not necessarily due to hyaluronic acid alone.

Topical skin care can change the appearance of the skin; it does not add volume to the tissues, which is the purpose of a filler. Hydrating the skin is therefore not a sure way to erase a wrinkle, nor a treatment for a skin disease.

Hyaluronic acid chains are not all the same size. This size can affect how they pass through the outer layer of the skin. For certain sizes and formulations, shorter chains can pass through it, unlike longer ones. Whether they pass through depends on the conditions of application; not all small chains necessarily pass through your skin in the same way.

Molecular weight refers to this size. It is not a sufficient basis for choosing a serum: penetrating the skin does not establish that a product is effective, and does not give it the effect of an injection.

A dermal filler is an injectable implant: a gel placed in or under the skin to give the face a smoother or fuller appearance. It aims to change the contours or volume where it is placed. If what bothers you is a hollow or a lack of volume, that is what a hyaluronic acid injection targets, rather than a moisturizer applied to the surface. Getting a dermal filler is a medical procedure, not cosmetic skin care.

Injectable skin hydration is a different injection, also called a skin booster. In this case, hyaluronic acid is injected into the dermis, below the surface of the skin, with the goal of hydration rather than volume. It is not meant to fill a hollow. An improvement in hydration is possible, but it depends on the formulation and the injection technique; more elastic skin is not an established effect. The result varies from person to person, with no guarantee.

Some fillers are gradually absorbed by the body: to maintain the effect, the injection may need to be repeated. How long it lasts depends on the material, where it is injected, the tissues and the amount of gel. During the assessment, ask what effect to expect from the proposed filler, how long it can last and what maintenance to consider. This duration does not automatically apply to injectable skin hydration; a complication, however, can last beyond the intended effect.

The injector’s training and experience matter. At CARE MD, in Sainte-Thérèse, on Montreal’s North Shore, hyaluronic acid injections are performed by a doctor or by a nurse injector supervised by a doctor; the backgrounds of our professionals help you prepare your questions about their experience.

Any filler can cause temporary effects, lasting effects, or both. Swelling and bruising are among the common reactions: they appear shortly after the injection and often go away within a few days or weeks. Other hyaluronic acid side effects can appear weeks, months or even years later; not all reactions are immediate or short-lived.

The most serious risk is unintentional injection of the gel into a blood vessel. The vessel becomes blocked and the tissues receive less blood. This risk is unlikely, but its consequences can be serious and permanent: tissue death, called necrosis, vision problems up to and including blindness, or stroke.

After applying a serum, things are different: if your skin stings, burns or turns red, stop using the product, gently rinse it off with water and ask for advice before using it again. If the reaction is strong or does not settle down, seek medical advice. The fact that hyaluronic acid is naturally present in the skin does not guarantee that a product will suit you.

Swallowing hyaluronic acid is yet another route. A supplement is no substitute for topical skin care or an injection, and the natural presence of the substance in the skin does not tell you what a supplement will do for you. A lasting benefit for your skin has not been established: a change in hydration over a few weeks is not enough to predict a benefit in the long term or for everyone. Nor should you expect a visible change simply because hydration varies.

If you take a supplement, mention it during the assessment, as you would your vitamins and natural health products.

Rather than starting from the name of the ingredient, start from what you want to change. If you are looking for better-hydrated skin, topical skin care targets hydration and the appearance of the skin; injectable skin hydration is another route, with a different technique and different risks. If contours or volume are what bother you, filler serves a different purpose. None of these goals automatically requires an injection.

Before a consultation, think about what you expect and what you are worried about. Write down your medical history, your allergies and any cosmetic treatments you have already had, including other injections and implants. Also mention everything you take: prescription and non-prescription medications, vitamins, minerals and herbal products.

• What change can this treatment make, and what change can it not make?
• What are the limitations and risks in your situation?
• What training and experience does the injector have?
• Would another approach be better suited to your concern?

An examination may show that a filler is not the most appropriate option and that another approach would suit you better. You can take your time to decide, or decide against it if you are not entirely comfortable.