Dr Hayot’s column

After several congresses around the world and years of experience in aesthetic medicine and surgery, Dr Bernard Hayot gives us his impressions on the use of volumizing hyaluronic acid: A critical analysis and a fresh look at injections of this filling product…

Hyaluronic acid: An alarming fact

“Over the years of practicing aesthetic medicine, I’ve come to realize thathyaluronic acid in dark circles fills hollow circles, but contrary to what aesthetic doctors think, the product does not absorb naturally!

I find patients, after 4, 6, 8 years, who still have the hyaluronic acid I injected years ago. As soon as they come back for a consultation, I realize that the product is visible through the skin and that it has swollen the face, but not reabsorbed!

It was from these observations and recurring manifestations that I began to think that the biodegradable virtues that the major laboratories claim for the hyaluronic acid they market were unverified. I began to understand that this molecule was in fact not completely biodegradable when injected deep into an area of the face that is not very mobile, such as the hollow ring of the eye!

My farewell to hyaluronic acid for dark circles

“When my patients come to my practice to rejuvenate their eyes, I notice that their dark circles, treated with hyaluronic acid injections, look puffy, form bags under the eyes or give a bluish appearance. I have to get rid of it!

For several years now, I’ve been injecting hyaluronidase into dark circles that have been over-injected, incorrectly injected or where the hyaluronic acid has not absorbed as expected. Hyaluronidase is a powerful antidote that removes all the acid from an area of the face. It offers my patients the possibility of going back in time, a little like a corrective “eraser”, which, while not rejuvenating them, avoids the pitfalls of failed aesthetic medicine.

Once I’ve performed hyaluronidase injections, it’s not uncommon for the eyes to look even deeper than before the hyaluronic acid injections. This appearance is often psychologically difficult for patients, who immediately feel aged, wrinkled and tired. So it’s urgent to overcome this resentment as quickly as possible: fat injections are the best answer to their problem!”

Hyaluronic acid to create volume: Caution is advised!

“While it’s true that I’ve found hyaluronic acid to be non-absorbable in dark circles, I’ve also found this to be true in other areas of the face, such as the cheekbones…
When my patients return to my practice 5 years after having undergone their cheekbone volumizing injections, I find that the product is still present and that the volumizing effect, in most cases, has not diminished, or has diminished only slightly.

Sometimes, I tend to believe that the hydrophilic virtue of hyaluronic acid continues to act like a sponge over all these years, and that the volumizing effect is increased tenfold over time. So much so, in fact, that my patients’ cheekbones look even fuller than after the injections.

I then avoid reinjecting my patients to avoid overdosing!
Ultimately, volumizing hyaluronic acid contributes to creating inflated faces and does not offer a natural result, unlike the very discreet result obtained with fat injections.”

Preserving hyaluronic acid to treat expression lines

I’ve always treated my patients’ expression lines with Botox or hyaluronic acid injections! With the right gesture, the right method and the right product, you can achieve a highly satisfactory result, especially in the nasolabial folds and perioral wrinkles.
Hyaluronic acid fills the skin break for a few years, but the product resorbs itself fairly quickly due to the mobility of certain areas of the face and the repetitiveness of the patient’s facial expressions.

Smiling, chewing, talking, eating, drinking and smoking all cause and deepen wrinkles. At the same time, all these actions gradually eliminate the hyaluronic acid that has been injected. In my opinion, it’s safe to inject this product as a powerful anti-wrinkle treatment in these areas of the face, and unpleasant surprises are rare!

Knowing how to keep up with the times and reappraise your profession as a plastic surgeon every day

“Why have I turned away from hyaluronic acid for dark circles in favour of fat injections?
A good surgeon must constantly ask himself the right questions to help his profession evolve and find the right operating techniques, products, gestures and dosages. Understanding how the face ages is not enough to rejuvenate it naturally. You also have to constantly question operating methods, products marketed by laboratories and molecular formulas, and evolve your technique by taking the necessary distance.

Every day, by observing my patients more closely and exchanging their impressions and feelings with them, I refine my technique and push my limits even further to find techniques that will offer them the most natural result possible.
For this reason, I have turned to 3 new fat injection techniques that have gradually led me away from hyaluronic acid:

• Anti-wrinkle fat injections
• Volumizing lipofilling
• Nano lipofilling: the new mesotherapy