Hyaluronic Acid

If you are talking skin hydration, then you have to understand what Hyaluronic acid is and how it works. Hyaluronic Acid or Hyaluronan is a very popular polysaccharide (carbohydrate) in the aesthetics industry and appears in many products both inside and outside of the syringe. 

An acid….like no other

A vague familiarity with topical skin treatments, might lead you to think that because of the suffix ‘acid’, we want this ingredient to exfoliate or peel the skin surface - think glycolic acid or azelaic acid. However, Hyaluronic acid is much more important and innate to normal skin function and structure - and therefore needs special attention so as to respect its value.

Hyaluronic acid (HA) is actually a sugar molecule - a carbohydrate. It is found in synovial joints (think hip and shoulder etc), the vitreous (jelly) of the eye and the umbilical cord - but 50% of total body Hyaluronic acid is found - yes - you have guessed it - in the dermis (in the skin). 

Its ‘party trick’ is being able to hold an enormous amount of water relative to its size (a quarter teaspoon of HA is thought to be be able to hold about 1.5 gallons of water or 1000 x its weight). Its primary function is therefore one of maintaining hydration. It is produced inside specialised cells called fibroblasts and extrudes out into the extracellular space or the ‘matrix of the skin’ where it is responsible for binding and retaining water. A high water content allows skin to provide protection from trauma, to play an active role in thermoregulation (or our temperature control) and provides the smooth, soft and even appearance of our skin in youth. SPOILER ALERT - HA it is yet another thing that declines as we age and with its decline goes the skins ability to hold moisture.

Size Matters

The simplicity of the structure of HA, meant that for years it was considered a relatively benign and uninteresting molecule - however - more recently its signalling abilities (its ability to start or stop other processes) have come to light and it has been re-framed as a real workhorse of the skin. What it does is dependent on multiple factors - the main one being the size of the molecule. Allow me to explain!

HA is categorized by its size - which in science is inferred by its molecular weight (MW). This is, in the interests of simplicity, best considered as Low or High for HA. LMW - HA or HMW-HA.

The mechanical strength of HA increases with its molecular weight and consequently HMW-HA is used for applications that require strong viscoelastic (combination of fluid like movement with the ability to return to original shape) properties and mechanical strength (of note, these characteristics make for an excellent dermal filler).

HMW-HA has also been found to produce anti-inflammatory and immunosuppressive signalling - another virtue when introducing a product into the body.

Low molecular weight HA or smaller molecules are far better at penetrating the skin and getting from skin surface, past epidermis to dermis.

A sub-class called Ultra Low Weight Hyaluronic Acid exists and this is generally avoided in aesthetics as its signalling capabilities are thought to promote inflammation  - something the industry would not want to happen to skin. Further research continues to be made into ULMW-HA as there is definitely more conversation to be had.

Where will I find it?

Knowing that it is a naturally occuring yet declining component of our skin, knowing that it can hydrate and maintain structure and therefore skin health, and knowing that in its high molecular weight form it is a calming influence in the skins extracellular matrix - you wont be surprised to hear that Hyaluronic acid forms the base of multiple different products in the aesthetic industry.

Most of the best dermal fillers are made from hyaluronic acid, injectable ‘beauty boosters’ have their roots in HA and finally an increasing number of serums and ‘dermaceuticals’ have topical HA as either a main or added ingredient. Even better than that - the use of HA is safe and highly effective at what it does! Lets take these products one at a time!

Dermaceuticals (otherwise known as ‘lotions and potions’)

You may not be quite ready to start injectable-based procedures using HA when in pursuit of an improved appearance of ageing skin. So are there any proven benefits of using a serum that contains HA?

A product that contains a HMW -HA will be an excellent surface hydrator. ‘Surface’ because the molcule size is just too big to penetrate down into the dermis. However, studies find that even the prescence of HMW-HA on the surface or sat in the epidermis with produce a notable hydrated appearance. It will also act as an excellent skin protector by forming a good skin surface barrier to bacteria and the like, and can act as a pump to help other ‘actives’ within the serum get down into the dermis where they can work.

A serum containing a LMW - HA will be able to penetrate the skin somewhat deeper and provide hydration at this level - however - the penetration depth will remain somewhat superficial in general terms owing to the fact that even LMW - HA are still relatively big molecules.

From a consumer viewpoint, whilst its nice to understand the level to which different sized HA molecues work - the reality is that you are unlikely to be told this level of detail. Mainly, the product will only tell you if it contains HA or not. You may see this written on the ingredients list as Sodium Hyaluronate - this is the sodium form of HA.

If you want your serum to improve the hydration of your skin, then HA is a fantastic ingredient to look for. Teoxane have spent 20 years researching and developing HA primarily for fillers but have included a topical version of HA in nearly every one of their dermoceutical products. If you would like to know more about these products then please contact me.

Dermal Fillers

This might be where I lose some readers - those who perhaps are nervous about filler as a concept. I encourage everyone - even those who are adamant they don’t want to use filler to read this. Knowledge is power - and demystifying fillers is beneficial for everyone. Remember - you only notice BAD fillers!

If you have got this far, you will probably appreciate why HMW - HA makes a great choice when designing a filler. Its viscoelastic, its strong, its replacing like for like, it attracts water and it is anti-inflammatory.

It is worth noting that the use of HA is also prolific within the medical world outside of aesthetics because of all of these wonderfullly positive charateristics.

HA - a powerful bioactive moecule. A schematic representation of the most important HA applications in the health related sector. Image taken from International Journal of Molecular Science, 2023 Jun 18;24 (12)

The main downside of HA is it very short half-life (or the time it takes to be inactivated/removed)of about 2-4 days. HA is essentially a long stranded molecule susceptible to enzymatic breakdown . By folding it and ‘cross-linking’ it (little bridges between the strands to hold them together), the stability, the durability and the life-span in the body all increase.

For this reason, when we talk about HA fillers we are always referring to cross-linked HA.

HA can be cross-linked using various thinigs - but the gold standard cross-linker is called 1,4 - butanediol diglycidylether or BDDE. As you can imagine, the safety profile, properties, storage requirements and lack of interruption to enzymatic breakdown in emergency mean that this product is an extremely well-developed and well researched one. It has a proven and unrivaled clinical track record of more than 20 years. This is the cross- linker used by Teoxane - the range of dermal fillers used at Dr Rebecca Griffiths - Medical Aesthetics.

Furthermore, as the the client base continues to expand, and the consumer wants a very natural result - it is paramount that any filler used moves with expression. Teoxane realised that this stretch and strength could be achieved by keeping the length of the HA chains as long as possible. Traditionally, to cross link them more easily some filler companies cut them shorter. These unique properties, along with an exemplary safety record are why I choose to use Teoxane dermal fillers in my clinic.

Beauty Boosters

The beauty booster is a relatively new concept - and an increasingly popular treatment option. The basic theory behind a beauty booster is delivering essential nutrients into the skin via a needle that support, encourage or improve the metabolism of the skin and thus improve the skins appearance.

Once again, an appropriate medium to deliver these nutrients owing to its characteristics as a hydrator, an anti-inflammatory and a recognized molecule within the skin is HA. The HA found in a beauty booster is however NOT crosslinked. In this instance, we DO want the product to disperse and intergrate across the surface of the skin in order that the nutrients are delivered throughout the layers. So whilst the common ingredient in a beauty booster and a dermal filler is HA - their mechanism of action is very different owing to the presence or absence of cross-linking.

There are many different brands of beauty booster: Profilo and Sunekos are two of the names doing the rounds on social media currently.

Currently in clinic I use Teoxane Redensity 1 and 2. These contain un-crosslinked hyaluronic acid to provide instant and cumulative skin hydration. Eight amino acids to support cell regeneration, collagen and elastin production, and tissue rebuilding and healing. Three antioxidants: Glutathione, N-acetylcysteine, and alpha lipoic acid protect the skin from damage caused by free radicals, which contribute to aging. The minerals Zinc and Copper: Essential for DNA synthesis, cell multiplication, and the maintenance of skin strength and elasticity. Vitamin B6 which plays and essential role in skin cell metabolism and finally, Lignocaine - to provide a numbing effect to improve comfort through the treatment.

Beauty Boosters are shown to work best where they are ‘loaded’ - for that reason we offer three sessions three weeks apart. Once loaded - a maintenance dose can be given every 6 months. My Beauty Booster clients are delighted with the improvement in their skin quality. The whole face, the peri-oral area, the neck and/or the decolletage can each be targeted independently - improving the skin quality in one area to balance the appearance across the whole face and neck.

If you would like to know more about Beauty Boosters then please reach out to me or better still, come for a free aesthetic consultation.

And so……

Hyaluronic acid is of paramount importance in the aesthetics world and should be an ingredient that you look for and purchase in your dermaceuticals to get a more effective and harder working serum or product and to replenish the hydration of your skin as it ages. It is an extremely well chosen and designed product to introduce back into the skin as either a filler or a beauty booster. It is a molecule to work with!

If you have any questions regarding any of the information given here then please let me know.