Hyaluronic acid fillers HA forms an integral part of the natural extracellular matrix which is found in high amounts in several connective tissues including the skin, the vitreous humor of the eye and the synovial fluid (Stern and Maibach, 2008). Chemically, HA is a linear polysaccharide composed of repeating disaccharide units of glucuronic acid and N-acetylglucosamine (Sudha and Rose, 2014). HA is considered to be the most popular dermal filler to replace volume loss due to normal aging for several reasons including: its hygroscopic property, biocompatibility and reversibility. Over the past several decades, various forms of HA fillers have been developed and they differ in many aspects including: the type and degree of crosslinking, gel viscosity, gel hardness, gel consistency, extrusion force, total HA concentration and duration of presence in the skin (Tezel and Fredrickson, 2008). Different FDA HA filler products are shown in (Table 1).
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