Hyaluronic Acid Filler Type Comparison: A Guide to Choosing by Firmness, Product, and Treatment Area
Are you troubled by wrinkles that deepen every time you look in the mirror, a blurred jawline, or a nose bridge that could use more definition?
In fact, most people choose hyaluronic acid fillers somewhat arbitrarily. And that choice makes a difference in the final result.
By the time you finish reading this article, you will no longer hesitate even when product names come up during your consultation.
- The science behind "firmness" and "structure (monophasic/biphasic)" in hyaluronic acid fillers
- Precise ingredient comparisons of representative products such as Juvéderm, Cléviel, and Restylane
- How to select optimal fillers by treatment area, including nose augmentation and skin quality improvement (hydrating injection)
- Safety data in hyaluronic acid injection and the efficacy of the latest combination formulations (HA-PN)
I understand how anxious you feel when a clinic's counselor asks "Which formulation would you like?" but only hears technical jargon and cannot figure out which one truly suits your face's anatomical structure.
But in the next 5 minutes, that anxiety will be resolved.
"Hyaluronic acid is the same ingredient no matter which product, right?" ――Do you think so? If you choose the wrong "firmness" or "structure" of a formulation, there is a risk that your treatment will result in an unnatural appearance. And there is a numerical value that determines that difference.
Basic properties of hyaluronic acid fillers: "Firmness" and "Rheology (flow science)"
First, there is one fact you need to know.
Hyaluronic acid (HA) is a glycosaminoglycan composed of alternating monosaccharides of d-glucuronic acid and N-acetyl-d-glucosamine, a biocompatible substance that exists naturally in the human body. In aesthetic medicine, HA fillers do not merely fill physical space. By expanding the extracellular matrix (ECM), they apply mechanical tension to fibroblasts, triggering biological changes. Fibroblasts bind to collagen through receptors called integrins, and when they receive this mechanical stretch stimulus, they promote the production of Type I collagen, which accounts for approximately 90% of the dry weight of human skin.
In other words, hyaluronic acid does not "fill"—it "builds."
Indeed, in a study where 0.7 mL of Restylane was injected into photodamaged skin, increased Type I collagen production was confirmed at 4 weeks and 13 weeks.
So, what numerical value creates the difference between formulations? The answer is the 3 indicators of "rheology (flow science)."
When selecting a filler, the most important indicator is the rheology (flow science) value. This includes G' (storage modulus: representing resistance to deformation and elasticity), G'' (loss modulus: representing viscosity), and their ratio, tangent delta (tan δ). Formulations with high G' resist deformation from external forces and excel at powerfully lifting and maintaining tissue.
Furthermore, the "form" of the formulation also comes in two types. This determines suitability for different areas.
HA fillers are classified into "monophasic" and "biphasic" based on their manufacturing process. Biphasic fillers form large pools of HA and behave by compressing surrounding collagen fibers, which is characterized by lower risk of overcorrection. In contrast, monophasic monodensified fillers spread HA pools in a way that divides collagen fibers, delivering high volumizing effects. Monophasic fillers tend to have high viscosity coefficient (G'') and relatively low elasticity coefficient (G'), and because they spread well within tissue, the risk of nodule formation is reduced.
So, which specific products have which values? Let's explore that in the next section.
Representative product lineups and their scientific characteristics
Countless HA fillers exist on the market. However, if you grasp the two axes of "concentration" and "cross-linking technology," the differences between products become clear at a glance.
When looking at the numbers, each product's "areas of strength" are clearly divided. The challenge is whether you can accurately apply that to specific facial regions.
"I want a higher nose, but I'm afraid of surgery requiring incisions..." For you with such genuine concerns, filler-based nose augmentation is an attractive option. However, knowing the fact that different formulations are suited to different areas is the strongest defense against failure.
Optimal selection by area: Nose augmentation (non-surgical rhinoplasty)
This is the point most commonly misunderstood.
Asian noses have intermediate characteristics (mesorrhine) between Caucasians (narrow nose: leptorrhine) and Africans (broad nose: platyrrhine). Specifically, features such as short nasal tip, short alar margin, and short columellar base are commonly seen, the nasal root (between the eyebrows) is flat and depressed, and the nasal bridge tends to be low, broad, and flat. Because the position is lower than the nasal root in Caucasians, injection must begin from the deepest point of depression. Rhinoplasty requires fillers with high elasticity (G') and cohesion that can maintain form while adapting to the surrounding tissue environment.
So, what do the actual data tell us?
In a study of 28 Korean women (ages 24–44, Rho 2021) comparing Cleviel Contour and Juvéderm VOLUMA, the baseline nasal height was 49.60 mm, nasal length was 41.15 mm, and nasofrontal angle was 146.11°. Following injection of an average of 0.64 mL of filler, at 48 weeks the nasal height increased 1.75 mm, the nasofrontal angle increased 3.66°, and nasal root elevation was maintained at 1.24 mm. Immediately after injection, nasal root elevation was more pronounced with Cleviel Contour, but long-term durability (up to 48 weeks, Rho 2021) was superior with Juvéderm VOLUMA.
In other words, "immediate effect" and "longevity" are different things. Depending on your goal, which one to prioritize changes.
Furthermore, in another study of 29 Asian patients, a protocol was implemented injecting up to 2.0 mL of Juvéderm VOLUMA on day 0 (average 1.36 mL, Liew 2016) and up to 1.0 mL (average 0.37 mL, Liew 2016) at 4 weeks. Of the 29 patients, 14 received additional treatment, broken down as 6 at the anterior nasal spine, 7 at the columella, and 13 at the nasal dorsum. Nasal injection carries risks of vascular occlusion and blindness, so injection into deep layers above the periosteum or perichondrium using extremely small amounts of 0.1 mL or less (or 0.05 mL or less) per injection at low pressure and slow speed is strongly recommended.
This limitation on injection volume is where technical skill makes a difference. It is one of the criteria you should verify when selecting a clinic.
Optimal selection by area: Skin quality improvement and aqua facial injection (hydration)
Physically "filling" wrinkles and "nurturing" skin are completely different matters.
Rather than physically filling wrinkles, a concept called "skin boosting" that improves overall skin hydration and texture is also becoming widespread. When using the Restylane Vital series, the standard technique involves using a dedicated "smart click" syringe to inject 0.01 mL per click into the dermis, performed in 3 sessions at 1-month intervals.
And the numbers back it up.
In a study of 60 women aged 19 to 60 in Korea (with baseline stratum corneum moisture content around 39, Choi), Elravie Balance was administered using an automated intradermal injector called Dermashine Balance (mesogun). This device, equipped with 9 32-gauge microneedles, injected 0.02mL each (1.5mL total, Choi) of HA at uniform depth into 75 points across the entire face. As a result, measurements using a corneometer confirmed that skin moisture content continued to improve significantly over 16 weeks following treatment completion.
Notice the point that improvement "continues" for 16 weeks. It's evidence that the skin keeps responding even after the procedure.
When you imagine something going wrong during a procedure meant to make you beautiful… it sends chills down your spine. To maximize safety, the key lies not only in the characteristics of the formulation, but in whether a "recovery method" is established in case of emergency.
Safety and Next-Generation Filler Technology (HA-PN Complex Formulation)
Here, we look at the "reasons to feel reassured" rather than "reasons to choose."
One of the greatest advantages of hyaluronic acid fillers is the existence of hyaluronidase, a "dissolution enzyme." In the event of vascular compression or misinjection, this enzyme can be used to rapidly break down HA and avoid serious complications such as tissue necrosis or blindness. According to a large systematic review comparing the safety of non-surgical rhinoplasty, among 1,600 patients studied, 1,174 (73.38%, Williams 2020) used HA, and 199 (12.44%, Williams 2020) used calcium hydroxyapatite (CaHA).
And there is a clear difference in complication rates.
The complication rate was only 0.77% in the HA group, whereas it was statistically significantly higher at 7.04% in the CaHA group (another study reported HA at 3.12% and CaHA at 19.05%, DeVictor 2021). A roughly ninefold difference. These numbers demonstrate that formulation choice is directly linked to safety.
But what if there were even more advanced technology?
In recent years, an "HA-PN complex formulation" combining hyaluronic acid and polynucleotides (PN) has garnered attention as a next-generation filler that suppresses side effects while promoting tissue regeneration. PN is a DNA fragment extracted from salmon milt and other sources, powerfully promoting fibroblast proliferation and collagen synthesis. In vitro studies showed that treatment combining 0.1% HA with 0.5% or 1% PN increased proliferation in human dermal fibroblasts (HDF) and mouse fibroblasts (L929) by approximately 20%.
In animal studies comparing volume changes of the initially injected filler, Juvéderm VOLUMA showed a maximum volume of 250mm3, VOLBELLA 158mm3, and HA-PN 0.5% 134mm3. After 24 weeks, VOLUMA maintained 120mm3, VOLBELLA 98mm3, and the HA-PN complex formulation demonstrated durability equivalent to existing HA fillers. Notably, regarding expression of the TRPV4 channel, a tissue irritation marker, the 1% HA-PN complex formulation showed extremely low irritation equivalent to PBS (negative control) compared to 2.0% VOLUMA and 1.5% VOLBELLA, suggesting higher safety upon injection.
"Maintain durability while minimizing irritation." This is the direction next-generation fillers aim for.
Summary of This Article
Finally, we organize this into three axes. If you remember just these, you won't hesitate during consultation.
- Choose by "firmness (rheology)":"For nasal and midface volumization, formulations with high G' (elastic modulus) such as Juvéderm VOLUMA or Cleviel Contour, which powerfully maintain shape, are appropriate.
- Choose by "purpose":"For skin dryness improvement and fine lines, soft monophasic fillers like Restylane Vital or Elravie Balance, which elevate moisture content by spreading a small amount uniformly in the dermis, or dedicated devices (mesoguns) are effective.
- Choose by "safety and regeneration":"For areas with high vascular risk such as rhinoplasty, HA fillers that can be dissolved with hyaluronidase in case of emergency are safest. Additionally, the latest HA-PN complex formulation is expected as a next-generation option that suppresses TRPV4 expression, a pain marker, while enhancing collagen regeneration at the cellular level by up to 20%.
If you think, "What about my case?"
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References
- Liew S, Scamp T, de Maio M, et al. Efficacy and Safety of a Hyaluronic Acid Filler to Correct Aesthetically Detracting or Deficient Features of the Asian Nose: A Prospective, Open-Label, Long-Term Study. Aesthetic Surgery Journal. 2016DOI
- Rho N, Youn C, Youn S, et al. A comparison of the safety, efficacy, and longevity of two different hyaluronic acid fillers in filler rhinoplasty: A multicenter study. Dermatologic Therapy. 2021DOI
- Trevidic P, Kim H, Harb A, et al. Consensus Recommendations on the Use of Hyaluronic Acid–Based Fillers for Nonsurgical Nasal Augmentation in Asian Patients. Plastic & Reconstructive Surgery. 2022DOI
- Trevidic P, Kim H, Harb A, et al. Consensus Recommendations on the Use of Hyaluronic Acid–Based Fillers for Nonsurgical Nasal Augmentation in Asian Patients. Plastic & Reconstructive Surgery. 2022DOI
- Chen B, Ma L, Ji K, et al. Rhinoplasty With Hyaluronic Acid. Annals of Plastic Surgery. 2020DOI
Author of This Article
Hiromitsu NakamuraPhysician, Ginza Clinic
Zetith Beauty Clinic Ginza, Osaka Shinsaibashi, and Fukuoka Clinics
He has a track record of research presentations at domestic and international conferences, and is involved in technical guidance and education across Zetith Beauty Clinic. He specializes in precise aesthetic medicine based on anatomical foundations, pursuing natural results tailored to each individual's bone structure and tissue.