Hyaluronic Acid Filler Types Comparison: Selection Guide by Firmness, Product, and Treatment Area
Are you troubled by wrinkles that deepen each time you look in the mirror, a blurred jawline, or a nasal bridge that could use a bit more height?
In fact, most people choose hyaluronic acid fillers "somewhat haphazardly." And that choice makes the difference in the final result.
By the time you finish reading this article, you will no longer be confused even if a product name comes up during your consultation.
- The scientific difference between hyaluronic acid filler "firmness" and "structure (monophase or biphasic)"
- Precise ingredient comparisons of representative products such as Juvéderm, Cléveiel, and Restylane
- Optimal filler selection by treatment area, such as rhinoplasty and skin quality improvement (aqua facial injection)
- Safety data for hyaluronic acid injection and the efficacy of the latest combination formulation (HA-PN)
I completely understand your concern — when a clinic's counselor asks you 'Which formulation would you like?' during consultation, you're faced with specialist terminology and feel anxious because you don't know which one truly matches your face's anatomical structure.
But in the next 5 minutes, that anxiety will be resolved.
Do you think 'Hyaluronic acid is the same ingredient no matter which one you choose?' If you select the wrong formulation based on 'firmness' or 'structure,' you risk an unnatural result despite your procedure. And there are specific numerical values that determine that difference.
Basic properties of hyaluronic acid fillers: 'Firmness' and 'Rheology (fluid dynamics)'
First, there is one essential 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 highly biocompatible substance that occurs naturally in the human body. In aesthetic medicine, HA fillers do not simply fill physical space. By expanding the extracellular matrix (ECM), they apply mechanical tension to fibroblasts, triggering biological changes. Fibroblasts bind to collagen via receptors called integrins, and when subjected to this mechanical stretch stimulus, they promote the production of Type I collagen, which comprises approximately 90% of the dry weight of human skin.
In other words, hyaluronic acid does not "fill"—it "nurtures."
Indeed, in a study in which 0.7 mL of Restylane was injected into photoaged skin, increased Type I collagen production was confirmed at 4 weeks and 13 weeks post-treatment.
So what numerical values create differences between formulations? The answer lies in three parameters of "rheology" (the study of flow).
The most important metric when selecting a filler is the rheology (flow properties) value. This includes G' (storage modulus: indicating resistance to deformation and elasticity), G'' (loss modulus: indicating viscosity), and their ratio, tangent delta (tan δ). Formulations with high G' are resistant to deformation from external forces and excel at lifting and maintaining tissue with strong support.
Furthermore, there are 2 types of formulation "shapes." This determines suitability for different treatment areas.
HA fillers are classified as "monophasic" or "biphasic" depending on their manufacturing process. Biphasic fillers form large pools of HA and behave by compressing surrounding collagen fibers, which has the characteristic of low risk of over-correction. In contrast, monophasic monodensified fillers have HA pools that spread 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'), spread well within tissue, and therefore have lower risk of nodule formation.
So, what specific numerical values does each product have? Let's explore this in the next section.
Representative product lineup and their scientific characteristics
Countless HA fillers exist on the market. However, if you understand the two axes of "concentration" and "cross-linking technology," the differences between products become immediately clear.
Looking at the numerical data, each product's "areas of strength" become distinctly apparent. The question is whether you can accurately match these to specific anatomical sites.
"I want a higher nose, but I'm afraid of surgical procedures that require cutting…" If you hold this genuine concern, rhinoplasty with fillers is an attractive option. However, knowing the fact that different formulations are suited to different areas becomes your best defense against failure.
Site-specific optimal selection: Rhinoplasty (non-surgical nose reshaping)
This is the point most commonly misunderstood.
Asian noses have intermediate characteristics (mesorrhine) between Caucasian noses (narrow: leptorhine) and African noses (broad: platyrrhine). Specifically, features commonly seen include a short nasal tip, short alar margin, and short columellar base, with the radix (root between the eyes) being flat and depressed, and the nasal bridge appearing low, wide, and flat. Because the radix is positioned lower than in Caucasian noses, injection must begin from the deepest point of depression. Nose reshaping 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, 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, nasal height increased by 1.75 mm, nasofrontal angle increased by 3.66°, and radix elevation was maintained at 1.24 mm. While radix elevation was more prominent immediately after injection with Cleviel Contour, long-term (up to 48 weeks, Rho 2021) maintenance was superior with Juvéderm VOLUMA.
In other words, "immediate effect" and "durability" are different things. Which to prioritize depends on your goal.
Furthermore, in another study of 29 Asian patients, a protocol was implemented with a maximum of 2.0 mL (average 1.36 mL, Liew 2016) of Juvéderm VOLUMA injected on day 0, and a maximum of 1.0 mL (average 0.37 mL, Liew 2016) at 4 weeks. Of the 29 patients, 14 received additional treatment, with breakdown being 6 at the anterior nasal spine, 7 at the columella, and 13 at the dorsum. Nasal injection carries risks of vascular occlusion and blindness, so injection technique into deep planes on or above the periosteum or perichondrium—using extremely small amounts of 0.1 mL or less per injection (or 0.05 mL or less), applied slowly at low pressure—is strongly recommended.
This restriction on injection volume is precisely where technical skill makes a difference. It is one of the key criteria to confirm when selecting a clinic.
Site-specific optimal selection: Skin quality improvement and hydra-infusion (hydration)
"Filling" wrinkles and "nurturing" skin are completely different things.
The concept of "skin boosting" — improving overall skin hydration and texture rather than physically filling wrinkles — is also becoming more widespread. When using the Restylane Vital series, a dedicated "Smart Click" syringe is typically employed to inject 0.01mL of microdose into the dermis per click, divided across 3 sessions at 1-month intervals.
And the numbers back it up.
In a study of 60 women aged 19 to 60 in Korea (baseline stratum corneum hydration approximately 39, Choi), Elravie Balance was administered using the Dermashine Balance automated intradermal injection device (mesogun). This device, equipped with nine 32-gauge microneedles, injects 0.02mL (1.5mL total, Choi) of HA at uniform depth into 75 points across the face. As a result, measurements using a corneometer confirmed that skin hydration continued to improve significantly for 16 weeks following treatment completion.
Note the point that improvement "continues" for 16 weeks. This is 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's chilling, isn't it? To maximize safety, the key lies not only in the characteristics of the formulation but also in whether a "recovery method" is established in case of complications.
Safety and next-generation filler technology (HA-PN composite formulation)
Here, we'll look at the "reasons to feel confident" rather than "reasons to choose."
One of the greatest advantages of hyaluronic acid fillers is the existence of hyaluronidase, a "dissolution enzyme." In cases of vascular compression or misinjection, this enzyme can be used to rapidly degrade HA, avoiding serious complications such as tissue necrosis or blindness. According to a large-scale 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 just 0.77% in the HA group, whereas in the CaHA group it was 7.04% — a statistically significant difference (another study reported HA at 3.12% and CaHA at 19.05%, DeVictor 2021). Approximately a 9-fold difference. This figure demonstrates that formulation choice is directly linked to safety.
But what if there were even more advanced technology ahead?
In recent years, "HA-PN composite formulations" combining hyaluronic acid and polynucleotides (PN) have received attention as next-generation fillers that promote tissue regeneration while suppressing side effects. PN is a DNA fragment extracted from salmon sperm, 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 of human dermal fibroblasts (HDF) and mouse fibroblasts (L929) by approximately 20%.
In animal experiments comparing volume changes of initially injected filler, Juvéderm VOLUMA showed maximum volume of 250mm³, VOLBELLA 158mm³, and HA-PN 0.5% 134mm³. After 24 weeks, VOLUMA reached 120mm³, VOLBELLA 98mm³, and the HA-PN composite formulation demonstrated durability equivalent to existing HA fillers. Notably, regarding TRPV4 channel expression — a tissue irritation marker — the 1% HA-PN composite 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, let me organize this along three axes. If you remember just this, you'll have no doubts at your consultation.
- Choosing by "firmness (rheology)":"For volumization of the nose and midface, formulations with high G' (storage modulus) such as Juvéderm VOLUMA or Cleviel Contour — which powerfully maintain shape — are appropriate.
- Select by **purpose**:For skin dryness improvement and fine wrinkles, soft monophasic fillers like Restylane Vital or Elravie Balance that evenly distribute microamounts within the dermis to increase moisture levels, or dedicated devices (Mesogun) are effective.
- Select by **safety and regeneration**:For areas with high vascular risk such as nasal augmentation, HA fillers that can be dissolved with hyaluronidase in case of emergency are the safest. Additionally, the latest HA-PN composite formulations are expected to be a next-generation option that suppresses the expression of TRPV4, a pain marker, while improving collagen regeneration at the cellular level by up to 20%.
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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
About the author of this article
Hiromitsu NakamuraPhysician, Ginza Clinic
Zetith Beauty Clinic Ginza, Osaka Shinsaibashi, and Fukuoka Clinics
He has a track record of presenting research at domestic and international academic conferences and is involved in technical guidance and education across Zetith Beauty Clinic. He specializes in precision aesthetic medicine based on anatomical evidence and pursues natural results tailored to each individual's skeletal structure and tissue.