Hyaluronic acid (HA) dermal fillers are the leading nonsurgical solution for facial volume restoration, wrinkle correction, and soft tissue augmentation. With over 5.3 million HA filler procedures performed in the U.S. in 2023, these injectables remain the most widely used class of temporary fillers, offering reversibility and a strong safety profile when administered by certified experts. Dr. Sherly Soleiman, MD, a board-certified physician and national trainer, leads all patient care and protocols at Cosmetic Injectables Center Medspa, ensuring the highest standards of safety and natural results.
What Are Hyaluronic Acid Fillers?
Hyaluronic acid is a naturally occurring polysaccharide found in connective tissue, skin, and cartilage. In dermal fillers, HA is synthesized via bacterial fermentation or animal sources, then cross-linked to increase durability. These fillers are classified as Class III medical devices by the FDA and are approved for adults over 21 for various facial and hand indications. Their effects typically last 6–12 months, with newer formulations extending longevity. HA fillers are fully reversible with hyaluronidase, offering a key safety advantage over permanent fillers.
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FDA Approvals and Regulatory Framework
The FDA regulates HA fillers under product code LMH (absorbable). Recent years have seen expanded approvals for new indications and advanced formulations. As of 2025, key FDA-approved HA fillers and their indications include:
| Product Name | Approval Date | Key Indications | Notable Features |
|---|---|---|---|
| Evolysse Smooth & Form | Feb 13, 2025 | Dynamic facial wrinkles, nasolabial folds | Cold-crosslinked HA, lidocaine, superior to Restylane-L in trials |
| RHA®3 | Oct 27, 2023 | Lip augmentation, nasolabial folds | Resilient HA, lidocaine |
| JUVÉDERM® VOLUMA® XC | Oct 6, 2023 | Temple augmentation | High G’ for structural support |
| BELOTERO BALANCE (+) | Sep 27, 2023 | Infraorbital hollowing | Soft, integrates well, lidocaine |
| Restylane® Eyelight | May 8, 2023 | Infraorbital hollowing | Under-eye volume, minimal swelling |
| JUVÉDERM® VOLUX™ XC | Jul 29, 2022 | Jawline definition | High-density, structural support |
| RADIESSE® (+) Lidocaine* | Sep 1, 2021 | Jawline contour | Calcium hydroxylapatite, not HA (context only) |
*Non-HA, included for comparison.
Full FDA Executive Summary (2025)
Regulatory Considerations
- Safety: The FDA highlights risks such as vascular occlusion, granuloma formation, and rare interference with breast imaging. Most side effects (swelling, bruising) are mild and resolve quickly.
- Labeling: New labeling addresses imaging interference and recommends post-approval studies on migration and lactation effects.
- Patient Device Cards: Issued for traceability and safety monitoring.
Clinical Uses: Indications and Areas Treated
HA fillers are FDA-approved for:
- Nasolabial folds (smile lines)
- Marionette lines
- Cheeks and midface volume loss
- Lips (augmentation and hydration)
- Jawline and chin definition
- Temples
- Under-eye hollows (tear troughs)
- Hands (volume restoration)
See our full range of filler procedures »
Off-Label Uses
While many areas are FDA-approved, experienced injectors may treat additional regions (e.g., nose, earlobes) based on clinical judgment. Off-label use requires full informed consent and careful risk assessment.
Comparison of Major Hyaluronic Acid Filler Brands
| Brand/Family | Key Products & Indications | Longevity* | Unique Features |
|---|---|---|---|
| Juvederm® | Ultra XC, Voluma, Volbella, Vollure, Volux, Skinvive | 6–24 months | Wide range, high cohesivity, Skinvive for skin hydration |
| Restylane® | Lyft, Defyne, Refyne, Contour, Kysse, Eyelight | 6–18 months | XpresHAn technology, Eyelight for under-eye |
| Belotero® | Balance (+), Intense, Volume | 6–12 months | Soft, integrates superficially, Balance (+) for under-eye |
| RHA® Collection | RHA 2, 3, 4, Redensity | 9–15 months | Designed for dynamic wrinkles, resilient HA |
| Versa™ | Versa, Versa Lips | 6–12 months | Spherification technology, minimal swelling |
| Skinvive™ | Skinvive by Juvederm | 6 months | Microdroplet skin hydration, not volumizing |
*Longevity varies by product, area, and individual metabolism.
2025 Research: Clinical Trials and Efficacy
Efficacy and Longevity
- Evolysse Form and Smooth: In a 2025 multicenter trial (NCT05325411), these cold-crosslinked HA fillers showed superior wrinkle reduction and high patient satisfaction compared to Restylane-L, with effects lasting 12 months. Study link
- ESTYME LIFT vs. Restylane Lidocaine: A double-blind trial found noninferiority at 1 month and superior results at 3–6 months for nasolabial folds, with mild, transient side effects. Study link
- Full-face treatments: Meta-analyses confirm significant improvements in skin hydration, radiance, and volume, with certain HA fillers outperforming others for cheek augmentation. Meta-analysis
Patient-Reported Outcomes
- High satisfaction rates are reported across studies, with improvements in self-perceived attractiveness and quality of life, including in oncology patients undergoing HA filler treatment. Oncology study
Safety, Complications, and Reversibility
Common Side Effects
- Swelling, redness, bruising, and tenderness at injection sites, typically resolving within days.
Serious Risks
- Vascular occlusion: Can lead to skin necrosis or, rarely, vision loss. Requires immediate recognition and treatment.
- Granuloma formation: Rare, delayed inflammatory reactions may occur, sometimes years after injection. Case study
- Imaging interference: HA fillers can appear on MRI and mammography, potentially mimicking pathology. FDA summary
Reversibility
- HA fillers can be dissolved with hyaluronidase, allowing correction of overfilling or adverse events.
Long-Term Considerations
- Sustained volume changes are possible, but rare cases of bone resorption have been reported with supraperiosteal injections. Histological review
Scientific Foundations and Historical Evolution
- HA fillers replaced bovine collagen in the early 2000s due to improved safety and biocompatibility. History overview
- Advances in cross-linking and molecular weight tailoring have led to modern, long-lasting, and highly biocompatible products. HA properties
Why Provider Expertise Matters
The safety and natural appearance of HA filler results depend on the injector’s skill, anatomical knowledge, and ability to manage complications. At Cosmetic Injectables Center Medspa, all procedures are performed by certified expert injectors under the full-time supervision of Dr. Sherly Soleiman, MD, who is a national trainer and clinical trial investigator for leading HA filler brands.
Meet our team of certified injectors »
Internal Links to Related Procedures
- Juvederm Fillers
- Restylane Fillers
- Belotero Balance
- RHA Fillers
- Versa Fillers
- Skinvive by Juvederm
- Undereye Fillers
- Lip Fillers
- Liquid Facelift
- Filler Correction (Hylenex/Vitrase)