Hyaluronic Acid Filler Longevity in the Mid-face: A Review of 33 Magnetic Resonance Imaging Studies.
Level 4 - case-series / case-control
Case series of 33 patients evaluated with MRI
PubMed 39015357 · doi:10.1097/GOX.0000000000005934
What was done
Magnetic resonance imaging (MRI) was performed over 2.5 years in 33 patients (24 asymptomatic and 9 with edema concerns) who had previously received mid-face hyaluronic acid (HA) filler injections. Patients with recent injections, permanent fillers, or specific medical histories were excluded. Two blinded radiologists evaluated the MRI scans to assess HA filler presence and volume.
What was found
MRI scans detected HA filler in all 33 patients, with zero instances of complete dissipation over a minimum 2-year post-injection period. Persistence was observed in 21 patients with no injections for 2–5 years, 12 patients for over 5 years, and up to 8–15 years in some individuals. Residual volume was graded as mild in 9 patients, moderate in 13, and severe in 11. Filler longevity reached up to 15 years across various products, with a reported 95% confidence interval of 84.47% ± 4.43%.
Why it matters
This study provides imaging evidence that cross-linked hyaluronic acid fillers can persist in facial tissue for years or decades, challenging standard assumptions of 3-to-12-month reabsorption and cautioning against premature reinjection schedules.
Limits
The study is limited by a small sample size (n = 33) and an uncontrolled case-series design. Selection bias is possible as 9 of 33 patients presented with edema, and precise original injection volumes, baseline imaging, and specific brand formulations were not standardized or independently controlled.
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