Skin aging goes beyond a chronological process and also results from extrinsic factors referred to as the exposome. Hyaluronic acid (HA) is an important component of the extracellular matrix, with loss starting at 25 years old. While many studies of HA concern topical use, few literature reviews only address the use of topical HA in dermatology. This review describes the different characteristics of HA‐containing cosmeceuticals, with a focus on skin aging and the impact of exposome factors on HA synthesis and degradation. A review was performed using the terms HA, hyaluronan, topical, dermatology, cosmetic, aging treatment, exposome, and cosmeceuticals. Results are also presented from a recent randomized controlled trial (RCT), which investigated the additional benefit of using a HA epidermic filler (HA‐filler serum) combined with Botulinum toxin type A (BoNTA) to treat signs of skin aging. Subjects were randomized to two groups: HA‐filler serum starting 24 h after the BoNTA injection then twice daily for 24 weeks, or the control group, which received BoNTA. HA is a key ingredient used in cosmeceuticals for its hydration/antiaging properties (hygroscopic, rheological, and viscoelastic). Several clinical studies indicate that HA is both well tolerated and effective, adjuvant to both post‐surgical and facial rejuvenation procedures. In the RCT, one of few studies to combine BoNTA and HA with a 6‐month follow‐up, the HA‐filler serum lengthened the duration of BoNTA's effect in reducing wrinkles. Numerous studies support HA‐based cosmeceuticals as a noninvasive, effective solution for improving skin hydration and rejuvenation.

Key words: Isotretinoin; Retinoids; Skin aging

The tear trough is one of the most challenging facial regions for soft-tissue filler injections. A thorough understanding of the underlying fascial, muscular, and vascular anatomy is crucial to perform safe and effective tear trough injectable treatments. To evaluate the location and function of the angular vein in the tear trough in three different facial expressions: repose, smiling, and max. orbicularis oculi contraction. Twenty study participants with a mean age of 48.3 years and mean BMI of 24.5 kg/m ² were investigated via functional ultrasound imaging. The diameter of the angular vein, the velocity, and direction of venous blood flow were analyzed in repose, smiling and during max. orbicularis oculi contraction. The angular vein was identified in 100% of the cases to travel inside the orbicularis oculi muscle (= intra-muscular course) within the tear trough whereas the angular artery was not identified in this location. The distance between the angular vein the inferior orbital rim was (lateral to medial): 4.6 mm, 4.5 mm, 3.9 mm, and 3.8 mm. The caudally directed blood flow was in repose 10.2 cm/sec and was 7.3 cm/sec at max. orbicularis oculi muscle contraction; however, no blood flow was detectable during smiling. The diameter and the venous blood flow of the angular vein varied between the three tested facial expressions. Based on these anatomical findings, the deep injection approach to the tear trough is recommended due to the intramuscular course of the angular vein

Background: Esthetic medicine has shifted significantly toward non‐surgical procedures, with the collagen biostimulator poly‐ l ‐lactic acid (PLLA) becoming increasingly popular for facial rejuvenation. However, the safety and patient satisfaction associated with PLLA facial treatments remain largely unexplored. Objective: This study aimed to evaluate the safety profile of PLLA treatment and assess patient mid‐ and long‐term satisfaction with the outcome. Methods: This prospective single‐center study was conducted at Bravo Clinic in Rio de Janeiro from August 2023 to August 2024. The patients' mid and lower face was treated by injecting Rennova Elleva (a collagen biostimulator containing 210 mg of PLLA) into the zygomatic and pre‐masseteric regions. All patients underwent monthly clinical evaluations for the first 150 days and kept diaries to self‐record any adverse effects during the first 30 days. Patient satisfaction was measured using the Global Aesthetic Improvement Scale (GAIS) on days 90 and 150 post‐injection. Results: The study included 52 female patients [mean age: 49.87 ± 10.7 years; mean body mass index (BMI): 23.99 ± 3.5 kg/m ² ]. Patients reported mild to moderate injection site reactions, including redness, pain, hardening, swelling, lumps, bruises, and skin discoloration, with most symptoms resolving within a few days. Clinically, no major adverse events were noted, except for one small, painless nodulation that resolved without intervention. On post‐injection Day 90, the average GAIS was rated at 2.32 ± 1.0. This rating remained stable at Day 150, with an average GAIS of 2.32 ± 0.8 ( p = 0.862). Inverse correlations were identified between the duration of mild pain and GAIS ( r _s = −0.546, p = 0.035), as well as between the duration of mild bruises and GAIS ( r _s = −0.598, p = 0.019). The duration of moderate pain was significantly associated with age ( r _s = −0.894, p = 0.041). Conclusion: Rennova Elleva, a PLLA‐based collagen biostimulator, is safe and well‐tolerated with a low incidence of adverse effects. It provides long‐lasting, satisfactory results for patients with mild to moderate facial sagging, rendering it an effective non‐surgical option for enhancing facial esthetics.