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"The controversies surrounding HA fillers—overuse, misinformation, and aesthetic uniformity—are gradually giving way to a more refined philosophy."
Hyaluronic acid (HA) has become the undisputed cornerstone of modern aesthetic medicine. As a naturally occurring glycosaminoglycan responsible for maintaining hydration, elasticity, and volume, HA’s introduction into injectable fillers revolutionized facial rejuvenation. Yet, as MUDr. Monika Kavková asks in her lecture “Beauty in Balance,” can the same substance that enhances beauty also destroy it?
The answer lies not in the material—but in the mindset and method. Used correctly, HA remains one of the safest, most effective, and most reversible aesthetic tools available. Used poorly, it can distort proportions, alter identity, and ultimately erode the very harmony it seeks to restore.
When performed with anatomical precision and artistic restraint, HA injection can create a subtle, refreshed appearance that restores confidence without betraying the hand of medicine.
In skilled hands, HA is not a sculpting mass—it is a dialogue between anatomy and artistry.
The same material can, however, become a symbol of excess. “Filler fatigue” and the “overfilled face” have become cautionary phrases in the aesthetic lexicon. Excessive use, superficial placement, or repeated treatments without full resorption stretch the tissues and obscure natural contours. Puffy midfaces, heavy under-eyes, or distorted proportions often result not from the filler itself, but from overcorrection and misunderstanding of facial dynamics.
Complications such as edema, nodules, or even vascular occlusion—though rare—underscore that safety begins with knowledge, not the needle. The most common error? Treating the symptom, not the structure.
True rejuvenation begins with understanding how the face ages—from the inside out. Every layer, from bone to skin, undergoes changes: bone resorption, fat compartment descent, ligament laxity, and dermal thinning. According to anatomical research by Swift and colleagues (Aesthetic Surgery Journal, 2021), these cumulative alterations shift the architecture of beauty over decades.
The line of ligaments is a concept describing a series of fibrous bands, or true retaining ligaments, that anchor the skin and underlying tissues to the facial bones, acting as anatomical landmarks for facial aging and cosmetic treatments. This «line» includes the temporal ligamentous adhesion (TLA), lateral orbital ligament (LOL), zygomatic ligament (ZL), and mandibular ligament (ML), which separate the face into mobile and fixed regions.
It is another key aid in achieving natural and balanced rejuvenation results is an understanding of this line of ligaments. Recognizing these lines of support allows injectors to rebuild structure before addressing surface imperfections, helping to achieve more natural-looking outcomes in cosmetic procedures such as dermal filler injections by directing treatment to restore support and lift to the face.
HA injections must respect depth, proportion, and expression.
In contrast, danger zones—glabella, nose, nasolabial folds, and tear trough—carry high vascular risk and demand extreme caution. Beleznay’s 2015 analysis showed that 98% of blindness cases linked to fillers originated from glabellar and nasal injections. Safety and artistry therefore intertwine: knowing where not to inject is as vital as knowing where to inject.
As aesthetic philosophy evolves, many clinicians, including MUDr. Kavková, are often turning toward hybrid fillers—combinations of HA and calcium hydroxylapatite (CaHA). These formulations merge HA’s hydrating softness with CaHA’s collagen stimulating strength, offering structure and longevity alongside natural pliancy.
Additionally, integrated protocols that combine HA, biostimulation, threads, and neurotoxins can achieve holistic rejuvenation when executed with proper sequencing and restraint. In particular, biostimulatory treatments have shown a significant increase in clinical application and scientific interest, reflecting their proven efficacy in improving dermal quality through collagen and elastin neogenesis. The goal is harmony, not volume—architecture, not inflation.
To avoid the pitfalls of excess, MUDr. Kavková advocates a few guiding principles:
The injector’s task, she emphasizes, is not to chase lines but to restore identity without altering it.
The controversies surrounding HA fillers—overuse, misinformation, and aesthetic uniformity—are gradually giving way to a more refined philosophy. Beauty today is not about volume but proportion, light, and motion. Patients no longer desire to look “different,” but rather like themselves, on their best day.
“HA is our friend,” concludes MUDr. Kavková, “if guided by artistry, science, and restraint. Our mission as injectors is to be architects of structure, not just injectors of volume—to restore harmony where time has taken balance.”
Aesthet Surg J. 2021 Oct; 41(10): 1107–1119. The Facial Aging Process From the “Inside Out” Arthur Swift, MD, 1 Steven Liew, MD, 2 Susan Weinkle, MD, 3 Julie K Garcia, PhD, 4 and Michael B Silberberg, MD, MBA 5 Hernandez CA, Schneider C, Gold D MH, Muniz M, Green JB, Alfertshofer M, Frank K, Cotofana S. After the Temporal Lifting Technique-What comes next? J Cosmet Dermatol. 2021 Dec;20(12):3857-3862. doi: 10.1111/jocd.14247. Epub 2021 Jul 21. PMID: 34021958. Choi MS, Kwak S, Kim J, Park MS, Ko SM, Kim T, Jeong DS, Rhee CH, Yang GH, Son WC, Kang WH. Comparative Analyses of Inflammatory Response and Tissue Integration of 14 Hyaluronic Acid-Based Fillers in Mini Pigs. Clin Cosmet Investig Dermatol. 2021 Jul 2;14:765-778. doi: 10.2147/CCID.S315076. PMID: 34239313; PMCID: PMC8260178.
