Abstract
Introduction: Techniques for administering injectable fillers for facial rejuvenation and aesthetic enhancement continue to evolve. Hyaluronic acid (HA) is the most commonly used soft tissue filler. The cross-linking process is also essential to improve the mechanical properties and control the rate of HA degradation. The great challenge lies in the rational choice of the product to be used according to the anatomical area to be corrected. Objective: This was to conduct a literature review on the different types of hyaluronic acid crosslinking and the appropriate choice of the product in different regions of the face, especially in areas where the product can be migrated due to the musculature, as the appropriate choice directly interferes with its benefits and results. Methods: The systematic review rules of the PRISMA Platform and the methodological quality of AMSTAR 2 were followed. The research was carried out from March to April 2025 in the Web of Science, Scopus, Embase, PubMed, Lilacs, Ebsco, Scielo, and Google Scholar databases. The quality of the studies was based on the GRADE instrument and the risk of bias was analyzed according to the Cochrane instrument. Results and Conclusion: A total of 138 articles were found. A total of 32 articles were fully evaluated and 12 were included and developed in the present systematic review study. The clinical studies showed homogeneity in their results, with Chi-Square (X2) = 72.2%>50%. Considering the Cochrane tool for risk of bias, the overall evaluation resulted in 40 studies with a high risk of bias and 20 studies that did not meet the GRADE. The studies generally showed safe effects, with a high success rate and aesthetic satisfaction with the participants' application of the types of hyaluronic acids. Restylane Defyne hyaluronic acid filler was safe and effective for augmentation of the chin region and was associated with high aesthetic improvement and patient satisfaction. Furthermore, studies have generally shown the beneficial effects of flexible hyaluronic acid fillers in the augmentation and perioral enhancement of the lips, demonstrating a significant improvement in the texture, red color, and fullness of the lips. A substantial increase in surface stretch (dynamic tension) was also observed, indicating tissue expansion and improvement in lip smoothness. The 20 mg/mL hyaluronic acid gel with lidocaine for cheek augmentation was safe and effective using a cannula and was non-inferior to needle injection. The evaluation of the effect of Sardenyashape® with lidocaine demonstrated its efficacy and safety for use in the correction of nasolabial folds. The success of lip filler treatment is the result of the combination of a visually volumizing effect, satisfaction with the anatomical shape, function, recovery, and psychosocial effects.