Safety and efficacy of hyaluronic acid for the correction of nasolabial folds: A meta-analysis

Soft-tissue augmentation of the face is increasingly popular and the number of available filling agents has increased dramatically, improving the range of options for hyaluronic acid (HA) fillers. However, their different efficacy and safety have not been systematically compared. To evaluate and compare the safety and efficacy of different types of hyaluronic acid (HA) for nasolabial fold correction. A literature search, using MEDLINE, PubMed and Google Scholar, and a manual search of references for additional relevant studies were performed. Randomized controlled trials (RCTs) and clinical trials (CTs) with 0.5-24 months’ duration, evaluating efficacy and safety after for HA augmentation therapy, were included. Overall, 18 RCTs (n = 2,521) and 7 CTs (n = 346) were included. Different HA fillers for nasolabial fold correction were associated with various efficacies. At the 6-month follow-up, the mean Wrinkle Severity Rating Scale (WSRS) score change from the baseline for HA was 1.21. In subgroup analysis, the Juvederm™ family achieved the best efficacy, while their adverse event incidence was significantly higher than other HA products. Monophasic fillers demonstrated a significantly better efficacy than biphasic fillers over the 6 month follow-up period, while biphasic fillers showed higher tolerance than monophasic fillers. Our meta-analysis proved both safety and efficacy for HA fillers. Juvederm™ family achieved the best efficacy, while the adverse event incidence for Juvederm™ family was significantly higher than for other HA products.