Purpose: With the increasing interest of the media and developing sociocultural architecture, the popularity of non-invasive procedures for facial rejuvenation is rising. Among non-invasive procedures, soft tissue fillers, especially hyaluronic acid derivates are leading with their ability to be used alone or in combination with other procedure. The aim of this study was to define the needs for touch-ups in different application sites after facial rejuvenation procedures with hyaluronic acid injections.

Material and Method: 220 patients received hyaluronic acid derivates for facial rejuvenation between the years 2004 and 2007 were studied retrospectively. On 220 patients 450 hyaluronic acid injections were used on 314 different localizations. Injections were done under local or regional anesthesia after adequate antisepsis. Superficial, mid-dermis and deep dermis injections were preferred according to the anatomic localization and individual patient needs. Serial puncture and linear threading methods were preferred for nasolabial sulcus and lips, whereas fanning was done in perioral and malar areas. Total number of injections were as fallows; 110 nasolabial sulcus, 78 lips,  38 perioral, 37 malar, 16 tear trough, 20 glabella, 8 nose, 6 mentum, 4 neck area.

Results: The most common complication was ecchymoses at the injection site. No asymmetries or acute allergic reactions were observed. Touch-up was needed in two groups.(Table 1) The first group was consisted of patients who had insufficient augmentation due to inadequate amount of injected material at the first session. In the second group though the initial volume was satisfactory an early resorbtion than expected was observed.

Tble 1: Touch-up was needed in two groups

Conclusion: Hyaluronic acid fillers are effective and reliable materials among soft tissue fillers. Touch up need for inadequate amount of injection was seen mostly at the nasolabial sulcus and malar areas whereas early resorbtion was the main reason for touch ups for lips. As a result of these findings the patients must be informed for the need of touch-ups before the procedure and certain areas are more prone to require a staged application of the filler material. This is especially important to mention to the patient in order not have any conflicts afterwards.