Buy virtually any pot of skincare these days and hyaluronic acid enjoys star billing on the INCI (ingredients) list. Hyaluron, hyaluronan, hyaluronate, sodium hyaluronate or simply HA – this is skincare’s It ingredient that no self-respecting serum should be seen without. A byword for hydration, HA can absorb an astonishing 1,000 times its weight in water – a single gram can hold up to six litres. Yet this is more than a super-moisturiser. Around half of the body’s natural HA is found in collagen, and clinical studies show that it stimulates the production of this vital structural protein. Add to that its role in cell proliferation and migration, plus its antioxidant, anti-inflammatory and healing prowess, and it ticks practically all the boxes of skincare’s Holy Grail. The fact that this substance is entirely natural can only swell its reputation.
Not an acid in the skin-peeling hydroxy sense, HA belongs to a group of sugars called glycosaminoglycans (GAGs) that form a gel that cushions joints and nerves, fills the eyes and plumps skin. Our bodies contain roughly 15g of HA, a third of which is broken down and reconstituted daily. But here’s the rub – with age, production slows. By our mid-40s, we make roughly half of all that our body needs. The consequences are felt in stiffer joints and seen in wrinkles and slacker features.
Discovered in connective tissue by German biochemist Karl Meyer in 1934, HA hit the headlines in 2000 after an ABC News documentary featured Yuzurihara, the Japanese “village of long life”, where an extraordinary number of elders in their eighties and nineties enjoyed active, wrinkle-free lives thanks to the phyto-oestrogens in their diet from plants, including soy, that increase the production of HA in the body. Japanese behemoth Shiseido had, however, already tapped HA’s anti-ageing potential, fermenting it from soy and streptococcus bugs (an unlikely yet fertile source). Launched in 1985, the resulting Bio‑Performance skincare range has just released Glow Revival Serum (£65 for 30ml), a silken, circulation-boosting veil. Shiseido also supplies raw HA to companies that make cosmetic fillers, which are also enjoying a renaissance.
So why, after decades of clinical and cosmetic use, is HA suddenly billed as the fount of all youthfulness? According to Lorna Jackson, editor of online cosmetic surgery magazine Consultingroom.com, demand is rising. “There are no firm UK stats, but plenty of anecdotal evidence that for the past few years, HA fillers have outstripped Botox,” she reports. One good reason is HA’s impressive portfolio of indications. Injected into the skin, it can plump cheeks and reshape chins, lift brows, smooth necks and contour jawlines, enhance lips and, controversially, genitals, as well as fill out lines. HA fillers can’t tighten like a full-on facelift, but as the trend towards minimally invasive procedures continues, they can successfully sculpt features and either complement or delay the need for surgery.
After losing face some years back, when celebrities with “extreme” trout pouts and oddly displaced features regularly hit tabloid headlines gleeful with schadenfreude, fillers have bounced back. “Techniques have advanced in the past decade. Facial sculpting with HA is far more durable than botulinum toxin [Botox] injections, which last for three to four months if you’re lucky,” says Jackson. The latest treatments also include rejuvenating the sinewy backs of hands and replumping saggy earlobes dragged down by years of wearing heavy earrings. “HA can’t fix stretched piercing, but it can plump surrounding tissue so that earrings fit more snugly,” Jackson explains. She also believes its prolific use in cosmetics is powering the HA revival. “You see HA again and again as a cream’s active ingredient,” she says. The borrow-back is ironic – cosmetics that routinely steal kudos from surgical procedures are helping to spread the message: “hydration from within” carries on where creams leave off.
“HA fillers have been used for years to treat lines, but more recently for hydration and improving skin tone, quality and texture,” says Dr Benji Dhillon, HA expert at the PHI Clinic. The latest deep hydration treatments were created after patients and practitioners noticed fillers gave skin a fresher glow. “Effects are difficult to measure, but objectively noticed,” says Dhillon. “When patients tell me they’ve been asked which cream they’re using, or if they’ve been away, I know I’ve done a good job.” What could be more natural?
To guide the “normalisation” home and challenge widespread misconceptions that procedures inevitably look extreme, Galderma, which makes HA filler Restylane, launched its global Proof In Real Life campaign earlier this year. The stars of this ingenious “before and after” roadshow are 10 sets of identical twins – one innocent of the needle, the other showcasing fillers or Skinboosters, Restylane’s latest refresher injections for improving overall skin quality. When the British twins, accompanied by their surgeon Dr Kuldeep Minocha, showed their faces in London in May, the results were indeed so subtle that if their siblings had stayed away you’d never have guessed. Perhaps even more impressive is Restylane’s new ambassador, actress Sharon Stone, 57, whose face has been deftly rebalanced by fillers after an aneurism in 2001.
Restylane, Juvéderm, Teosyal, Perfectha, Belotero – a handful of names among some 160 global HA brands. Which to choose? “All have their own ways of cross-linking and stabilising the HA molecule to slow its destruction in skin,” says Jackson. “Surgeons worth their salt use products backed by sound clinical evidence.” Stability versus facial mobility is a major challenge, and g-prime (a gel’s resistance to stress) is pivotal. “Thickness is also important,” says Dhillon. “It’s high g-prime HA for cheeks; lower for lips.” At the Omniya Health & Beauty Mediclinic, Dr Sarah Tonks injects thin lips with light, hydrating Teosyal RHA1, then uses denser Juvéderm Volift two weeks later, to define the lip outline in her Repair, Restore & Volumise Lip Treatment (from £750). Her clients are also encouraged to maintain hydration with SkinCeuticals AOX Lip Complex (£35 for 10ml).
The most natural results come courtesy of fillers that won’t show you up when you smile. Teosyal RHA1 (from £450) claims to be the first range of resilient HA fillers designed to work with facial dynamism yet produce longer-lasting results. An ongoing study reports patients still have smoother nose-to-mouth lines 15 months after treatment, while a new “painless” pen promises trauma-free injections. Dermatologist Dr Jules Nabet is enthusiastic, saying: “One patient recently said she felt neither pain nor the product in her face.”
Injection-phobes will be heartened by new needle-free treatments. Transdermal patch company Innoture has created Radara (from £190), a high-tech delivery system sold in clinics that’s used daily for a month at home. The patches are coated with microscopic “needles” less than half a millimetre long that painlessly punch micro-channels for HA serum to penetrate the skin’s deeper layers. An eight-week trial showed up to 35 per cent wrinkle reduction and found the patches virtually doubled the power of the serum. “This is the new era in micro-needling that mixes hydration with collagen synthesis,” Dhillon enthuses. “It’s like applying a plaster. There’s no pain, bleeding or downtime as with derma-rollers.”
A further alternative to mesotherapy, or needling, is the mTherapy Beauty Pod, £299 (including four podlets; refills £60 for four, £180 for 16), a device that pressure-steams HA into the skin’s surface. During this two-phase, two-minute treatment developed by cosmetic specialist Dr Daniel Sister, the serum in the first podlet steam-cleans skin, before the second mists it with a mix of vitamins, minerals and HA – 20 minutes later skin is visibly plumper and lines seem finer. In trials, 57 per cent of testers reported firmer-feeling skin after the first session. For optimum results, which also include tighter pores and brighter skin, 10 sessions are recommended: twice weekly in the first fortnight, then once a week.
Treatments like these bridge the gulf between clinic and bathroom, while exploiting skincare’s fast-growing “power-tool” trend. But there’s good news on the strictly cosmetics shelves too. Whereas in the past topically applied HA molecules were considered too big to penetrate beyond the skin’s upper layers, they can now be engineered to reach at least the epidermal/dermal junction where new cells proliferate. And so HA now fosters plumper, firmer skin right through from exfoliators such as Goldfaden MD Doctor’s Scrub (£65 for 100ml) and body firmers like Bakel Jalbody Radical Lifting Treatment (£80 for 150ml) to SkinCeuticals Hydrating B5 Masque (£49 for 75ml), a weekly pick-me-up for dehydrated skin. One major advantage of formulas with HA is they tend to be light and non-greasy, making them ideal for wearing under make-up or sunscreen, as well as a post-shave soother for gloop-resistant men. A recent study at Poznan University found lightly textured moisturisers, rather than heavier oil-based creams and ointments, better ensure HA absorption. “The larger the water content, the more stable formulation can be due to hygroscopic (water-absorbing) properties of hyaluronic acid,” researchers concluded.
“HA’s strong moisture-retentive capacity makes it an excellent temporary plumping ingredient, providing its molecular weight is small enough to penetrate the skin,” confirms Dr Marko Lens, whose Zelens Z Luminous Brightening Serum (£135 for 130ml) contains sodium hyaluronate (the salt of HA), which sinks in easily. The advent of multiweight molecules has inspired some companies to take a belt-and-braces approach for serums that aim to plump the skin’s upper layers with high-weight molecules, while targeting fibroblasts in the deeper dermis with low-weight HA to stimulate home-grown production. Anne Semonin Precious Pearl Youth Radiance Elixir (£250 for 40ml), exclusive to Harrods, instantly firms the surface with high-weight HA pearls suspended in a low-weight, deeply plumping serum.
“Syringed” onto skin by a dose-specific mock needle that does not actually penetrate skin, Fillerina (from £38) is a 14-day treatment combining six grades of HA to plump cheeks and lips, while softening lines. Lips seem to respond most fully, but the 10-minute wait for the gel to sink in is tedious. Not so Perricone MD Hyalo Plasma (£110 for 30ml), a gel with a triple-HA formula that plumps, minimises wrinkles and leaves skin exquisitely smooth and dewy. Equally silken is Teoxane Cosmeceuticals RHA Serum (£79 for 30ml) from the Teosyal skincare range, formulated to complement its fillers. Teoxane RHA R[II] Eyes (£49 for 15ml) and Prep Cleansing Solution (£21 for 200ml) are also worth trying. A joy to use is BioEffect EGF Day Serum (£110 for 30ml), a moisturising version of the popular EGF Serum (£125 for 15ml), with firming epidermal growth factors extracted from greenhouse-grown Icelandic barley. “HA works in synergy with EGF, giving an instant moisturising effect, while EGF slowly builds the skin’s ability to retain moisture,” says BioEffect’s scientist/founder Björn Orvar. The results are palpably firming. A few drops of a simple HA serum can also transform regular creams into super-moisturisers, or offset the drying effects of prescription Retinol. Susanne Kaufmann Hyaluron Serum (£105 for 30ml), Dr Gabriela Magic Beauty Face Lift Serum (£207 for 30ml) and Paula’s Choice Resist Hyaluronic Acid Booster (£42 for 20ml) all fit the bill.
Having slathered it on, why not consider sipping it? Accessing depths that even the needle can’t reach, nutriceutical tipples are taking “beauty from within” to literal limits in Japan, where a third of looks-friendly oral supplements contain HA. In the UK, Tonks recommends her clients drink Aneva Derma Skin Beverage (£110 for 360g, 30 days’ supply), to boost hydration and improve the results of fillers. Originally a medical supplement for osteoarthritis patients who began to notice plumper, more glowing skin as well as more flexible joints, each scoop of this soluble powder delivers 210mg of hydrolised HA along with 10,000mg of collagen fragments directly to the small intestine, which absorbs them readily, unlike pills that are more complex to digest. Expect to notice the glow within six weeks. Also worth a glug is Fountain, The Beauty Molecule Extra Strength (£68 for 240ml, six weeks’ supply), which combines HA with “longevity” antioxidant Resveratrol, and Beauty & Go Bioactive Beauty Drink (£3 for 250ml). Taking HA orally to benefit skin has its sceptics, yet a 2014 study published in the Nutrition Journal seems to clinch it. A daily oral intake of 120mg of HA in capsule form significantly increased skin moisture for people with dry skin, it concluded.
Can this miracle molecule do no wrong? “Hyaluronic acid has benefits that we still don’t understand fully and have yet to exploit,” muses Dhillon. “It’s the most exciting ingredient in skincare and we’ve only scratched the surface.” The acid test may yet be surpassed.