Fillers, as the name so clearly conveys, restore lost volume in pretty much any part of your face, and some parts of your body. There are at least a couple dozen different hyaluronic acid fillers in the U.S., and they have slight variations—in things like viscosity—so injectors can choose the perfect one for the task at hand, whether it’s smoothing tiny lines around the lips or building a sharper jawline. A lot can be done with this one molecule and the public has fully embraced its line-smoothing, cheek sculpting abilities: Fillers are the second most popular minimally-invasive cosmetic procedure, according to a 2023 report by the American Society of Plastic Surgeons (neuromodulators like Botox are the first).
Now, two new hyaluronic acid fillers are popping up on treatment menus: Evolysse Form and Evolysse Smooth. Approved by the FDA in February, they are starting to roll out now. Both are approved for treating the nasolabial folds, which are also known as the laugh lines, with Form being a bit thicker than Smooth (more on that soon).
So… why are there new fillers on the block? And what do you need to know about them?
For starters, while the two Evolysse injectables are made from hyaluronic acid, the way they are created is a bit different than their siblings. If you’ll indulge us in a quick science lesson: Usually, hyaluronic acid is cross-linked (or bonded together so it stays together beneath the skin) at high temperatures during the injectable formulation process. The bonding process itself can actually eat away at the hyaluronic acid, however, so that’s where the high temperatures come in—heat speeds things up so it takes less time for the cross-linking agent (usually a chemical called BDDE) to work and damage is minimized. The catch 22 here is that heat breaks down the hyaluronic acid a bit, too.
Evolysse takes thermal energy out of the equation, with cross-linking performed at near freezing temperatures, says Rui Avelar, MD, chief medical officer and head of research and development at Evolus. At cold temperatures, Dr. Avelar and his team were able to use less BDDE to achieve the desired stiffness of the hyaluronic acid gel, and the hyaluronic acid experienced less fragmentation (i.e. breaking down into smaller pieces).
So, what does all that mean for your face? “When you put a traditional filler into the nasolabial folds, people typically start to look a little puffy,” explains Michael Kaminer, MD, a board-certified dermatologist in Brookline, Massachusetts and associate clinical professor of dermatology at Yale Medical School, who was an investigator during the clinical trials for Evolysse. In those trials, he says, “at that three-month mark, people didn’t look like the typical puffy patient that we see when we inject products into the nasolabial fold. When we started to have our investigator meetings, people were saying the same thing like, ‘Hey, have you noticed that the people are starting to look a little bit more natural? They’re getting an improvement in the fold, but they’re not looking puffy.’” This is because the hyaluronic acid in Evolysse is less fragmented, says Dr. Kaminer, explaining that the more you can preserve the natural structure of the hyaluronic acid in a filler, the more natural its results will be. (There’s no data comparing the structure of hyaluronic acid in Evolysse directly to that of the hyaluronic acid in other fillers.)
