AGENTES DE RETICULAÇÃO EM PREENCHIMENTO DÉRMICO A BASE DE ÁCIDO HIALURÔNICO UTILIZADOS NA ESTÉTICA FACIAL

In recent years, minimally invasive aesthetic procedures, especially botulinum toxin and hyaluronic acid (HA) fillers, have experienced significant global growth. In Brazil, HA is the second most popular non-surgical procedure, driven by the pursuit of safe and effective facial rejuvenation. Its biocompatibility, hydration, and volumizing capacity justify its widespread clinical use. However, to achieve greater durability and stability, HA undergoes a cross-linking process. Although this increases its efficacy, it can influence tissue response and be associated with potential complications. The aim of this study was to conduct a narrative literature review on the properties and safety of the different cross-linking agents used in commercially available HA formulations. Among them, 1,4-butanediol diglycidyl ether (BDDE) is widely used to increase filler durability but raises concerns due to residual epoxides with potential cytotoxic effects. Another important agent is divinyl sulfone (DVS), which promotes highly efficient cross-linking, providing greater resistance to degradation and prolonging the product’s duration. However, its high reactivity requires strict control of manufacturing parameters to ensure biocompatibility. New technologies, such as BDDE cross-linked with lysine, Vycross®, and RHA®, have improved the quality of formulations and expanded clinical options in facial aesthetics. In conclusion, practitioners must have a deep understanding of the properties, indications, limitations, and risks of cross-linking agents to make an informed product choice, thereby ensuring safety and the quality of aesthetic outcomes.