Lay rater evaluation of naturalness and first impression following treatment of lower face wrinkles with hyaluronic acid fillers

BACKGROUND Hyaluronic acid (HA) dermal fillers formulated with XpresHAn TechnologyTM were subjectively assessed by investigators and subjects. AIMS To test whether treatment with HA dermal fillers (HARR and HARD ) deemed natural by injectors and subjects are considered natural by the public and receive positive first impressions. METHODS Videos of open-smile expressions of subjects at baseline to Day 42 were assessed by "lay raters" (n = 3004) who indicated agreement with "Face looks natural" and first impressions using Likert-type scales. RESULTS Naturalness of facial appearance was noninferior at Day 42 compared with baseline. Assessments of first impression demonstrated statistically significant changes from baseline in overall first impression, social skills, dating success, attractiveness, and athletic success. Rater gender and age did not affect scores. Subgroup analysis found three groups had significant positive changes: those aged ≤ 55 years, subjects with natural outcome, and those that received more than 4 mL of filler. Subjects without a natural outcome had a significant negative change. CONCLUSIONS Treatment with HA facial fillers, HARR and HARD , produces outcomes deemed natural by injectors, subjects, and the public. While subjective, this study demonstrates that clinicians should aim for a "natural outcome" that receives optimal first impressions from the public.