Achieving High Projection Without Compromise: Process Optimization of a New Resilient Hyaluronic Acid for Deep Structural Support

Abstract Background Traditional technology used to create cohesive hyaluronic acid (HA) injectables for aesthetic use often relies on increased HA concentration and high crosslinking to maximize strength and robustness. As a result, natural HA integrity may be compromised, leading to less dynamic rheology, difficulty in hyaluronidase degradation, and poor tissue integration. Objectives The aim of this study was to demonstrate high projection capability, reversibility, and smooth tissue integration with an HA injectable gel produced from an optimized crosslinking process without high 1,4-butanediol diglycidyl ether modification. Methods TPVM was created using optimized Preserved Network Technology (PNT+) crosslinking technology and evaluated against the existing US-approved and Conformité Européenne (CE)-marked resilient hyaluronic acid (RHA) fillers (RHA1-RHA4 in Europe, RHA Redensity, RHA2-3, and RHA Dynamic Volume in the United States). Assessments included physicochemical properties, rheology, injectability, hyaluronidase degradation, physician-rated injection ease across 3 indications, and long-term tissue integration in minipigs up to 156 weeks. Results Despite a modification degree of 2.1%, among the lowest in the marketed fillers, TPVM achieved the highest elastic modulus (G′ = 629 ± 8 Pa), linear viscoelastic region (454 ± 15 Pa), and resistance to compression force (10.5 ± 0.1 N). Injectability was rated “very easy” or “easy” in over 94% of cases across midface, chin retrusion, and jawline indications. Like all RHA gels, TPVM reached complete hyaluronidase degradation within 30 min. Histological evaluation at 52 and 156 weeks confirmed smooth tissue integration and progressive gel degradation with no encapsulation or persistent inflammation. Conclusions Optimized PNT+ crosslinking technology decouples gel mechanical performance from the degree of chemical modification, enabling superior projection capacity while preserving enzymatic reversibility and tissue integration.