See, Touch, Feel, and Express: Achieving Safe and Natural Outcomes With HA Fillers—An International Consensus

Abstract

Background: The concept of “natural outcomes” in filler treatments has been explored in clinical studies and literature, yet remains loosely defined, subjective, and lacks standardized assessment criteria. Aims: To propose a multidimensional Natural Outcomes Framework to systematically define, assess, and communicate natural outcomes following hyaluronic acid (HA) filler treatment, facilitating attainment of desired results. Methods: An international aesthetic multidisciplinary panel developed consensus statements and a practical framework for achieving safe and natural outcomes with HA fillers based on insights from a literature review, survey, and expert meeting. Results: This expert consensus emphasizes safety as a foundational aspect of natural outcomes. The framework extends beyond visual outcomes (“See”) to encompass tactile (“Touch”), experiential (“Feel”) and expressive (“Express”) dimensions of naturalness, which can be assessed by various methods. The panel identified three categories of factors affecting natural outcomes: product, patient, and injector factors. Treatment can be optimized by selecting HA fillers with biomimetic design, suitable rheological properties, and low inflammatory potential; ensuring knowledge and technical competency; individualizing treatment plans; and fostering effective communication. A practical clinical workflow was devised to guide the attainment and assessment of safe and natural outcomes from pre-treatment to follow-up. Conclusions: The Natural Outcomes Framework offers a structured approach to achieving safe and desired outcomes with HA fillers, aligned with this principle: “treat the patient, not the photograph.” It promotes patient-practitioner alignment on treatment goals and use of appropriate products based on biomimetic design principles, contributing to the attainment of predictable and satisfying results with aesthetic HA filler treatments.