Hyaluronic acids (HAs) can have very different actions not only depending on injector and host factors but also depending on their molecular weight. Whereas short chain HA has immunological activity long chain HA influences fibroblasts and may stimulate them to produce collagen. Although this is generally thought to be a positive feature it may be disadvantageous in certain localizations.

We have encountered 23 patients who developed fibrous tissue next to the nasolabial folds accentuating them and becoming very obvious while smiling. Hyaluronidase injection did not reduce this mass. Intralesional triamcinolone acetonide injection led to rapid improvement.

Dr. Ioannis Peros was born on the island of Kos and studied Medicine at the National and Kapodistrian University of Athens. He later specialized in Dermatology and Venereology in Germany at the University Hospitals of Ulm, Munich, and Kassel, followed by further training in Germany, the United States, and France alongside leading experts in the field. Since 1999, he has held a doctorate from the University of Marburg in Germany and has further focused his work on dermatologic surgery and liposculpture through international training programs.

Dr. Peros served as Director of Training in Dermatologic Surgery at Evangelismos Hospital from 2007 to 2012 and is a certified mentor of the American Society for Dermatologic Surgery (ASDS) as well as a founding member of DASIL. He has been actively involved in seminars and conferences across Europe, Asia, America, and Africa, with expertise in CO2 lasers, IPL, liposuction, fat transfer, chemical peels, growth factor therapies, tumor removal, and reconstructive surgery. In his aesthetic practice, he emphasizes natural-looking outcomes and follows the philosophy of “less is more.”