In this episode of The Dr. Randi Show, I sit down with Rui Avelar, MD of Evolus, the company behind Evolysse, the first hyaluronic acid filler recognized for use in patients experiencing facial changes associated with weight loss medications. As these medications continue to change bodies and faces, this conversation explores what that shift means for aesthetic medicine and injectable innovation.
This episode covers:
• Evolysse and its entry into the U.S. injectable market
• Hyaluronic acid fillers and the shift toward more natural outcomes
• Evolysse as an entry point for patients new to injectables
• Early patient and injector feedback from clinical use
• Evolysse for use in patients experiencing medical right loss related facial changes
• The growing intersection of weight loss medications and aesthetics
This conversation explores how weight loss medications are reshaping facial aging, and why Evolysse marks a meaningful shift in addressing volume loss, skin changes, and natural-looking correction in aesthetic medicine.
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Episode FAQ
What is Evolysse, and how is it different from other hyaluronic acid fillers?
On this episode of The Dr. Randi Show, Dr. Rui Avelar, Chief Medical Officer at Evolus, introduced Evolysse, the company’s line of hyaluronic acid (HA) injectable gels, which host Dr. Randi Boyette described as the first major filler innovation in over a decade. Dr. Avelar explained that hyaluronic acid is a compound the body already makes, found in the skin and joints and used to retain water and moisture, and that its structure is highly preserved across species. In his view, the key difference with Evolysse is the manufacturing process, which he said does a better job of preserving the natural structure of the HA than typical manufacturing steps that can change it. He noted that Evolus even launched a campaign called Drop the F Word, encouraging people to talk about hyaluronic acid rather than the broad term filler. This reflects Dr. Avelar’s professional perspective as an Evolus executive and is not medical advice.
How can hyaluronic acid filler look natural instead of overfilled?
On The Dr. Randi Show, Dr. Rui Avelar compared today’s filler conversation to the early days of botulinum toxin, when many people wanted a completely frozen look that is now widely seen as overdone. Dr. Avelar said the same lesson applies to fillers: they can do marvelous things, but it is possible to overfill, which is why so many patients now say they do not want to look overfilled and prefer to age gracefully. He described hyaluronic acid injectables as a good fit for that goal because HA is a natural compound, and he noted that injecting it may even stimulate some of your own collagen. According to Dr. Avelar, clinical studies of Evolysse suggested injectors tend to need less material to reach an outcome, which he believes supports a more natural result. This reflects Dr. Avelar’s professional perspective and is not medical advice.
What do patients and injectors notice with Evolysse, and does it swell or deflate after injection?
On The Dr. Randi Show, Dr. Rui Avelar said the feedback Evolus hears most from injectors is that they seem to get more correction with less material, while patients often describe a very natural outcome and a gel that feels smooth and soft. Dr. Avelar explained that some gels contain a lot of free hyaluronic acid, so injectors may over-inject and then the result settles over four to six weeks, while other gels absorb water and swell over the following weeks, so patients may start out under-corrected. With Evolysse, he said the feedback has been that injectors can inject to correction, so the result at the injector’s office is generally the result the patient keeps, though he stressed there are always exceptions. He also shared an anecdote from dermatologist Dr. Doris Day, who described herself as conservative about new products but chose to try Evolysse, and whose first patient texted that the result was magic. Dr. Avelar noted that this story is not scientific evidence. This reflects Dr. Avelar’s professional perspective, individual results vary, and this is not medical advice.
Which areas of the face can Evolysse Form, Smooth, and Sculpt treat?
On The Dr. Randi Show, Dr. Rui Avelar explained that Evolus holds the rights to the Evolysse line in the United States and Europe, and that Europe has a full portfolio of products. Dr. Avelar described Evolysse Form as a middle option with some structure and some softness, used in deeper wrinkles and folds such as the nasolabial folds and marionette lines. He described Evolysse Smooth as softer and more liquid-like, which in Europe has been used very superficially for fine lipstick lines around the mouth and for a soft look in the lips, and which can also be used in wrinkles and folds. He said Form and Smooth were the two products launching in the United States, and that Evolysse Sculpt, the most structured product, which can be used in the mid-face to build cheekbones and restore volume, had strong study data and had been filed with the FDA, with a United States launch targeted for the second half of 2026. Europe also has a lip-specific product. This reflects Dr. Avelar’s description of his company’s products and is not medical advice.
Is hyaluronic acid filler a good first injectable, and can it be dissolved?
On The Dr. Randi Show, Dr. Rui Avelar said hyaluronic acid gels can be a good entry point for someone new to injectables because their backbone is a natural compound and they are highly efficacious. Dr. Avelar highlighted one key benefit compared with the category of fillers often called biostimulants: if a patient is unhappy with the aesthetic outcome or there is a complication, an enzyme called hyaluronidase can dissolve hyaluronic acid. In his view, that ability to reverse the treatment makes HA fillers a reassuring first step. Host Dr. Randi Boyette shared that she has had filler dissolved in the past and finds the option comforting. This reflects Dr. Avelar’s professional perspective and is not medical advice.
How does Evolus train injectors and make filler more approachable for patients?
On The Dr. Randi Show, Dr. Rui Avelar said Evolus has tried to keep things simple, accessible, and educational. Dr. Avelar explained that it starts with the science and with clinical trial data showing safety and effectiveness, which he called the price of admission, noting that Evolysse Form and Smooth are FDA approved in the United States and the full line is approved in Europe. He said the brand intentionally does not look like traditional pharma, pointing to the Drop the F Word campaign as an example. Because patients build trust with their provider, he said Evolus focuses heavily on educating injectors, with medical affairs clinicians who offer in-depth training on the product, injection technique, and facial anatomy so injectors feel confident and patients have a good experience. This reflects Dr. Avelar’s professional perspective as an Evolus executive and is not medical advice.
How are dermal fillers regulated in the United States compared with Europe?
On The Dr. Randi Show, Dr. Rui Avelar explained that the United States has two dominant filler families, while Europe has hundreds of hyaluronic acid fillers, largely because of differences in regulatory scrutiny. Dr. Avelar said Europe moved from the older Medical Device Directive (MDD), under which clinical studies were not always required, to the Medical Device Regulation (MDR), which now requires some form of clinical trial. In the United States, he said fillers are Class III medical devices, and the FDA expects rigorous data on manufacturing, biocompatibility, longevity, efficacy, and safety, which he believes benefits everyone. Drawing on 20 years of practicing medicine and his work in research and development, he said new technologies can sometimes create new problems, which is why he values humility and was drawn to Evolysse, whose approach he described as improving a problematic step in the cross-linking process rather than introducing new chemistry. This reflects Dr. Avelar’s professional perspective and is not medical advice.
Can filler be used for facial changes after GLP-1 weight loss?
On The Dr. Randi Show, Dr. Rui Avelar said Evolysse is, to his knowledge, currently the only filler whose labeling recognizes its use in patients with wrinkles and folds attributed to weight loss, including GLP-1 weight loss. Host Dr. Randi Boyette noted that many people using GLP-1 medications seek skin tightening or filler as a first treatment for changes in their skin. Dr. Avelar also shared a statistic from a survey he had heard about: among the GLP-1 users surveyed, 20 percent had not even heard of the field of aesthetics before, which he sees as a new door opening for people looking for solutions to volume loss. This reflects Dr. Avelar’s professional perspective, and anyone considering treatment should speak with a qualified provider. It is not medical advice.
How do Jeuveau and Evolysse work together, and why did Evolus launch a neurotoxin first?
On The Dr. Randi Show, Dr. Rui Avelar described Evolus’s neurotoxin Jeuveau and its Evolysse hyaluronic acid line as a natural pairing because of the large overlap in patients. Dr. Avelar said botulinum toxin is the number one asset in aesthetics by a wide margin, which is why Evolus started there, and that hyaluronic acid injectables are the second, making Evolysse a logical next step for a small company. He said Jeuveau, launched in 2019, has been the fastest growing neurotoxin for the last several years, and that rather than simply competing for share, Evolus aimed to expand a market he estimated is only about 10 percent penetrated by focusing on millennials. He also said the company has published data suggesting the treatment can help stave off the wrinkling process. On messaging, he described Jeuveau as a precise drug, which he believes can support a more subtle, natural look. This reflects Dr. Avelar’s professional perspective as an Evolus executive and is not medical advice.
What is the future of aesthetics over the next five to ten years?
On The Dr. Randi Show, Dr. Rui Avelar said he sees the future of aesthetics as bold and very positive. Dr. Avelar pointed to room for more creativity in biostimulants, very early work in areas such as gene therapy, growing attention to skin quality as we age, and innovation in biomaterials that could positively impact regenerative medicine. He noted that the field is far from saturated, and said new audiences, such as GLP-1 users who had never heard of aesthetics before, could encourage more investment from companies and build a bigger community around the industry. He also credited Evolus CEO David Moatazedi with describing the company as a performance beauty company that aims to bring products at least as good as the standard, and ideally better. This reflects Dr. Avelar’s professional perspective and is not medical advice.
