Efficient cross linking of hyaluronic acid (HA) is provided by a manufacturing process. In the process HA is activated by an initial cross linking in an aqueous solution. Unreacted cross linking agent is removed from the activated HA. Cross linking of the activated HA is finalized without addition of any additional cross linking agent in a suspension of a liquid precipitating medium and the activated HA in precipitated form. The resulting cross linked HA products exhibit high effective cross linker ratio and other favorable properties making the products useful as implants and in medical and cosmetic surgery.
