Hyaluronic Acid (HA) helps and can contribute to skin rejuvenation through different mechanisms; HA fillers have a physical filling effect that helps in cases of severe facial wrinkles simply by physically filling them up, giving them a youthful appearance.
Another mechanism by which HA fillers help with facial rejuvenation is improving skin hydration, as HA molecules can retain water and, thus, can help in skin hydration and wrinkle reduction by that mechanism.
There is also the mechanism is collagen production; HA can stimulate collagen production, leading to better skin elasticity and fewer wrinkles with less depth. The other mechanism by which HA can help skin quality augmentation is its anti-inflammatory properties. When combined with anaesthetics such as lidocaine, it has been observed that post-injection swelling and redness were further decreased.
Some studies have also investigated other variables such as wrinkle depth, skin thickness, patient satisfaction, luminosity, firmness, and scarring in HA filler-injected patients versus controls. A study conducted by Betemps et al. showed that HA fillers improved elastin, collagen type I, collagen type III, and fibrillin-1 expression in the injection site.
That said, other study results did not show a significant difference for the elasticity and melanin index. This can have various reasons considering the mechanism by which HA is known to affect the skin elasticity and melanin index; skin elasticity is mainly determined by the amount and structure of skin collagen and elastin fibres.
The main role of HA injections is to enhance skin hydration and create intradermal tension, indirectly improving collagen and elastin production and extracellular matrix enhancement. This indirect effect can depend on many factors, such as the injection technique, structural changes of skin due to aging, dietary and nutritional aspects of patients' lifestyles, the amount and concentration of HA injected, and the variations between different types of HA used.
Regarding melanin index reduction, although some studies have suggested that HA can lead to a reduction in melanin index when combined with other products, no exact mechanism is known as of today by which HA can affect melanocytes. Melanin index can also differ greatly between individuals due to genetic factors, variations in skin types, and existing melanocyte activities. This means that further studies accounting for intergroup variations have to be conducted in order to find, if any, possible significant relationship between melanin index and HA.
The differences in the impact on elasticity versus hydration and radiance likely stem from distinct biological mechanisms.
Hydration affects skin plumpness and surface texture, while elasticity is influenced by deeper components like collagen and elastin fibres. This highlights the complexity of skin's response to HA fillers, showing that while they effectively enhance hydration and radiance, their impact on elasticity may be more variable.
However, HA fillers can also have some side effects. These can be summarized as redness, pain, tenderness, firmness, swelling, itching and bruising, bumps, and rarely discoloration. This necessitates careful administration and follow-up and patients undergoing HA filler injections for any minor and major side effects.
HA-based fillers, when used for the right patients and with the right dosing and timing, can contribute to skin quality when compared to controls. Radiance and hydration of participant skins were significantly improved when compared to control subjects. The elasticity change was not significant compared to controls.
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Zhou, R. and Yu, M. (2025), The Effect of Local Hyaluronic Acid Injection on Skin Aging: A Systematic Review and Meta-Analysis. J Cosmet Dermatol, 24: e16760. https://doi.org/10.1111/jocd.16760
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