Review Finds HA Fillers Improve Skin Radiance

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Skin hydration and moisturization are crucial for maintaining the skin’s barrier function and aesthetic properties. Hyaluronic acid (HA), a glycosaminoglycan found in connective tissues, plays a central role in maintaining hydration and skin elasticity due to its unique ability to retain water.¹ A recent review explored the mechanisms of HA in skin rejuvenation and evaluated the efficacy of HA-based treatments on hydration, elasticity, radiance, and melanin index, using data from systematic reviews and meta-analyses of randomized controlled trials (RCTs).²

“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,” researchers behind the review wrote. “Radiance and hydration of participant skins were significantly improved when compared to control subjects.”

Hydrated skin is vital for maintaining a healthy and youthful appearance. Hyaluronic acid contributes significantly to skin hydration by binding water molecules, enhancing the extracellular matrix, and promoting structural integrity.¹ With aging, endogenous HA production declines, leading to dryness, reduced elasticity, and wrinkles. HA is widely used in dermatology as an injectable filler or topical agent to improve skin hydration, firmness, and radiance.³ However, variability in study designs, injection techniques, and HA formulations complicates the evaluation of its clinical efficacy.

Methods

The systematic review was conducted following PRISMA guidelines. Four databases (PubMed, Scopus, Embase, Web of Science) were searched for RCTs assessing the impact of HA injections on skin quality. Inclusion criteria required studies with a control group (placebo, saline, or no treatment) and outcomes such as hydration, elasticity, wrinkles, or melanin index. The methodological quality of studies was assessed using the JBI appraisal tool, and meta-analyses were performed using the random-effects model.

Results

From 1526 records, 12 studies met the inclusion criteria, and 6 were included in meta-analyses. The following outcomes were analyzed:

• Hydration: Researchers stated 4 studies with 404 participants demonstrated a significant improvement in skin hydration with HA injections compared to controls (SMD = 1.34, 95% CI = 0.14–2.54, p < 0.05). HA’s ability to bind water molecules contributes to enhanced hydration and plumpness of the skin.
• Elasticity: Three studies (299 participants) showed a non-significant improvement in skin elasticity (SMD = 0.25, 95% CI = −0.20–0.70, p = 0.27). Researchers stated the variability in results may stem from the dependence of elasticity on deeper structural components like collagen and elastin, which are indirectly influenced by HA.
• Radiance: The review noted 3 studies (307 participants) indicated a significant improvement in skin radiance (SMD = 0.51, 95% CI = 0.22–0.80, p < 0.05). This outcome was attributed to HA’s hydration and its potential stimulation of fibroblast activity.
• Melanin Index: Two studies (68 participants) revealed no significant reduction in the melanin index (SMD = −1.74, 95% CI = −4.89–1.41, p = 0.28). Researchers stated melanin production is likely influenced by genetic and environmental factors rather than HA treatments.

Discussion

The review found that HA fillers improve hydration and radiance through their water retention capacity and stimulation of extracellular matrix components. Their impact on elasticity appears less pronounced, likely due to the multifactorial nature of elasticity, which includes collagen and elastin production. Researchers noted the lack of significant changes in the melanin index underscores the need for further investigation into HA’s role in pigmentation.The variability in study designs, HA formulations, and patient characteristics highlights the complexity of evaluating HA’s efficacy.

Conclusion

Researchers concluded that HA-based fillers significantly enhance skin hydration and radiance but show limited effects on elasticity and pigmentation. While generally safe, HA injections require careful administration to minimize adverse effects. They suggested further research is needed to establish standardized treatment protocols and assess long-term outcomes.

References

1. Draelos ZD, Diaz I, Namkoong J, et al. Efficacy evaluation of a topical hyaluronic acid serum in facial photoaging. Dermatol Ther (Heidelb). 2021;11(4):1385-1394. doi:10.1007/s13555-021-00566-0
2. Zhou R, Yu M. The effect of local hyaluronic acid injection on skin aging: A systematic review and meta-analysis. J Cosmet Dermatol. 2025;24(1):e16760. doi:10.1111/jocd.16760
3. Kleine-Börger L, Hofmann M, Kerscher M. Microinjections with hyaluronic acid in combination with glycerol: How do they influence biophysical viscoelastic skin properties?. Skin Res Technol. 2022;28(4):633-642. doi:10.1111/srt.13167