Injectable Hydrators: Are They Worth It?

Is there any evidence to support the use of ‘injectable hydrators’? The idea of ‘injecting’ moisture into skin is not a new idea. It is well recognised that hyaluronic acid (HA) in the dermis of the skin is partly responsible for skin ‘plumpness’ by holding water in the dermis and it may also increase the production of collagen and other components of the dermis.

As we age, the amount of HA in the dermis decreases. Because HA is a large molecular weight molecule it does not penetrate the skin when applied topically. Therefore, the idea of injecting it directly into the dermis to replenish and rejuvenate the skin was considered a logical next step.

Kerscher et al (2008) was the first paper showing improvement of cheek skin elasticity and skin roughness in 19 female patients after a series of 3 sets of injections of hyaluronic acid (Restylane Vital/silk) spaced 4 weeks apart. However, this study did not have a control group (you would use saline injections as a placebo) which is a major issue because it is possible that microneedling alone to a certain depth can stimulate the production of new collagen and even new elastin in the dermis, therefore also improving skin elasticity and roughness.

I have done a fairly extensive literature review a number of times over the past few years and I cannot find a vehicle-controlled study of these ‘injectable hydrators.’ (if anyone has, please DM me!!!). The ‘medical device’ FDA approval for this specific product was gained in 2014 and the clinical study of efficacy looked at the use of it for lip augmentation and the correction of wrinkles around the lips only and used a ‘no treatment’ control – so not specifically as a skin ‘hydrator.’

That being said, I have used this product as well as similar HA products made by other companies a number of times, on myself and on patients in very specific situations. For example, most recently I had a patient who was getting dryness due to Isotretinoin so I injected her lower facial skin only and she reported a good improvement in dryness in the weeks following the treatment. This is, however, absolutely not evidence of effectiveness. Considering it is relatively painful and pricey, it would definitely not be my first-line treatment for dry skin. Has anyone had a treatment like this? What were your thoughts? I’d love to know!