Quantitative Ultrasonographic and Shear Wave Elastographic Assessment of Infraorbital Tissue Changes After Non-cross-linked Hyaluronic Acid and Amino Acid Therapy

Objective The aim of this prospective single-arm interventional study was to quantitatively assess changes in infraorbital tissue thickness and elasticity after non-cross-linked hyaluronic acid and amino acid therapy using B-mode ultrasonography and two-dimensional shear wave elastography (2D-SWE). Methods This prospective, open-label, single-arm interventional study was conducted between January 2024 and December 2024 and included 40 female patients undergoing non-cross-linked hyaluronic acid and amino acid therapy for infraorbital rejuvenation. Treatment-related changes in infraorbital tissue thickness and elasticity were evaluated using B-mode ultrasonography and 2D-SWE before treatment and three months after the initial treatment. Patient-reported satisfaction, physician-assessed clinical response, and short-term safety outcomes were also assessed. Results In the patient satisfaction assessment, 34 patients (85%) were satisfied with the procedure, whereas six patients (15%) were not satisfied. Lower eyelid epidermis-dermis thickness increased from 1.34 ± 0.34 mm before treatment to 2.05 ± 0.39 mm after treatment, corresponding to an approximately 53.0% increase (p<0.001). Palpebral orbicularis oculi thickness increased from 0.95 ± 0.29 mm to 1.33 ± 0.41 mm, corresponding to an approximately 40.0% increase (p<0.001). Lower eyelid epidermis-dermis elasticity increased from 3.96 ± 0.95 kPa to 4.99 ± 1.28 kPa, corresponding to an approximately 26.0% increase (p<0.001), and palpebral orbicularis oculi elasticity increased from 4.39 ± 1.07 kPa to 5.36 ± 1.75 kPa, corresponding to an approximately 22.1% increase (p<0.001). Retro-orbicularis oculi fat (ROOF) pad elasticity increased from 4.44 ± 1.42 kPa to 5.01 ± 1.77 kPa, corresponding to an approximately 12.8% increase; however, this change did not reach statistical significance (p=0.068). Conclusion Two sessions of non-cross-linked hyaluronic acid and amino acid therapy were associated with measurable short-term increases in infraorbital epidermis-dermis thickness, palpebral orbicularis oculi thickness, and selected tissue elasticity parameters on B-mode ultrasonography and 2D-SWE, with no serious adverse events observed during the three-month follow-up period.