Six-Month Changes in Periorbital and Perioral Wrinkles and Facial Skin Quality following Low-Cross-Linked Hyaluronic Acid

INTRODUCTION: Fine wrinkles in the periorbital and perioral regions present therapeutic challenges because of thin dermal structure and high mobility. In these delicate facial areas, high-G' fillers may be limited by concerns regarding superficial placement and palpability, whereas non-cross-linked boosters often provide only short-lived effects. Low-G' hyaluronic acid formulations with favorable cohesivity, low complex viscosity, and high water affinity were developed to improve durability while maintaining flexibility suitable for intradermal treatment in thin, highly dynamic facial regions. METHODS: This observational study enrolled 25 subjects with facial wrinkles (Wrinkle Severity Rating Scale [WSRS] ≥ 2) who received three sessions of intradermal microinjections at 4-week intervals and were followed for 24 weeks to evaluate efficacy, durability, and safety. Outcomes included changes in wrinkle severity, global aesthetic improvement, objective skin quality parameters, and ultrasound-based dermal measurements. RESULTS: By week 24, mean WSRS scores decreased from 3.06 ± 0.51 to 1.79 ± 0.45 in the periorbital region and from 3.18 ± 0.49 to 2.01 ± 0.46 in the perioral region, with earlier improvement observed in the periorbital area and more gradual changes in the perioral area. Global Aesthetic Improvement Scale (GAIS) demonstrated improvement in 81.8% of subjects by investigator assessment and 86.4% by subject assessment. Objective measures showed significant changes in elasticity, surface texture, hydration-related indices, and transepidermal water loss, along with increased dermal thickness and echogenicity on ultrasound. No serious adverse events were observed over the 24-week period. CONCLUSIONS: These findings support the potential utility of low-G' hyaluronic acid with favorable cohesivity, low complex viscosity, and high-water affinity as a treatment option for fine wrinkles in thin, highly dynamic facial regions. The observed improvement across clinical, biophysical, and ultrasound-based measures suggests a broader contribution to skin quality enhancement beyond wrinkle correction alone.