Skin boosters: types, effects, and the limits of the evidence

What the term skin booster refers to

A skin booster is not the name of a single drug. It is a broad term for treatments that inject small amounts of a substance into the skin to improve skin quality, such as hydration, elasticity, and texture. In the medical literature it is also discussed under the name mesotherapy, and it is described as a method of injecting very small amounts of a biocompatible substance, divided among several layers of the skin ^[1].

Most of the studies reviewed in this article looked at hyaluronic acid. Hyaluronic acid is an important component of the extracellular matrix (the material that surrounds and supports cells), and it is described as beginning to decrease from around age 25 ^[3]. In aesthetic medicine it is widely used because of its reported role in skin rejuvenation, but it has also been pointed out that consistent recommendations on how to use each product are lacking ^[4].

Study results for hyaluronic acid injections

A 2023 systematic review screened 2,996 publications and included 13 studies of injectable hyaluronic acid for facial skin quality in adults ^[2]. Eight studies evaluated hyaluronic acid alone, and 5 evaluated cocktail products mixed with other ingredients ^[2]. All types of products showed significant improvement in hydration, firmness, a tired appearance, brightness, texture, radiance, and elasticity, and the effect of hyaluronic acid alone was more pronounced than that of the cocktail products ^[2].

Safety was good and satisfaction was high, but the authors stated that large randomized controlled trials are needed ^[2]. This means the effects are at the promising stage, not that the question has been settled.

A 2025 review of a complex combining low- and high-molecular-weight hyaluronic acid (a hybrid cooperative complex) summarized clinical studies in which the degree of wrinkles, skin roughness, and skin sagging decreased and improvement in skin surface hydration lasted for up to 6 months ^[5]. There were also findings that the vitality of fibroblasts (cells that make collagen) and the production of collagen and elastin increased, but these came from cell experiments ^[5].

Treatment methods and number of sessions

In a 2022 review of 34 papers on hyaluronic acid mesotherapy, non-cross-linked hyaluronic acid (non-cross-linked HA) was given in 1 to 6 sessions at intervals ranging from weekly to every other month, and cross-linked hyaluronic acid (cross-linked HA) was given in 1 to 3 sessions at intervals of 4 to 36 weeks ^[1]. Most studies used thin 23- to 32-gauge needles to make many shallow injections, and methods such as nappage, depot, and fine linear injection were also used ^[1].

A 2018 expert consensus on non-animal stabilized hyaluronic acid gel proposed an approach of up to 3 initial sessions followed by ongoing maintenance treatment ^[4]. It stated that changes are visible even after the first session, but that when treatment is repeated at intervals of 4 to 6 months, gradual improvement in skin texture can be seen for up to 12 months ^[4]. However, this is a consensus of an expert panel, and its level of evidence differs from that of results from randomized controlled trials.

Methods used besides hyaluronic acid

A method of injecting diluted botulinum toxin into the dermis as many very small droplets has also been studied for improving facial skin ^[6]. There are prospective studies and case reports in which botulinum toxin helped with facial flushing and skin texture, but their number is still small ^[6].

Topical hyaluronic acid cosmetics are also widely used because of their moisturizing and anti-aging properties, and it has been summarized that many studies show them to be an effective noninvasive way to improve skin hydration and rejuvenation ^[3]. In one randomized controlled trial, applying a hyaluronic acid serum after botulinum toxin injections made the improvement in wrinkles last longer ^[3]. However, the sources reviewed for this article include no studies directly comparing topical products with injections.

Side effects and precautions

A 2022 review stated that choosing the right hyaluronic acid product and placing it precisely at the intended depth in the dermis are key to improving the effect and reducing side effects ^[1]. The side effects mentioned there include an uneven skin surface and the Tyndall effect ^[1]. The Tyndall effect is known as a bluish tint that shows through the skin when hyaluronic acid is placed too shallowly.

A 2023 systematic review summarized that hyaluronic acid injections were quite safe ^[2]. Even so, because it is an injection treatment, reactions such as bruising, swelling, pain, and redness can occur, and in rare cases more serious problems may develop, so it is a good idea to let the clinic know right away if you notice any unusual symptoms after treatment.

Factors that affect results and what to check during your consultation

Even with the same treatment, results differ depending on skin condition, age, and lifestyle. A 2022 review stated that older people with severe photoaging may need other rejuvenation treatments as well, and that maintenance treatment every few months is needed to keep the results ^[1]. Checking the following during your consultation can help set realistic expectations.

• The skin concerns you want to improve (hydration, texture, elasticity, and so on)
• The ingredients to be used and whether they are cross-linked
• The expected number of sessions, the interval between them, and the maintenance plan
• Possible side effects and what will be done if they occur
• Recent treatments, medications you are taking, and any history of allergies