Ingredient Beauty BenefitsRoute · Injection
Hyaluronic acid filler: the thing every other injectable on this site uses as its control
In a double-blind split-face trial following 174 people for 15 months, new hyaluronic acid fillers were **non-inferior** to an established one. That pattern is characteristic: there are many randomised trials, **almost all filler against filler**, and they mostly conclude 'no difference'. But it has one property nothing else here has — **it can be dissolved.**
Last checked Sep 17, 2026
Hyaluronic acid filler is the most widely performed injectable procedure in the world. And it holds a particular place on this site: the trials on the CaHA, PCL and hADM pages all used hyaluronic acid as their control.
It is the benchmark the others measure themselves against. We built this page later, but if you have read those three, this is the one to read again first.
This is not a topical cosmetic. It is an injected procedure performed in a clinic, and this layer is kept separate from the ingredient layer. Topical hyaluronic acid has its own page in the ingredient layer, and it is the same molecule but an entirely different subject — one sits on skin, the other goes into dermis.
We have not opened the Korean device approval record, so the classification here says 'being verified'.
What is established
Non-inferior over 15 months of follow-up
The 2020 trial is the firmest thing on this page: a 15-month, multicentre, randomised, double-blind, split-face study in 174 subjects with moderate-to-severe bilateral nasolabial folds. Two newly developed resilient hyaluronic acid fillers were compared against an established comparator available in the United States.
Mean Wrinkle Severity Rating Scale scores and responder rates improved significantly, and non-inferiority was established over 15 months. There were no meaningful differences between the fillers. Participants spanned all Fitzpatrick phototypes.
There are more trials of the same shape — a 12-month randomised comparison from 2017 (severe nasolabial folds, two hyaluronic acid fillers) and a 2022 multicentre study (moderate-to-severe folds, Chinese population). We could not confirm their detailed figures from the abstracts, so they are listed as sources only.
How to read it: a non-inferiority trial is designed to show that a new product is no worse than an existing one. The question these answered is closer to which product to choose than to whether the volumising works at all.
That said, for a volumising procedure this limitation bites less hard than it does for a device like radiofrequency or microfocused ultrasound, because the material physically occupies space.
- Randomised controlled trial in people · 174 participants · 65 weeks · Compared with another active ingredient · Funding not declared · Endpoint scores from blinded assessors PMID 32217842
We found no trial comparing against injecting nothing
Here is the sentence this site has now written on ten procedure pages. Every randomised hyaluronic acid filler trial we read used another filler as its control.
Gathering what this layer has established so far:
- Radiofrequency: control was another device. No sham control.
- Microfocused ultrasound: control was another setting of the same device, or another device.
- CaHA, PCL, hADM: control was another filler.
- Hyaluronic acid filler: control was another hyaluronic acid filler.
This is a structural feature of aesthetic trials. To register a new product you compare it against an existing one, and that is what regulators ask for. There is no commercial reason to compare against doing nothing.
So the answer to 'does this procedure work' usually comes from physics rather than from a trial — put a material with volume somewhere and that place is filled. That is a reasonable inference, but it is not the kind of evidence this site demands elsewhere.
It can be dissolved — and on this layer, only it can
This is where hyaluronic acid filler differs decisively from every other injectable here.
An enzyme, hyaluronidase, dissolves it. Which means there is a way back both when the result is unwanted and when a vessel has been occluded.
The 2026 systematic review shows the contrast in its own title: visual loss in 'non-hyaluronic acid injectables'. Grouping the non-HA products separately is itself the point. Its counts:
- CaHA: at least 11 published cases of vascular occlusion causing visual impairment
- PLLA: 2 · PDLLA-CMC: 2 · PDLLA-HA: 1
- PCL: no published blindness cases, one facial artery embolism
Vascular occlusion happens with hyaluronic acid fillers too. Having a way to reverse it does not mean there is no risk. It means what you can do about it is different.
What that actually changes: choosing an irreversible material from the start and choosing a reversible one are different decisions. Compare only on how long each lasts and this axis disappears.
Known risks
- Pain, swelling, bruising and redness at the injection site.
- Nodules, lumps and asymmetry.
- Tyndall effect — placed too superficially, it shows through as a bluish tint.
- Vascular occlusion. Rare but real, and it can reach visual loss. Hyaluronidase can reverse it, but timing matters.
- Delayed nodules and granulomas are reported.
- Any adverse reaction needs to be seen immediately by the clinic that performed the procedure.
What is not established
- We found no trial comparing against injecting nothing.
- Differences between products — since the trials mostly end in 'no difference', the evidence on which product is better is thinner than you would expect.
- What repeated treatment over many years produces.
- We have not verified the Korean device approval class.
Whether to have it done is a decision to make with a doctor.
What this article relies on
- PubMed — 미국 국립의학도서관 문헌 데이터베이스National Library of Medicine · Checked on 2026-09-16