FDA Approved Cosmetic & Skin

Hyaluronic Acid

also known as: HA, Hyaluronan, Sodium hyaluronate, Juvéderm, Restylane, Synvisc, Euflexxa

A naturally-occurring glycosaminoglycan, injectable cross-linked forms of which are the most-used dermal fillers worldwide and are FDA-approved for osteoarthritis-related knee pain.

A high-molecular-weight polysaccharide that binds water and occupies extracellular space; injectable cross-linked formulations provide soft-tissue volume for aesthetic filling and viscosupplementation for osteoarthritic joints, with molecular weight and cross-link density tuning the product's longevity and tissue behavior.

Mechanism of action

Native HA binds large amounts of water (up to 1000x its mass), providing hydration and structural support in the extracellular matrix. In skin, it interacts with CD44 and RHAMM receptors and influences fibroblast signaling; cross-linked dermal filler additionally stimulates de novo collagen production through sustained mechanical stretching of the surrounding matrix. In joints, injected HA temporarily restores synovial fluid viscoelasticity and may modulate chondrocyte signaling, though systematic reviews disagree on clinical benefit magnitude. In all applications, effects are reversible via endogenous hyaluronidase or deliberate injection of exogenous hyaluronidase.

Primary uses

Dermal filler for facial wrinkles, volume loss, and lip augmentation
Viscosupplementation for osteoarthritis of the knee (and off-label other joints)
Ophthalmic viscoelastic in cataract and anterior segment surgery
Dry eye and wound healing topical formulations
Biostimulatory injectables (Profhilo, Skinboosters) for skin quality

Typical dosing

0.5–5 mL per session single procedure; repeat every 6–18 months (dermal injection, intra-articular injection, or topical)

Product-specific. Dermal filler: 0.5–2 mL per facial region. Intra-articular knee: 2 mL weekly × 3 injections (single-dose products also available). Concentration commonly 20–25 mg/mL.

Regulatory status

Multiple FDA approvals. Intra-articular injectables (Synvisc, Euflexxa, Orthovisc, and others) are approved for osteoarthritis of the knee. Dermal fillers (Juvéderm, Restylane, Belotero, RHA, Revanesse, and others) are approved as Class III medical devices for correction of facial wrinkles and volume loss. Also approved for ophthalmic viscoelastic use in cataract surgery and for dry-eye formulations.

References

[review] Fallacara A, Baldini E, Manfredini S, Vertuani S. "Hyaluronic acid in the third millennium." Polymers (Basel), 2018;10(7):701.
[clinical-trial] Bellamy N, et al. "Viscosupplementation for the treatment of osteoarthritis of the knee." Cochrane Database Syst Rev, 2006;(2):CD005321.
[review] Wongprasert P, et al. "Evaluating hyaluronic acid dermal fillers: a critique of current characterization methods." Dermatol Ther, 2022;35(6):e15453.

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Quick facts

Class

Note: Hyaluronic acid is a glycosaminoglycan polymer (repeating disaccharides of D-glucuronic acid and N-acetyl-D-glucosamine), not a peptide. It is included here because injectable HA is a mainstay of the same aesthetic and regenerative-medicine market as peptide therapeutics.

Subcategory

glycosaminoglycan polymer

Sequence

Not applicable — HA is a linear polymer of repeating [D-glucuronic acid (β1→3) N-acetyl-D-glucosamine (β1→4)] disaccharides.

Molecular formula

(C14H21NO11)n

Half-life

dermal: up to 12 months (cross-linked); intra-articular: 17 hours to 1.5 days — Uncross-linked native HA is degraded by hyaluronidase within days. Cross-linked dermal fillers (typically via BDDE) last 4–12 months depending on product chemistry and injection site. Hyaluronidase enzymes can be used to dissolve HA fillers on demand — a key reason for their dominance in aesthetic medicine.

Evidence level

High

Disclaimer

This entry is for educational purposes only and does not constitute medical advice. Dosing information reflects published regulatory or research data and is not a recommendation. Many compounds described here are not approved for human use in the United States. Consult a licensed medical professional before considering any peptide therapy.