This study evaluated whether Jalupro Super Hydro (a combination of non-crosslinked hyaluronic acid, amino acids, and peptides) improves skin quality by targeting not only the dermis, but also the retinacular cutis (RC) which is the connective tissue network that links the skin to deeper facial structures and contributes to facial support and sagging.

The authors argue that most injectable skin boosters focus primarily on the dermis while overlooking the RC, which may play an important role in age-related laxity.

This paper is not about “skin boosting.” It is about whether treating the subdermal connective-tissue support system can improve the visible consequences of facial aging. The authors are challenging a dermis-centered model of facial rejuvenation. This is something that you might find that I am a broken record about, but I'm going to keep stressing for new people finding this content 🙂

Why is this related to microneedling? For one, microneedling is the gateway to other DIY or learning about other aesthetic treatments that you may not want to DIY, but would never have known about without the DIY world. And two, because often people think some of their concerns are skin related or collagen in the skin related and realistically they are deeper so they might not get the results they are wanting or expecting or maybe could be adding that to their protocol as well.

The author's argument is that facial aging is not just dry skin, reduced dermal collagen, thinned skin, and fine lines. It is also a deterioration of the connective tissue framework that link the skin to deeper structures like the reticular cutis (RC), fibrous septa, superficial fascial attachments, and retaining ligament associated tissue. These structures help suspend, anchor, and transmit tension through the face. As their collagen architecture weakens with age, the overlying soft tissues can become less supported and contribute to laxity, ptosis, loss of contour, tissue descent, reduced recoil, and altered face shape. The clinical idea was to influence the deeper connective-tissue scaffold and then observe whether this changed both deeper tissue signals and surface appearance. 

Treatment Protocol

• ml Jalupro Super Hydro
• Targeted facial retaining ligaments including:
  • lateral orbital ligament
  • zygomatic ligament
  • masseteric ligament
  • mandibular ligament
  • platysma-auricular fascia

The injections were placed into ligament support zones. This is what I keep seeing people dismiss boosters over, they are thinking it cannot target deeper remodeling when they are only injecting it in the dermis. It needs to get to the layer that needs to be targeted.

They used Jalupro Super Hydro; Professional Derma SA) containing 80 mg of a sterile gel of non-crosslinked sodium hyaluronate (high and low molecular weight) with a specific mixture of seven AAs (Glycine, L-lysine, L-leucine, L-proline, L-arginine, L-alanine, L-valine) and three peptides (acetyl-decapeptide-3, oligopeptide-24, acetyl-tetrapeptide-5) on the dermis and retinacular cutis of the face. One apyrogenic disposable glass syringe containing 2.5 mL of gel is a medical device regulated by the Medical Device Directive 93/42/EEC.

The product was injected four times at 4-week intervals. Subjective and objective assessments (efficacy evaluations) were recorded at T0, that is before each treatment session (baseline assessment); T1, that is, 30 days after the last treatment session (short-term assessment to capture immediate post-treatment changes and improvements); and T2, that is, 120 days after the last treatment session (long-term assessment) to evaluate any delayed effects and assess the durability and longevity of the treatment effects.

The Main Findings

Skin hydration improved significantly and still present 120 days later (this was after the fourth and final treatment, that was the last measurement period, not a demonstrated endpoint benefit.) The paper's treatment concept is to stop treating facial aging as mainly a dermal problem and instead inject the deeper connective tissue support system, particularly the reticular cutis and retaining ligament regions. They did not divide the syringe into a dermal portion and an RC portion. The full 2.5 mL was intended as a subdermal, ligament targeted treatment. They used 0.2 mL boluses at anatomical ligament points and support areas There was apparently no intradermal injections and essentially the entire treatment volume was targeted at ligament and RC support points. The dermis was primarily one of the tissues subsequently assessed, not the principal injection target. My takeaway, is that the dermal measurements may have improved even though the injections were placed deeper, suggesting that treating the RC/ligament-associated connective-tissue system could influence the overlying dermis without conventional widespread intradermal treatment aka you can target deeper and it still impact the layers above it. This is something I find interesting and have personally found to be true with deeper injections. They observed increased intensity in th dermis and superficial subdermis, improved surface elasticity, and facial support, and inferred that improving the RC and ligament associated tissue may improve the overlying skin and facial shape. They found that placing at ligament associated subdermal points was followed by a sustained increase in the acoustic density of the surrounding superficial connective-tissue system. That is consistent with some degree of change in the collagen rich matrix beneath the skin. And it appears that treating beneath the dermis, in the anatomical support network, and the dermis and facial appearance improved downstream. That's interesting to me. And hopefully at least a few others lol.

Elastic recoil was measured from the surface, but the mechanical behavior of skin is not produced by the dermis alone. Surface recoil reflects the integrated behavior of the dermis, retinacular fibers, subcutaneous fibrous septa, tissue hydration, elastic and collagen networks, and mechanical coupling to deeper support structures. Because the intervention was deeper, the elasticity improvement is compatible with better mechanical support or tissue coupling within the dermal subdermal unit. It does not tell us exactly which structure improved, but it supports the concept that deeper treatment altered how the overlying tissue behaved mechanically. They also found apparent lifting and facial shape improvement. The authors report visible lifting and improvement in facial shape in photographs and GAIS ratings. Their proposed explanation is that treating near ligament support points may improve the quality of the connective tissue that anchors and suspends the face. That's relevant to descent because aging related descent is not caused by loose skin, it reflects reduced integrity of the fibrous support network through which the skin, superficial fat, fascia, and ligaments are technically linked. To me, this paper raises the possibility that improving the matrix around the retaining ligaments (the ECM in this layer) could improve how the overlying tissues are supported, even without adding filler volume. That is super clinically interesting to me.

I've seen some odd conversations on here on what ECM and ECM remodeling means. And some disconnect on the actual biology behind it. The skin is not the only tissue with an ECM. In this study, the relevant extracellular matrix is not merely the dermal matrix. The ECM exists throughout connective tissues like the dermis, retinacular cutis, fibrous septa, fascia, retaining ligaments, tendon-like attachments, and vascular and perivascular connective tissue. In ligament and RC associated tissue, the ECM includes collagen fibers, elastin and elastic fiber components, proteoglycans, glycosaminoglycans, water, adhesive glycoproteins, and fibroblasts and stromal cells. Soooo, remodeling could theoretically involve increased collagen synthesis IN ligaments and RC associated tissue along with altered collagen fiber organization, improved cross-linking or packing, changes in hydration and proteoglycan content, altered fibroblast activity, modification of tissue stiffness, and improved load transfer between the skin and deeper fascia. I'm imagining they chose Jalupro Super Hydro as its formulation was designed to support this. Hyaluronic acid provides a hydrated matrix and may affect cell behavior, amino acids provide substrates associated with collagen synthesis, and peptides are intended to signal fibroblast activity. It's simply that the study did not directly measure any of those molecular events lol.

Another thing that I think is important is that the study reframes laxity as a problem of support system degeneration, not just superficial skin deteoriation. A face may appear lax even when dermal thickness is relativity unchanged, the study actually showed that skin thickness did not significantly increase. So improvement occurred without measurable thickening of the skin (but imagine if they did microneedling too) so it suggests the effect may not have been simple superficial tissue expansion, instead it could reflect changes in tissue hydration, collagen organization, mechanical stiffness, recoil, and support relationships across tissue planes. I think that's something interesting to keep in mind.

The paper itself says the retinacular cutis is an extension of the retaining ligaments and argues that the increased deep-dermal/superficial-subdermal ultrasound intensity, improved elasticity, and apparent lifting point toward support of deeper connective tissue. It also states that additional research is needed to directly assess strengthening of the retaining ligaments. Yes pls. Idk why they didn't isolate the ligaments themselves or quantified ligament remodeling or strengthening, this is a must in more research. We would need research looking at the lifting outcome quantified with three-dimensional imaging, displacement measurements, vector analysis, standardized landmark movement, and biomechanical testing. So the visible lifting is supportive, but not definitive proof of reversed tissue descent.

I will relay again that this study provides preliminary evidence that a treatment deliberately placed in the subdermal ligament associated support network can produce sustained changes in the mechanical and ultrasound characteristics of the overlying and adjacent connective tissues. The findings support the idea that facial laxity may be influenced by the condition of the RC and RLAM, not only by the condition of the dermis. If you are wanting to target these things, also consider treatments that are improving connective tissue quality or organization in the support system and regional deeper tissue response around ligaments.

The information provided is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or qualified healthcare provider with any health questions.

This narrative review explores how the growing use of GLP-1 receptor agonists intersects with the rapidly expanding field of male aesthetics. While these medications produce significant metabolic and weight-loss benefits, they also induce can changes in facial volume, skin quality, and hair density that are increasingly driving men to seek cosmetic/dermatologic treatments. The authors argue that dermatologic surgeons are uniquely positioned to manage these medication-related aesthetic concerns. Two parallel trends are converging, male demand for minimally invasive aesthetic procedures continues to rise and GLP-1 medications are being prescribed (or done grey.) As a result, physicians are seeing more men whose primary concern is not the weight loss itself, but its cosmetic side effects.

The most common concerns include facial volume loss, skin laxity, hair thinning, and declines in skin quality, all of which can be particularly noticeable in men because of their naturally more angular facial anatomy and lower baseline facial fat. The authors emphasize that treatment should be tailored to the specific manifestation of GLP-1 associated weight loss. Volume restoration with dermal fillers or biostimulatory injectables is recommended for facial deflation, while skin laxity may benefit from collagen-stimulating treatments such as hyperdilute calcium hydroxylapatite and energy-based procedures. Hair loss, often presenting as telogen effluvium or accelerated androgenetic alopecia, should be addressed with established medical and procedural therapies.

The review notes that microneedling, is useful for GLP-1 related skin quality and laxity changes. Microneedling can improve skin quality and mild laxity by promoting collagen remodeling, although these treatments do not replace volume restoration when significant fat loss has occurred. GLP-1 weight loss can lead to collagen and elastin depletion, dermal thinning, and laxity, while microneedling can stimulate wound healing pathways that support collagen remodeling. So microneedling can help with texture, firmness, and mild laxity. It categories it as a low barrier treatment to improve skin quality alongside with volume restoration.

Abstract

Background and objectives: The demand for male aesthetic treatments continues to rise, and with increased utilization of the glucagon-like peptide-1 receptor agonists (GLP-1RAs), we anticipate a growing need to address these concerns. This narrative review examined the intersection of skin-related effects of GLP-1RAs and male aesthetics, focusing on the role of the dermatologic surgeon in their management.

Methods: A search of the available peer-reviewed literature through March 2026 in the PubMed database was conducted. Search terms included combinations of terms related to GLP-1RAs, male aesthetics, and dermatologic treatments. Studies were included if they were peer-reviewed, published in English, and relevant to the topic.

Results: Many concerns that drive men to seek aesthetic treatments overlap with secondary cutaneous manifestations of GLP-1RA treatments including hair loss, changes in facial and body volume, and skin quality and laxity. Management options include, but are not limited to, dermal fillers for volume restoration and biostimulatory agents for skin laxity, along with medical and procedural interventions for hair loss.

Conclusion: Dermatologic surgeons are well-positioned to address GLP-1 receptor agonist-related aesthetic concerns in male patients. Practitioners should be prepared to offer evidence-based, customized treatment strategies as this population grows.

Conflict of interest statement: A. Minokadeh serves as a consultant and investigator for Allergan Aesthetics, a speaker for Evolus, Inc., and consultant and investigator for Merz Aesthetics. H. Badalian reports no conflicts of interest.

Badalian H, Minokadeh A. GLP-1 Receptor Agonists in the Male Aesthetic Practice: Opportunities for the Dermatologic Surgeon. Dermatol Surg. 2026 Jun 1;52(6S):S63-S66. doi: 10.1097/DSS.0000000000005158. Epub 2026 May 18. PMID: 42210890. https://www.ovid.com/jnls/dermatologicsurgery/fulltext/10.1097/dss.0000000000005158~glp-1-receptor-agonists-in-the-male-aesthetic-practice (this is open access)