Target Treatment Zones: A Zone-Based Clinical Framework for Skin Quality Improvement Using Non–Cross-Linked Hyaluronic Acid and Glycerol

Abstract

Background

Aesthetic medicine has progressively shifted from volume toward skin quality as a key determinant of perceived age and facial attractiveness. Although non–cross-linked hyaluronic acid–based injectables are widely used to improve skin hydration and appearance, clinical application remains largely technique-driven, and structured decision-making frameworks addressing skin texture and visual skin quality as distinct therapeutic objectives remain limited.

Objective

To introduce target treatment zones (TTZs), a skin quality-first, anatomy-guided decision-making framework within the visual aesthetic (VA) methodology, designed to support selective dermal intervention for texture refinement and patient-perceived improvement in skin quality without altering facial volume or contour.

Methods

Evidence on skin quality as a foundational aesthetic parameter was reviewed alongside the rationale for dermal texture refinement using non–cross-linked hyaluronic acid combined with glycerol. The TTZ framework integrates anatomical zoning, zone-specific clinical relevance, and biologically appropriate dermal depth selection. Illustrative clinical cases from routine aesthetic practice are included to demonstrate clinical feasibility, practical application, and conceptual understanding rather than objective efficacy.

Results

The illustrative cases supported the practical application of the TTZ framework for identifying clinically relevant treatment zones and selecting localized dermal intervention while seeking to minimize overtreatment. Serial clinical observations suggested possible improvements in hydration, surface texture refinement, and visual skin quality without volumetric change or contour distortion, while changes in skin texture homogeneity, fine superficial lines, pore appearance, and perceived skin brightness were observed. No formal efficacy analysis was performed.

Conclusion

TTZs are proposed as a conceptual clinical framework that may support the incorporation of skin quality enhancement as a structured planning step rather than as a solely technique-dependent intervention. As an extension of the VA methodology, TTZs are intended to complement structural rejuvenation strategies and support natural, skin-centered aesthetic outcomes.