Beyond Volumization: Repositioning Hyaluronic Acid Fillers as Anatomy‐Guided Structural Support Tools in the Era of Biostimulators

Background Hyaluronic acid (HA) fillers remain widely used in facial rejuvenation, yet concern about overfilled syndrome and unnatural volumization has shifted attention toward biostimulators. These concerns may reflect a mismatch between volumetric treatment logic and structural problems of facial aging. Objective To propose an anatomy‐guided framework that repositions HA fillers from default volume replacement toward selective structural support and lifting‐oriented treatment planning. Methods A targeted narrative review of anatomical, clinical, rheological, biological, and vascular‐safety literature was conducted using PubMed, Google Scholar, and relevant journal databases through July 2026. Results Facial aging involves skeletal remodeling, fat‐compartment changes, dermal deterioration, and altered relationships among retaining ligaments and mobile soft tissues. Ligament‐associated HA injection is best interpreted as mechanical scaffold augmentation in selected periosteal or periligamentous support zones rather than injection into the ligament itself or ligament regeneration. Current evidence supports the plausibility of support‐mediated contour improvement but does not establish true tissue repositioning independent of projection or volumizing effects. Product selection should consider plane, function, G′, cohesivity, viscosity, swelling tendency, and vascular risk rather than G′ alone. HA and biostimulators have complementary and overlapping roles. Conclusion HA fillers should not be viewed as obsolete because of overfilling. Appropriate patient selection, anatomy‐guided planning, conservative dosing, region‐specific product selection, and vascular safety may allow HA to function as a structural support tool. The future of HA filler treatment is not less HA, but better‐directed HA.