Hypertonic Dextrose in Aesthetic Dermatology: Route-Dependent Evidence, Biological Rationale, and Research Priorities

Objective: To critically evaluate whether local hypertonic dextrose has sufficient biological and clinical support to be considered an independent dermal biostimulant in aesthetic dermatology. Methods: PubMed/MEDLINE was searched from inception through June, 2026, with backward and forward citation tracking. Direct evidence included human aesthetic or dermatologic studies using local dextrose and translational studies examining dermal delivery or tissue response. Evidence was appraised by design, comparator, blinding, cointerventions, outcome validity, follow-up, and directness to a dextrose-specific effect. Results: Six human reports enrolled 125 participants in aggregate, and 2 translational studies examined pneumatic delivery. Favorable signals were reported for facial laxity, atrophic lesions, pores, fine wrinkles, and acne-scar volume. However, every human protocol included pneumatic pressure, microneedling, focused ultrasound, hyaluronic acid, or another active cointervention. A 5% versus 20% split-face study supports a concentration-dependent or osmolarity-dependent signal within pneumatic delivery, not glucose-specific neocollagenesis. Translational studies demonstrate device-induced tissue injury and penetration into fat and fascia. Reported adverse events were mainly transient; 2 cases of postinflammatory hyperpigmentation occurred in one 30-patient series. Conclusion: Hypertonic dextrose should be regarded as an investigational, route-dependent adjunct rather than an established stand-alone biostimulant. Controlled trials should isolate device, vehicle, osmolarity, and glucose-specific effects and include objective structural endpoints and long-term safety follow-up.