📌 Key Takeaways
- A retrospective analysis of 299,413 treatment sessions across 110 Japanese clinics (2020–2024)
shows adults aged 40+ now account for 63.7% of all HA injections — up from 39.4% in 2021. - The orbital rim (tear trough area) surpassed the nasolabial fold
as the most-treated site in 2024, representing 22.6% of all injection sites. - Average sessions per clinic rose from 391.7 (2021) to 1,068.9 (2024) —
a 2.7× increase that signals genuine demand growth, not just network expansion. - The shift reflects a broader industry transition:
from localized contouring to full-face structural rejuvenation.
The assumption that hyaluronic acid (HA) fillers are primarily a treatment for younger patients
has been challenged by one of the largest clinical datasets ever published in Japan.
In January 2026, a research group affiliated with the Tokyo Chuo Biyou Geka (TCB) clinic network
published a nationwide big-data analysis in the Journal of Clinical Medicine.
The study examined 299,413 treatment sessions and 417,590 injection sites
across 110 clinics between October 2020 and December 2024.
The findings point to a structural shift in who seeks HA injections — and why.
About the Dataset: Scale, Design, and Limitations
Before interpreting the findings, it is important to understand
the nature and boundaries of this dataset.
① Network-specific data: This dataset reflects TCB’s own clinics,
not a random sample of Japan’s broader aesthetic medicine market.
The network’s marketing strategy, pricing, and training protocols
may influence patient demographics and site selection.
② Session count, not unique patients: The figure of 299,413 represents treatment sessions,
not individual patients. Repeat visits by the same patient are counted multiple times.
③ Product standardization effect: The switch to YVOIRE (LG Chem) across all clinics in 2021
may have influenced injection site preferences,
as different HA formulations have different rheological properties suited to different anatomical zones.
What “63.7% Over 40” Actually Means
The age distribution shift documented in this study is unambiguous.
In 2020, patients in their 20s represented the largest age cohort.
By 2023, adults in their 40s had become the dominant group,
and the 40+ bracket as a whole crossed the 50% threshold.
The network expanded from 64 to 110 clinics over this period,
which partially explains the raw volume increase.
However, the paper itself highlights a more telling metric:
average sessions per clinic rose from 391.7 in 2021 to 1,068.9 in 2024 —
a 2.7× increase that cannot be attributed to network growth alone.
It reflects a genuine expansion in per-clinic demand.
Why the Orbital Rim Became the Top Injection Site
In 2024, the two most-treated facial zones were:
In 2021–2022, the nasolabial fold and pretarsal fullness (lower eyelid area)
were the dominant treatment zones.
The orbital rim has risen steadily year over year,
reaching the top position in 2024.
Facial aging is not simply a surface phenomenon.
It originates from structural changes deep within the face —
a concept known as the “Inside-Out” theory.
Three anatomical mechanisms drive the rise of orbital rim treatment:
① Orbital expansion with age: The bony orbit enlarges over time,
reducing the skeletal support for overlying soft tissue.
② Deep fat compartment atrophy: Structures such as the deep medial cheek fat
diminish with age, causing surrounding tissue to descend.
③ Anterior projection restoration: Injecting along the orbital rim
rebuilds the structural foundation from within,
addressing the root cause rather than surface symptoms.
The clinical logic has shifted from “filling the nasolabial fold directly”
to “restoring the deep scaffolding that prevents the fold from forming.”
Age-Stratified Injection Patterns: Younger vs. Older Patients
Under 20: Pretarsal fullness (lower eyelid volume / aegyo-sal area) at 46.7% —
the dominant site. Chin augmentation also prominent.
Primary goal: contouring and facial definition.
30s–40s: Increasing treatment of nasolabial folds, orbital rim,
and mid-cheek groove.
Shift from single-site to multi-site treatment planning.
50s (50–59): Orbital rim at 30.1%, nasolabial fold at 26.8%.
Pretarsal fullness drops to low levels.
Primary goal: full-face rejuvenation.
Marionette line treatment rises sharply —
odds ratios for patients 40+ were statistically significant (p < 0.05).
Age was identified as a significant predictor of multi-site treatment (p < 0.001).
From Contouring to Full-Face Design: What This Shift Means
The change documented in this dataset is not simply about
“a broader demographic seeking aesthetic treatments.”
It reflects a deeper shift in patient motivation.
What patients are asking for has changed:
The demand has moved from localized enhancement —
“sharpen the chin,” “define the double eyelid” —
to a more analytical approach:
“understand why my face looks older and address it structurally.”
This raises the bar for clinical communication:
Clinics that cannot explain why the orbital rim is being treated,
or why multiple sites are addressed simultaneously,
will find it harder to retain patients in this demographic.
The gap between physicians who can design a full-face treatment rationale
and those who simply inject where patients point
is becoming increasingly visible — and commercially significant.
What this data reveals is what has long been hidden
behind the phrase “getting filler.”
Adults over 40 now represent more than 60% of sessions,
and the orbital rim has become the top injection site.
This tells us that the primary patient seeking HA treatment today
is someone who wants to understand the structural causes of facial aging —
and address them deliberately.
That is a fundamentally different motivation
from “I just want something affordable and quick.”
For clinic operators and industry observers:
this remains a TCB-network dataset.
Generalizing it to the entire Japanese market would be premature.
That said, the scale, duration, and granularity of site-level classification
make this one of the most detailed HA injection analyses published in Japan to date.
The ability to recruit, train, and retain physicians
who can articulate a full-face design rationale
will likely become a key differentiator
in competing for the 40+ patient segment.
Summary
- A retrospective analysis of 299,413 treatment sessions across 110 TCB network clinics (Oct 2020 – Dec 2024)
was published in the Journal of Clinical Medicine on January 22, 2026
(DOI: 10.3390/jcm15020893).
Generalization beyond the TCB network requires caution, as the authors themselves note. - The share of patients aged 40+ rose from 39.4% (2021) to 63.7% (2024),
crossing the 50% threshold in 2023.
Average sessions per clinic grew 2.7× (391.7 → 1,068.9),
indicating demand growth beyond network expansion. - The orbital rim became the most-treated site in 2024 at 22.6%,
followed by the nasolabial fold at 20.6%.
This reflects growing clinical adoption of deep structural approaches
to address skeletal and fat compartment changes associated with aging.
Age was a significant predictor of multi-site treatment (p < 0.001). - The transition from contouring to full-face rejuvenation design
demands greater explanatory capacity from clinicians.
For patients, the ability to evaluate whether a clinic operates with a coherent treatment philosophy
— not just technical injection skill — is becoming increasingly important.
Rather than filling surface lines directly, clinicians are increasingly targeting the deep skeletal and fat compartment changes
that cause those lines to form — an approach grounded in the “Inside-Out” theory of facial aging.
but to address age-related structural changes in bone and soft tissue.
Greater awareness of facial anatomy and aging mechanisms —
partly driven by social media and more transparent clinical communication —
appears to be expanding the 40+ patient base.
and how it functions within the overall facial structure.
A practitioner who can assess whether a nasolabial fold stems from orbital bone changes
or direct soft tissue descent — and design treatment accordingly —
represents a meaningfully higher standard of care.
Product selection (HA formulations vary in firmness, longevity, and site suitability)
should also be discussed transparently.
Source: Tamura T, Tamura T, Okumura K, Teranishi H. “From Contouring to Rejuvenation: A Nationwide Big-Data Analysis of Hyaluronic Acid Injection Trends in Japan.” Journal of Clinical Medicine. 2026;15(2):893. doi:10.3390/jcm15020893 (Primary source — full text directly verified)
