The goal of this randomized, split-face, double-blinded clinical trial is to evaluate the efficacy and safety of Elravie Re2O (particulated human Acellular Dermal Matrix, phADM) as a skin booster compared with hyaluronic acid (HA) skin booster alone in adults with skin roughness.

The main questions it aims to answer are:

1. Does phADM combined with HA improve objective skin measurements and subjective skin assessments more effectively than HA alone?
2. Is phADM + HA treatment safe and well tolerated?

Researchers will compare one half of participant's face treated with phADM + HA versus the opposite cheek treated with HA alone to see if phADM provides superior skin improvement.

Participants will:

1. Be randomly assigned to receive three intradermal injections at one-month intervals, with phADM + HA on one cheek and HA alone on the other.
2. Undergo follow-up visits over 20 weeks for evaluation of ACSS score, instrumental skin quality measurements (e.g., skin density, volume, wrinkles), and satisfaction (GAIS).
3. Be monitored for local adverse events and changes in vital signs to assess safety.

Inclusion Criteria:

• Male or female aged 30 to 65 years old
• Those with an Allergan Cheek Smoothness Scale (ACSS) score of 2-3 during screening

Exclusion Criteria:

• Those who have received dermal fillers, botulinum toxin injections, mesotherapy, or other cosmetic procedures (e.g., laser) on the face within 12 months of screening or plan to receive such treatments during the trial period.
• Those who received facial wrinkle correction treatment within 6 months of screening
• Those with inflammatory diseases in the facial area
• Those with infectious diseases, skin grafts, keloids, or hypertrophic scars on the face.
• Those with autoimmune diseases
• Those who have experienced anaphylaxis or severe complex allergies for any reason
• Those who were prescribed anticoagulant therapy within 2 weeks of the screening date
• Those with a history of serious cardiopulmonary disease
• Breastfeeding
• Those who have started using or taking external or oral agents for wrinkle improvement within 30 days of screening

Individual participant data (IPD) will not be shared due to privacy concerns and institutional policies that restrict data sharing beyond the research team. Data were collected under a protocol that did not include participant consent for public or external data sharing.