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Meng Jiang,1 Haiyan Cheng,1 Yan Li,1 Hongmei Ai,2 Jun Li,3 Yanjun Liang,4 Wei Xu1 1Department of Dermatology and Venereology, Beijing Friendship Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Plastic Surgery, Emergency General Hospital, Beijing, People’s Republic of China; 3Department of Medical Cosmetology, Nanjing Women and Children’s Healthcare Hospital, Nanjing, People’s Republic of China; 4Department of Medical Cosmetology, Taiyuan Central Hospital, Taiyuan, People’s Republic of ChinaCorrespondence: Wei Xu, Department of Dermatology and Venereology, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, Beijing, 100050, People’s Republic of China, Email 2403649155@qq.comBackground: Horizontal neck lines are an early and conspicuous marker of cutaneous aging. Intradermal hyaluronic acid (HA) injections have become a standard minimally invasive countermeasure, yet comparative data for composite HA solutions in Asian populations remain scarce.Purpose: To evaluate the efficacy and safety of injectable sodium hyaluronate composite solution (NCTF® 135 HA) compared with injectable sodium hyaluronate composite solution (HEARTY®) for the correction of moderate-to-severe neck wrinkles.Methods: In this prospective, multicenter, randomized, evaluator-blinded, active-controlled, non-inferiority trial, 188 subjects with moderate-to-severe neck wrinkles were randomly assigned (1:1) to the experimental group or the control group, with both groups receiving three sessions of non-cross-linked injectable sodium hyaluronate composite solution at 4-week intervals. Improvement of Allergan Transverse Neck Lines Scale (ATNLS), subject-assessed Global Aesthetic Improvement Scale (GAIS) and adverse events (AEs) were evaluated and compared before the 3 injection sessions and at 4, 12, and 24 weeks post-final injection.Results: At week 4 post-final injection, the ATNLS response rates were 88.30% in the experimental group and 85.11% in the control group, respectively, with a between-group difference of 3.19% (95% confidence interval (CI): [− 0.0723, 0.0987], p = 0.5410), demonstrating non-inferiority of the experimental treatment to the active control. Among the secondary endpoints, neither ATNLS response rates at additional time points nor subject-assessed GAIS responder rates showed statistically significant differences between groups. A total of 128 adverse events were reported, with no statistically significant difference between groups: 26 (27.66%) in the experimental group and 38 (40.43%) in the control group. No device- or procedure-related serious adverse events occurred.Conclusion: Injectable sodium hyaluronate composite solution (non-cross-linked) provides safe, effective, and non-inferior correction of moderate-to-severe neck wrinkles compared with active control, expanding minimally invasive therapeutic options for cervical rejuvenation.Keywords: multicenter, neck wrinkles, hyaluronic acid, mesotherapy, neck rejuvenation