Evidence Notes · No. 07
← All notesHyaluronic acid injected into the plaque, usable in the active phase when most other injectables are not. Safe, promising — and resting on a smaller evidence base than the brand name suggests.
Peyronie's disease is a condition where restrictive scar tissue (called a plaque) builds up inside the penis. This leads to curved, often painful erections and can significantly impact a man's sexual function and quality of life.
For years, treatments have been limited to either highly invasive surgery or injections that are only approved for the late, "stable" phase of the disease. However, a newer treatment using a specific formulation of hyaluronic acid, known under the brand name Perovial, is changing how specialists manage the condition—especially in its early stages.
This guide breaks down the latest medical evidence—including systematic reviews, early clinical data, and randomised trials—to help you understand if Perovial injections are the right choice for you.
The treatment involves a series of injections directly into the penile plaque (intralesional injections) using Perovial, a highly purified, buffered solution of hyaluronic acid (HA) sodium salt. Hyaluronic acid is a naturally occurring substance found in high concentrations in the body's connective tissues.
Perovial is currently the first hyaluronic acid formulation specifically approved for the treatment of Peyronie's disease. A typical treatment programme consists of several injection sessions (ranging from three injections given every two weeks, to a 10-week weekly protocol, depending on the clinic), often combined with at-home penile stretching and vacuum device therapy to mechanically stretch the plaque.
In Peyronie's disease, the plaque is formed by disorganised, inflamed collagen. Hyaluronic acid is a large, highly polarised molecule that draws in water, deeply hydrating the tough scar tissue.
By injecting HA directly into the plaque, it acts to soften the scar. Scientific reviews show that hyaluronic acid possesses anti-inflammatory and antioxidant properties, which help to halt the progression of the disease and remodel the abnormal collagen. This mechanical softening, especially when combined with gentle stretching exercises, allows the penis to straighten.
Yes, current evidence suggests it is an effective and safe option. Systematic reviews of hyaluronic acid for Peyronie's disease confirm that intralesional HA injections significantly reduce plaque size, improve penile curvature, and enhance overall erectile function.
In a recent 2026 clinical experience study specifically using Perovial, over 82% of treated patients experienced measurable improvements in their penile curvature and reported better outcomes on standardized symptom questionnaires.
Curve improved
82%of treated patients
A 2026 clinical-experience study. A single cohort, not a trial.
Median curvature reduction
15°acute-phase patients
A preliminary study. A second series reported 55° falling to 43°.
What kind of evidence this is These are cohorts and clinical experience, not randomised trials. Hyaluronic acid as a class has stronger backing than this particular formulation does, and the two should not be quoted as though they were the same thing.
Clinical studies tracking men treated with Perovial show a meaningful reduction in curvature. In one preliminary study of acute-phase patients, the median curvature was reduced by 15 degrees. Another clinical series reported that patients started with an average curve of 55 degrees, which improved to an average of 43 degrees after treatment.
Patients are typically evaluated about a month after their final injection to measure the final curvature improvement.
Because hyaluronic acid physically hydrates and softens the plaque while calming inflammation, patients—particularly those in the acute (early and painful) phase—frequently notice significant pain relief quite rapidly. The structural improvements (straightening) happen gradually over the course of the injection programme as the tissue remodels.
Current observational studies evaluate patients a few months post-treatment and note that the improvements in curvature and symptoms hold steady. Because hyaluronic acid physically remodels the collagen structure, the results are expected to be long-lasting. However, as this is a relatively novel formulation, long-term follow-up data spanning several years is still being collected by researchers.
Unlike surgery, which is a one-off event, injection therapies are inherently multi-step processes. If a patient completes a standard protocol of Perovial injections but desires further straightening, the treatment can potentially be repeated, or the patient can transition to other therapies like surgery. In the available data, around 17% of patients did not experience an improvement from the initial protocol.
One of the most attractive features of hyaluronic acid injections is their safety profile. Unlike some other injectables that carry a risk of rupturing the penile tissue, HA is extremely well-tolerated with minimal side effects.
In clinical studies, the most common side effects were minor bruising (ecchymosis) at the base of the penis (often caused by the local anaesthetic injection) or a small, temporary collection of blood under the skin (haematoma). There were no reports of severe or dangerous complications.
Perovial injections appear to protect and improve erectile function. Clinical trials and retrospective studies consistently show that men receiving hyaluronic acid injections report improved scores on the International Index of Erectile Function (IIEF). By reducing pain and improving the physical deformity, men find it easier and more comfortable to maintain an erection suitable for sex.
Perovial suits
The cost: a smaller correction than surgery, and a brand-specific evidence base that is still early.
Collagenase suits
The cost: a small but real risk of penile rupture, and it cannot be used while the disease is active.
Perovial is used mainly in the acute phase of Peyronie’s disease — the early stage, when the plaque is still forming, the curve is still changing and erections are painful. That is also the stage at which the disease can settle of its own accord, which is part of why the evidence here is hard to read. It is a reasonable option for a man who wants something minimally invasive and will accept a smaller correction than surgery in return for a much lower risk.
(Note: Patients with purely ventral (downward) curvatures or completely calcified (bone-hard) plaques were excluded from early Perovial studies, meaning it may not be suitable for those specific presentations.)
The evidence supporting the general use of hyaluronic acid for Peyronie's disease is strong, backed by systematic reviews, meta-analyses, and a double-blind randomised controlled trial.
However, the evidence specifically evaluating the branded Perovial formulation is currently considered promising but preliminary. The existing data relies on retrospective reviews and small early-experience cohorts. While the early results are highly encouraging, larger, prospective clinical trials are needed to fully establish its long-term superiority.
Systematic reviews, meta-analyses and a double-blind randomised trial against verapamil.
Retrospective reviews and small early-experience cohorts. Encouraging, not established.
Bruising and small haematoma are the common events. No severe complications reported.
The distinguishing claim, and the reason it is discussed at all — but the supporting data are early.
Follow-up runs to months rather than years. Longer data are still being collected.
A regulatory note Perovial is a prescription-only medicine. Nothing on this page is an offer of treatment; suitability is decided by a consultant after assessment.
Hyaluronic acid as a class has good evidence behind it in Peyronie’s disease, including a double-blind randomised trial against verapamil. The Perovial formulation specifically does not — that rests on retrospective reviews and small early cohorts, which is why this page grades the two separately. What can be said is that it is well tolerated, that bruising is the usual complaint, and that the reported improvements in curvature and pain are meaningful rather than transformative. It offers a smaller correction than surgery at a much lower risk. No particular outcome can be promised, and anyone presenting it as settled is ahead of the evidence.
Every figure on this page is traceable to one of these. Where a study is small, unrandomised or industry-sponsored, that is stated in the text rather than left in the footnote.
Where this leaves you
Assessment establishes whether the disease is still active or has settled. Perovial belongs to the active phase; once the shape has held steady for months, other options become appropriate.