What is Retuo (Elravie Re2O /BNAJU)? Effectiveness, Downtime, and Differences from Other Preparations

Rituo Injection Fees

Do you have concerns or questions like these?

Hello, this is Smart Skin Clinic, a cosmetic dermatology clinic that performs over 24,000 injections annually.

Conventional skin boosters, so to speak, provide "nutrition" to the skin. Rituo, by contrast, is a treatment that essentially replaces the "framework" of the skin itself. That is precisely why it can be an option for those who have not been satisfied with previous treatments.

In this article, from the perspective of aesthetic dermatology, we thoroughly explain—from a specialist's standpoint—how Rituo works, its effects, downtime, and how it differs from other skin boosters.

Supervisor Information

Group Chief Director, Smart Skin Clinic Group

IshiiIshii KotaKota

Career

Graduated from Juntendo University School of Medicine

Worked at Tokyo Women's Medical University Hospital and affiliated facilities

Worked at a major aesthetic clinic in Tokyo

Affiliations / Qualifications

Board-certified specialist, Japan Surgical Society

Board-certified specialist, Japanese Society of Anti-Aging Medicine

What is Rituo (Re2O)? Features of the treatment

Rituo (product name: Elravie Re2O in the Korean version, BNAJU in the Japanese version) is a skin booster formulation developed by Humedix in Korea.

It is characterized by a novel approach and main ingredient never seen before.

How does it differ from conventional skin boosters? The concept of "directly supplementing"

If you have tried conventional skin boosters but find it hard to feel results, your skin's structure and regenerative capacity may have weakened.

Conventional skin boosters took the approach of injecting PDRN, PDLLA, porcine collagen, and the like to "activate cells and promote the synthesis of the substances that make up the skin."

On the other hand, Rituo is characterized by “an approach that directly replenishes the extracellular matrix (ECM)—the very structure that provides the foundation for lost firmness and elasticity—into the dermis” . Think of it as installing new pillars in a house whose foundation has collapsed. By “rebuilding” the skin’s foundation, the fibroblasts that produce collagen and elastin are activated.

What is the main ingredient "hADM"? A collagen structure derived from human skin

Rituo contains 150 mg of human acellular dermal matrix (hADM) as its main ingredient .

hADM is derived from human skin tissue from which cells and lipids that trigger immune responses have been completely removed, leaving only the ECM structure. Although it is “human-derived,” it contains absolutely no “cells themselves”; it consists solely of collagen structures , and is therefore considered unlikely to cause a foreign body reaction or rejection.

Because it retains the three-dimensional structure of the ECM intact, after injection your own fibroblasts can readily use this scaffold, creating an environment in which they can easily produce collagen.

Rituo is a treatment designed to improve skin texture while reinforcing the foundation that supports the skin's structure.

Attracting attention in Korea! The "5th-generation" skin booster following Rejuran and Juvelook?

In South Korea in recent years, Lituo has been described as the “5th-generation skin booster”.

This is a metaphor used to clearly convey that it is attracting attention as a “new wave” following Rejuran and Jubelook. In fact, since its launch in November 2024, Lituo has been rapidly gaining traction in South Korea; according to South Korean media reports, as of August 2025, it had expanded to approximately 1,000 business partners.

There is one point to note here.
There is no official or academic standard for this “Xth-generation” terminology. Since the classification and definitions vary depending on the media outlet, clinic, or manufacturer, we recommend treating this as merely a “marketing term.”
In fact, some clinics classify Lituo as “4th generation,” while others classify it as “5th generation.”

Therefore, rather than simply viewing Rituo as “5th generation,” we believe it is more accurate to understand it as a new category of product focused on ECM (extracellular matrix) and hADM (acellular allogeneic dermis).

Effects you can expect from Rituo｜Changing the skin from its foundation

Rituo is a treatment that focuses on the skin's foundation to address age-related loss of firmness, uneven texture, dryness, and more.

Improvement of open pores and texture

The causes of pore concerns are not only sebum; loss of firmness and uneven texture also play a major role.

As collagen density in the dermis recovers, the structure supporting the pores is strengthened, resulting in a more even skin texture. By reflecting light evenly, you can achieve a look where pores appear less noticeable.

Restoration of firmness and elasticity

As ECM is replenished, it acts as a support structure, activating fibroblasts. As a result, the production of collagen and elastin is promoted , restoring elasticity that seems to push back from within.

Because the dermis is rebuilt over a period of weeks to months, the change is natural.

Improvement of dry skin

The ECM also contains proteoglycans, which improve the water-retention environment of the dermis.

Unlike hyaluronic acid, which “moisturizes the surface,” this product restores the skin’s ability to retain moisture from within, helping to improve dry skin.

As a result of the improved texture and moisture, many people also feel a sense of clarity and a brighter tone.

Improvement of redness

Redness has multiple contributing factors, including inflammation, weakened barrier function, visible capillaries, and friction.

hADM is known to act as a scaffold involved in wound healing and collagen formation, and it is anticipated to help improve post-inflammatory redness.

It is one of the effects that also holds promise for those troubled by chronic redness or the redness of acne scars.

However, because the factors behind redness vary, it is necessary to determine whether the treatment is suitable.

Furthermore, a randomized, split-face, double-blind study published in February 2026 compared skin conditions in 20 subjects, injecting a test formulation containing phADM on one side and a non-cross-linked hyaluronic acid formulation on the other, over a period of 20 weeks. The test side showed greater improvement than the control side in skin density, volume, elasticity, wrinkles, pores, moisture level, barrier function, and pigmentation/redness indices.

(Citation)Lee, Y. I., Chau, N. H., Nguyen, N. H., Ham, S., Baek, Y., Kim, J., & Lee, J. H. (2026). Injectable particulated human acellular dermal matrix booster for skin restoration: An integrated randomized, split-face, double-blinded clinical trial and preclinical study. International Journal of Molecular Sciences, 27 (5), 2193. doi:10.3390/ijms27052193

Who Rituo is recommended for

Rituo is recommended for those with concerns such as the following:

Comparison｜Rituo, Rejuran, and Juvelook

We have compared the differences with representative skin boosters in a table.

Item	Lituo	Rejuran	Juvelook
Main ingredient	hADM (human-derived acellular dermis)	PN (salmon-derived polynucleotide)	PDLLA (polylactic acid derivative)
Approach	Replenishes the ECM scaffold to reinforce the foundation and activate fibroblasts	DNA fragments promote skin regeneration	Stimulates and increases collagen production
Duration	6–12 months	More than 12 months	12–24 months
Main indications	Pores, dark spots and dullness, texture	Sagging, fine lines around the eyes, dark circles	Acne scars, pores

It is also possible to combine multiple formulations. For details, please consult us during your counseling.

The difference from Rejuran (PN formulation): "creating" versus "replenishing" the structure

Rejuran is a formulation that "stimulates" collagen production by injecting DNA fragments (PN: polynucleotides) that act directly on fibroblasts. While it is excellent in terms of signaling input to cells, its effectiveness is limited when the "place—that is, the scaffold—where collagen is produced" has been depleted.

Because Rituo replenishes that "scaffold" itself, it is complementary to Rejuran.

This combination—using Rejuran to activate cells while using Lituo to prepare the ECM foundation—is expected to produce synergistic effects.

In addition, while Rejuran is highly effective, its distinctive stickiness (viscosity) made injection quite painful—a drawback. Rituo is also recommended for those who gave up on Rejuran because of the pain.

The difference from Juvelook (PDLLA): immediate results and a natural sense of volume

Juvelook is a formulation whose main ingredient is PDLLA (a polylactic acid derivative), combining the immediate firmness provided by its hyaluronic acid component with the slow-acting stimulation of collagen production provided by PDLLA. It is long-lasting and has particular strengths in improving sagging and lack of volume.

There are differences between “ECM Replenishment (Rituo)” and “Collagen Production Stimulation (Jubeluck),” so it’s best to choose the one that suits your symptoms and goals .

Which layer is it injected into?

Injectable formulations vary in both their ingredients and intended purposes.
Therefore, it is extremely important to administer each formulation at the appropriate “depth” and “volume” to ensure optimal results.

In the case of Rituo, the main injection layer is "from the superficial to the deep dermis (the full thickness of the dermis)."

The skin is structured in layers, starting from the surface: the "epidermis," the "dermis" (comprising the superficial, middle, and deep layers), the "subcutaneous fat layer," and the "muscle layer," each of which plays a distinct role. From the superficial to the deep dermis is the region responsible for the skin's various functions, from the texture and firmness of the skin's surface to structural support deep within.

The full thickness of the dermis is the range where Rituo's ingredients and intended effects can be most effectively drawn out, and this is the medical rationale behind our clinic's practice of injecting this formulation into this range.

How to think about pain and anesthesia during the procedure

Rituo is not as painful as Rejuran, but there is some pain from the needle insertion during the procedure.

To relieve discomfort, we use topical anesthesia (cream anesthesia), leaving it for 20 to 30 minutes to take effect before the procedure. In addition, we take measures to minimize discomfort during treatment through cooling, the use of fine needles, and control of the injection speed.

Downtime, side effects, and risks

How long do redness, swelling, bruising, and unevenness last?

The main downtime symptoms and their estimated durations are as follows:

There are individual differences, but in most cases you can work and wear makeup from the next day. However, some bruising may remain in areas with thin skin, such as under the eyes. If you have an important event coming up, we recommend allowing plenty of time before scheduling your treatment.

Risks such as allergy, inflammation, and lumps

In rare cases, the following risks may arise:

Rituo has the cells and fatty components that cause immune reactions removed. In addition, human-derived preparations are said to be less likely to cause immune reactions than animal-derived preparations.

Downtime symptoms usually ease over time. If you notice increased pain, itching, or redness, there may be an infection or an allergic reaction. Treatment may be necessary, so please contact the clinic promptly.

Regarding safety

Rituo is an injectable formulation composed of human-derived ingredients and uses no synthetic ingredients.

Of course, because it is a human tissue-derived preparation, the risk of infection cannot be said to be zero; however, Rituo's hADM uses raw material processed at an FDA (U.S. Food and Drug Administration)-approved facility and has also obtained approval from the MFDS (Ministry of Food and Drug Safety of Korea).

That said, it is not a pharmaceutical approved by Japan's Ministry of Health, Labour and Welfare. Because it is a human tissue-derived preparation, please check in advance with your physician or the Japanese Red Cross Society regarding whether you can donate blood after the procedure.

Those who require special caution

If any of the following apply to you, please consult the physician in advance:

Those who are not eligible for the treatment

Aftercare and daily-life precautions following the procedure

Here are some tips on how to spend your time so as not to worsen redness or swelling.

To reduce swelling and bruising, avoiding irritation and applying cooling and rest are effective.

Please do not rub the injection site firmly on the day of treatment or the following day.

Wash your face gently, and refrain from harsh cosmetics, scrubs, and peels for about a week.

When do the effects start? How many sessions are needed? How long do they last?

Recovery process

Rituo's effects appear gradually over a period of 2 to 4 weeks.

Using the injected hADM as a scaffold, fibroblasts are activated and new collagen and elastin are formed, from which results can be expected.

The ideal way to receive treatment: why 3 sessions (one course) every 3 to 4 weeks are recommended

In line with the cell-reconstruction cycle, Rituo treats three sessions every 3 to 4 weeks as "one course."

Although a single treatment is effective, undergoing multiple sessions allows you to repeatedly promote the three steps—ECM replenishment, fibroblast activation, and collagen production—resulting in more stable results.

Maintenance interval for keeping results lasting

After completing one course of treatment, we recommend undergoing maintenance treatments every 3 to 6 months to maintain the results.

The ECM naturally decreases with age. By continuing to replenish it with Rituo, you can keep the skin's foundation in good condition over the long term.

Combination with other treatments

Supplementing your skin's structure with Rituo may enhance your skin's response to subsequent treatments. Your doctor will determine whether these treatments can be combined and in what order, so please let them know your preferences during your consultation.

For example, the following combinations are possible:

Photo Facial *Available only at the Jimbocho location*

It improves surface dark spots, dullness, and redness of the skin, aiming to enhance skin quality and firmness.

A photofacial is a treatment that uses a device emitting a special type of light called IPL (Intense Pulsed Light).
It breaks down melanin pigment to lighten dark spots and targets the small blood vessels that cause redness. Furthermore, it acts on the dermis to stimulate the production of collagen and elastin, which can help improve skin firmness and elasticity.

XERF (radiofrequency)

This is a combination that improves the skin's internal structure and promotes collagen production.

XERF is a radiofrequency treatment that can deliver thermal energy three-dimensionally, from the dermal layer to the subcutaneous fat layer. It can be expected to address multiple skin concerns at once, such as a double chin, sagging along the facial line, improvement of nasolabial folds and marionette lines, and tightening for skin firmness, radiance, and pores.

Usage guidelines

Rituo is managed in units of "1 vial (1 bottle)," with each vial containing a high concentration of 150 mg of hADM (human-derived acellular dermis). This single vial is dissolved in an optimally balanced solution and injected so that it is distributed evenly across the entire face.

As a rule, the injection is administered evenly across the entire face, but it can be arranged depending on your desired result.

This formulation is effective not only for improving the skin texture of the entire cheek area but can also be used on areas where signs of aging are particularly noticeable, such as under the eyes, on the neck, and around the mouth.

If you are unsure where and how much should be injected, the physician will suggest an appropriate amount during your counseling.

Treatment Flow

Smart Skin Clinic Pricing

Rituo Injection Fees

FAQ

 Can I receive treatment while pregnant or breastfeeding?

Because the safety of treatment for those who are pregnant or breastfeeding has not been established, our clinic does not perform the procedure in these cases. Please feel free to consult us after childbirth or once you have finished breastfeeding.

Are there any points to be aware of because it is a human-derived preparation?

Rituo has its cellular components removed under strict quality control. However, because it is a human tissue-derived preparation, the risk of infection is theoretically not zero.

Can I receive it if I have sensitive skin?

Sensitive skin in itself is not an absolute contraindication. However, depending on the cause of any existing redness or inflammation, it may be better to prioritize skincare treatment or topical treatment first. Please consult the physician in advance.

Does it help with dark circles under the eyes?

It may be suitable for concerns involving thinness and loss of firmness in the skin under the eyes. However, because dark circles have different causes—such as blue, brown, and shadow-type circles—suitability needs to be determined through an examination.

Can I donate blood?

Because this is a human tissue-derived preparation, whether you can donate blood after the procedure will be determined by the criteria of the Japanese Red Cross Society. For details, please check with your physician or the Japanese Red Cross Society.

Can I have it on the same day as other treatments?

Whether treatments can be combined depends on the details of the procedure, the area, and the skin's condition. At our clinic, the physician makes this decision based on the treatments planned for that day, so please share your wishes at the time of your counseling.

 When will I start to notice the effects?

Most people feel a slight sensation of firmness right after the treatment, but the true effect from ECM reconstruction emerges over the 2 to 4 weeks following the procedure. Many people feel it most strongly 1 to 2 months after completing one course (3 sessions).

Our commitment

Because Rituo is a formulation that is used by dissolving a powder, it requires appropriate concentration adjustment and a uniform injection technique that avoids lumps. At our clinic, a physician who is thoroughly familiar with the delicate characteristics of this formulation performs the injection by hand.

With advanced technology—based on over 24,000 injections performed annually—we directly control the injection depth, volume, and angle to evenly distribute active ingredients into the dermis according to the skin’s thickness and structure in each area, ensuring optimal results.

We also continually incorporate the latest information on Rituo and various other skin boosters to provide safe, effective treatments.

Our physicians propose the optimal plan tailored to each individual's skin condition and wishes. We never engage in pushy sales.

For Rituo, come to Smart Skin Clinic

Rituo is not merely about adding moisture; it is an injectable treatment that focuses on the skin's foundation.

Unlike conventional injectables, it rebuilds the entire scaffold that produces collagen and elastin, taking a foundation-focused approach to multifaceted skin concerns such as firmness, elasticity, pores, dryness, and fine crepey lines.

If you are troubled by firmness lost with age or by skin quality that has not improved no matter what you try, Rituo may be one option for you.

Please do come and consult us at a free counseling session.

Details

Treatment Time	Approximately 30 minutes (consultation not included)
Recommended Number & Frequency of Treatments	・It is recommended to undergo a series of three treatments at intervals of 3 to 4 weeks ・After that, maintenance treatments are recommended approximately once every 3 to 6 months
Downtime	About 24 hours
Treatment on the day of counseling	Available
Makeup	Possible from the next day
Skincare	Possible immediately after the procedure (done gently)
Shower	Possible from the same day
Pain	A slight pricking sensation when the needle is inserted.

*Results vary from person to person.

Legal Notices

Rituo (Re2O / BNAJU) treatment includes procedures using pharmaceuticals or medical devices that are not approved in Japan. The pharmaceuticals and devices used in the treatment have been obtained through personal import procedures based on the judgment of our physicians.

Please refer to this page for information on medications and similar items that require caution in personal importation.
Ministry of Health, Labour and Welfare, "Medications and Similar Items That Require Caution in Personal Importation."

Reference

Humedix

Lee, Y. I., Chau, N. H., Nguyen, N. H., Ham, S., Baek, Y., Kim, J., & Lee, J. H. (2026). Injectable particulated human acellular dermal matrix booster for skin restoration: An integrated randomized, split-face, double-blinded clinical trial and preclinical study. International Journal of Molecular Sciences, 27 (5), 2193. doi:10.3390/ijms27052193

CLINIC LIST

Clinic List

Jimbocho Clinic

〒101-0054
3-16-1 Kanda Nishiki-cho, Chiyoda-ku, Tokyo, EX Kanda Nishiki-cho Building 8F (general reception) / 7F

Hours: Mon–Fri 11:00–20:00 / Sat & Sun 10:00–19:00

Yokohama Clinic

〒221-0835
TS Plaza Building 2F, 2-23-2 Tsuruya-cho, Kanagawa-ku, Yokohama-shi, Kanagawa

Hours: 10:00–19:00

Hatchobori Clinic

104-0032
2nd Floor, Tokyo NS Building, 2-29-4 Hatchobori, Chuo-ku, Tokyo

Hours: 10:00 a.m.–7:00 p.m. (Closed from 1:00 p.m. to 2:00 p.m.) / Closed: Mondays and Thursdays

About the physician supervision of this site

This site is operated under the supervision of a Smart Skin Clinic supervising physician.

This page was produced in accordance with the Medical Advertising Guidelines Medical Advertising Guidelines revised and enforced in June 2018, under which we produce and provide this information.

• Scope of supervision: treatment descriptions, risks and side effects, price display
• Last Reviewed: August 1, 2026

*Treatment effects vary from person to person. Please be sure to consult a physician regarding side effects and risks.