Objective To explore the efficacy and safety of hyaluronic acid filler injection in facial aesthetics. Methods A total of 88 patients who underwent facial aesthetics in Nanjing Mebel Beauty Hospital from January 2023 to January 2024 were selected as the research subjects. According to the random number table method, they were divided into the control group and the observation group, with 44 patients in each group. The control group received collagen filler injection, and the observation group received hyaluronic acid filler injection. The aesthetics effect, durability of aesthetics effects and complications were compared between the two groups. Results The total improvement rate in the observation group (90.91%) was higher than that in the control group (59.09%) (P <0.05). There were no significant differences in the stratum corneum hydration and transepidermal water loss between the two groups at 1 week after injection (P >0.05). The stratum corneum hydration in the observation group was higher than that in the control group at 10 and 20 weeks after injection, and the transepidermal water loss was lower than that in the control group (P <0.05). The incidence of complications in the observation group (4.55%) was lower than that in the control group (20.45%) (P <0.05). Conclusion Compared with traditional collagen filler injection, the application of hyaluronic acid filler injection in facial aesthetics has a more ideal aesthetics effect, with higher durability of aesthetics effect, lower incidence of complications, and greater application efficacy and safety.