Skincare and skin health have risen to ever-increasing prominence in public opinion in recent years, with many attributing its boom in popularity to the COVID-19 pandemic and the associated periods of mandated isolation. In a survey of 2000 respondents conducted in 2021, 63% of millennial consumers and 57% of Generation Z participants in the United States took their skincare routine seriously (Petruzzi, 2022), and 43% of UK adults increasingly consider non-surgical procedures as a normal part of their beauty and personal care routine, which is mirrored by a 40% drop in cosmetic surgeries since 2015 according to the British Association of Aesthetic Plastic Surgeons (Mintel Group, 2021).
Compounds such as hyaluronic acid (HA) are currently regarded by many in the beauty and aesthetics industry as integral to the development and maintenance of healthy and aesthetically pleasing skin, and there are many claims regarding HA's ability and efficacy in moisturising and rejuvenating the skin. It is thus incorporated into many topical skincare products, with some of these erroneously and misleadingly marketed as topical ‘fillers’. However, it must be noted that topical HA is unable to rival the efficacy of injectable HA, due to the fact that topically applied products—even those containing smaller HA molecules—will never be able to penetrate further than the epidermis, the topmost layer of the skin (Lui and Nassim, 2020).
» An alternative option that many patients are unaware of is the existence of ‘skin boosters’, which can be defined as biological materials or bio-actives that help or encourage the skin to increase or improve its function. These are relatively new to the market, with the term ‘skin booster’ being introduced in 2015; however, due to the variety of treatments and products available, there is no clear and universal definition of what exactly the term refers to «
An alternative option that many patients are unaware of is the existence of ‘skin boosters’, which can be defined as biological materials or bio-actives that help or encourage the skin to increase or improve its function (Guinan, 2022). These are relatively new to the market, with the term ‘skin booster’ being introduced in 2015; however, due to the variety of treatments and products available, there is no clear and universal definition of what exactly the term refers to (Yi et al, 2023). Therefore, practitioners should be aware of the products available and their function, safety and efficacy, in order to sufficiently educate patients and manage their expectations of what skin boosters can achieve.
Skin boosters: the optimal delivery method
The primary component in skin booster products is HA, which is injected subcutaneously and which is more efficacious than topical HA in improving skin texture, elasticity, hydration and overall appearance. Skin boosters are differentiated from dermal fillers: although the latter are also injectable HA formulations, these have a more viscous structure and better lifting power and are therefore used for targeted wrinkle augmentation and adding volume to the face (Kleine-Börger et al, 2022; Ghatge and Ghatge, 2023). Conversely, skin boosters are less viscous, more mouldable and are superficially injected to achieve revitalisation of the skin, which is achieved through stimulation of the dermal extracellular matrix, a dynamic structure that surrounds and anchors cellular components in tissues (Kerscher et al, 2017; Huang et al, 2022). HA is a humectant, a substance that retains moisture, and is thus capable of binding over 1000 times its weight in water; it naturally occurs in many areas of the body, including the skin itself, fulfilling a stabilising role in the extracellular matrix and playing a pivotal part in increased collagen production (Kerscher et al, 2017; Lui and Nassim, 2020).
» Unlike many other lauded, supposed cure-all ingredients in the beauty and aesthetics landscape, HA is capable of actually living up to the claims; however, its degree of efficacy is significantly affected by its mode of delivery «
By acting as the delivery method by which additional HA can be introduced into the skin, skin boosters ensure an improvement of skin quality without significant volume changes. For instance, a treatment regimen consisting of three small-particle HA injections was demonstrated to improve hydration levels and prevent trans-epidermal water loss by a significant degree in patients' faces, necks and hands (Nikolis and Enright, 2018). Indeed, in the same study, results from the trans-epidermal water loss analyses indicated that this treatment regimen may have actually increased the skin's ability to retain moisture by reversing possible damage to the skin's water–barrier function (Nikolis and Enright, 2018). Skin boosters' hydration retention effect has been found to last as long as 9 months after a single treatment, and HA injected into the skin layer has been demonstrated to lead to the synthesis of new collagen, elastin and HA; better texture or less roughness; the reduced appearance of fine lines; and enhanced skin elasticity (Kapoor et al, 2021).
Patient care, selection and education
The most common skin booster injection technique consists of multiple microinjections over a large area into the dermal or immediate subdermal layer, with relatively small volumes of 0.01–0.05 ml per injection point (Kleine-Börger et al, 2022). Some patients may require one skin booster treatment that lasts for 6-9 months, while others will require two or more treatments at 4-6-week intervals or a course of treatment for the best results (Guinan, 2022).
Practitioners must consider whether the patient is suitable for treatment and be honest about what a skin booster aims to achieve: if skin quality improvement is the aim of the treatment, a booster may be appropriate; however, if the patient is aiming to address volume loss at deeper layers of the face, skin boosters will not be the most suitable option (Guinan, 2022). However, skin boosters can form part of a holistic treatment plan that encompasses a variety of therapies. For example, dermal fillers can be used to address volume loss and, once the volume is replaced, the skin booster can enhance the results by making the overlying skin smoother and more hydrated (Guinan, 2022). A study involving 60 patients treated with a targeted injection of platelet-rich plasma combined with a skin booster has also offered promising results, with patients' facial skin indicators, quality of life and satisfaction with their appearance improving significantly after one course of treatment (Shen et al, 2023).
» Conversely, skin boosters are less viscous, more mouldable and are superficially injected to achieve revitalisation of the skin, which is achieved through stimulation of the dermal extracellular matrix, a dynamic structure that surrounds and anchors cellular components in tissues «
Conclusion
Unlike many other lauded, supposed cure-all ingredients in the beauty and aesthetics landscape, HA is capable of actually living up to the claims; however, its degree of efficacy is significantly affected by its mode of delivery. Unlike topically applied HA, skin boosters are capable of revitalising the skin from the inside out, increasing hydration and improving elasticity through elevated collagen production. For patients who desire skin that appears hydrated and ‘plump’, but who are hesitant about dermal filler treatment, skin boosters may be the ideal compromise, revitalising and enhancing the skin without adding potentially unnecessary volume.