Removing wrinkles, contouring and volumising aesthetic concerns are, of course, effective techniques to rejuvenate the face, but poor skin quality can mean that results are not always as impressive as they could be.
Most practitioners will also find that they often have a cohort of patients who do not need anything other than skin optimisation treatments, so it would be unethical to treat them with products that will not have the desired effect. However, turning them away when the practitioner has no solution does not feel great either.
While powerful devices such as radiofrequency and laser can boost collagen and elastin production to enhance the skin's appearance, they require an expensive investment of money and time. Of course, great skincare can make a difference, but committing to a routine requires dedication from the patient and, generally, slower results. So, this year, the author began researching alternatives.
Introduction to regenerative medicine
Literature reviews and conference sessions led to an interest in regenerative medicine. One study defines this as an ‘interdisciplinary field of research and clinical applications focused on the repair, replacement or regeneration of cells, tissues or organs to restore impaired function resulting from any cause, including congenital defects, disease, trauma and ageing’ (Khunger, 2014).
Regenerative techniques have been most commonly used in general medicine and, as the above definition indicates, focus on tackling the concern from the source. This is in contrast to the traditional approach of primarily treating symptoms.
» By stimulating fibroblasts, polynucleotides boost collagen production, improve elasticity and increase hydration.
They also calm inflammation and rebalance melanocyte activity to create an even and refreshed skin tone «
In recent years, regenerative medicine has caught the attention of aesthetic experts who recognise how it could also be beneficial in this field. ‘Regenerative medicine is being used to reverse the ageing of tissues and repair scarring to an unprecedented level,’ writes Dr Aamer Khan in his book Regenerative medicine in aesthetic treatments (2021).
He explains how the body's cells communicate with one another in a very precise way: ‘These intracellular messages not only help to determine how we feel and function, but they also have a profound impact on the body's inherent ability to heal itself’ (Khan, 2021). Additionally, he explains that, as the body ages, intracellular communication and the body's powers of regeneration decline, which is why the effects of ageing become more pronounced (Khan, 2021).
Treatments now being used in regenerative medicine seek to address this. Dr Khan (2021) says: ‘We can use the power of cellular intelligence to actually revert the intracellular matrix back to a younger state’.
One such treatment promising to do just that involves the use of polynucleotides.
Understanding polynucleotides
Cells house the body's deoxyribonucleic acid (DNA) and ribonucleic acid (RNA), which are responsible for the storage and reading of instructions needed for an organism to develop, survive and reproduce. Both are linear polymers, consisting of sugars, phosphates and bases, with DNA consisting of two strands and RNA having one strand. Both are made up of subunits called nucleotides. Therefore, polynucleotides are linear polymers whose molecule is composed of many nucleotide units (Mackenzie, 2022).
Going back to cells, it is well known that fibroblasts are a type of cell in connective tissues that produce collagen and help maintain the structural framework of tissues. Ultimately, well-functioning fibroblasts are what keep people looking young.
Inevitably, fibroblast function declines with age, leading to a decrease in collagen production.
This is where polynucleotides come in. When injected into the skin, the practitioner is going back to the start; more polynucleotides mean fibroblasts are regenerated and collagen production gets going again. As quoted by Dr Khan earlier in this article, the intracellular matrix is being reverted to a younger state. In the author's opinion, this is a truly innovative and exciting phenomenon.
Polynucleotides in action
Like many other regenerative medicine tools, polynucleotides have a history of being used in general medicine before their introduction to the world of medical aesthetics. Studies have reported their successful use for knee osteoarthritis and chronic wounds, such as venous ulcers, among others (De Caridi et al, 2016; Stagni et al, 2021)
Polynucleotides are generally extracted from fish in a cruelty-free process, whereby they are highly purified. The brand that the author favours—Plenhyage XL—uses polynucleotides taken from royal wild salmon off the coast of Alaska. It has been used worldwide since 2015 and has a well-established, effective treatment protocol favoured by practitioners.
They are then incorporated into a polymerised injectable gel that can be administered to the patient via needle or cannula. Polynucleotides are completely absorbed by the body and have a half-life of approximately 3 hours.
Injection techniques vary depending on the indication that the practitioner is treating and the products being used. Literature reports suggest that the average volume of polynucleotides administered to each side of the face is approximately 1ml (Park et al, 2016). If the tear trough is being treated, in their experience, the author has found that 0.5ml per side is suitable.
Plenhyage XL is available in two doses: medium, which has a 2% high molecular weight of polynucleotides, and strong, consisting of a 2.5% high molecular weight. In the author's experience with this brand, the medium is great for smaller concerns, such as the periorbital and perioral areas, while strong is best used on larger facial areas, as well as the neck, décolletage, inner arms, thighs and knees.
Three treatments are usually recommended, spaced 3–4 weeks apart.
Expected results
By stimulating fibroblasts, polynucleotides boost collagen production, improve elasticity and increase hydration. They also calm inflammation and rebalance melanocyte activity to create an even and refreshed skin tone (Figure 1).
A clinical study involving 15 patients treated with polynucleotides found that, after 20 weeks, hydration had improved by 115% and elasticity was increased by 38%. A mice study also found that epidermal thickness increased by more than 50% and collagen was boosted by 47%. In the author's experience, results generally last between 6 and 9 months.
Side effects that can occur include redness and swelling, which settles after 1–2 days. Depending on the injection technique used, small papules can also be observed that, again, will settle after a few days. The author always discusses their patients’ capacity for downtime in advance to best inform the technique that is used.
The literature does not report any complications from treating patients with polynucleotides, and no clinically significant local or systemic side effects have been reported (Araco et al, 2022). Thanks to the intensive purification process, they have a very low risk of causing an allergic reaction (Park et al, 2016).
Polynucleotides can be used in combination with any other aesthetic treatment, including toxin, dermal filler, mesotherapy and ultrasound. The author's general protocol is to use the ultrasound first, wait 2 weeks for the skin to settle and then start a course of polynucleotides for optimum results.
Summary
Introducing polynucleotides to the author's clinic has been hugely beneficial. They enable practitioners to enhance patients’ results and provide an effective solution to those who simply need to work on their skin quality.
Huge improvements have been seen in patients presenting with fine lines and wrinkles, tear trough concerns, sun damage, rosacea and scarring. In addition to their success rate, polynucleotides work well alongside other treatments, have minimal downtime and an extremely low risk of complication, making them stand out to both patients and practitioners.
Regenerative techniques are expected to revolutionise the aesthetic market over the coming years and, as patient awareness increases, it is likely that practitioners will see a significant increase in demand for treatments that transform the skin from within. Getting on board with polynucleotides, alongside other regenerative tools, will certainly set you ahead of the curve.