Biostimulators

The Science of Biostimulators for Melasma

• Mature onset melasma has an element of photoaging
• Photoaging stimulates pigment as a reactive phenomena 
• Biostimulators reverse photo & cellular aging
• By reversing skin aging, pigment production is reduced
• Biostimulators consists of a group of injectables
• It takes up to 12- 18 months for best results
• Biostimulators are combined with lasers & energy based devices

What are biostimulators?

Biostimulators are a group of injectables that remodel & rejuvenate the deeper dermal layers of skin. Mature onset melasma is partly caused by cellular aging, hence reversing the aging process indirectly addresses pigment production. 

Biostimulators consist of different types of molecules which include DNA derived substances, hybrid hyaluronic acid as well as compounds such as poly-L-lactic acid. The Melasma Clinic employs over half a dozen such ingredients to effectively reverse aging.

What can biostimulators do for my skin?

1. Slow down pigment production in melasma patients. 
2. Remodel the dermal layer of skin, improving skin quality, fine lines & wrinkles.
3. Provide skin tightening & lifting. 
4. Correct volume deficits, rejuvenate & restore.

Each biostimulator has a specific application, some hydrate, others tighten. The ideal biostimulator depends on your skin type & clinical findings. 

Why employ biostimulator injectables to treat melasma?

Biostimulators remodel the deeper layers of skin. Most cases of late onset melasma have an element of skin aging, termed cellular senescence. Changes in the deeper layers of skin stimulates pigment production as a protective mechanism. 

By treating cellular aging, we indirectly reduce melanin production, in turn improving both skin quality & melasma. 

How long do biostimulators take to lighten melasma pigmentation?

You will notice very little change in melasma pigmentation if you use inject biostimulators by themselves. 

Injections are best combined with more effective melasma treatments including senolytics, senotherapeutic agents, medical management, lasers & peels. Biostims are not first line treatment, but can be considered when your melasma pigments lightening plateaus over time. The best results are seen 12 to 18 months after initial therapy with injectables. 

When do we introduce biostimulators into your melasma program?

We introduce injectables during 3 phases of melasma treatment

1. After you receive a marked reduction in melasma pigmentation. This is the most common way to start biostimulators. Injectables are designed to prolong remission time of the disease, hence reducing relapse rates. 
2. For resistant melasma including dermal melasma. Again, the success rate is around 40%
3. Early in the course of treatment for patients who see a long term goal, & or anti-aging benefits. 

How are biostimulators delivered?

The most effective & efficient way of delivering biostimulators is via injections. The number of injections depends on the type of molecule employed. 

At the clinic we use over ½ dozen biostimulators depending on your skin’s chronological age, volume loss, pigment type & skin quality. Additionally we take into consideration your melasma treatment phase (pigment reduction vs remission phase). 

Do injectable biostimulators work on all forms of melasma pigmentation?

No, even with optimal treatment, 15 to 20% of melasma is still resistant to treatment. 

Dermal melasma is hardest to treat. At this moment in time we can not predict who will respond, & who are more resistant to therapy. 

Are injections painful & what is recovery like?

Injectables are well tolerated as we mix numbing solutions prior to injecting. A session takes between 2 to 4 minutes to perform. Recovery depends on the injectable used. As a guide-

• Rejuran: 18 to 36 hours
• Profhilo: 6 to 18 hours
  CAH/PLLA: Mild swelling 1-3 days

What is Rejuran & can it treat melasma?

Rejuran is classified as a polynucleotide, however it can be placed along the biostimulatory scale as a very weak biostimulator as compared to other injectables such as CAH or PLLA. Rejuran is one of our favorite injectables for melasma pigmentation. It has very little side effects. 

Here is the summary of Rejuran–

• Contains salmon DNA
• Requires 2-4 injections over 2-5 months
• Rejuran is always combined with medical therapy + lasers for melasma
• Has a success rate of 30-60%
• Requires injections that do sting 
• Has a downtime of 18 to 36 hours
• Acts as a scaffolding in your skin

What is Sculptra & is it a good biostimulator for melasma patients?

Sculptra is a very old biostimulator that entered the market in the early 2000s. It has a long safety record & is used for both volume as well as skin ‘tightening’. 

Sculptra comprises PLLA or poly-L-Lactic acid. We use this product in volume depleted patients. In the context of pigment reduction, it can give subtle improvements in skin quality after 2-4 injections. 

Here is the summary of Sculptra–

• Injectable biostimulator to provide tissue tightening over skin lightening
• Provides increases in dermal collagen over a course of 3-6 months
• Requires 2-4 injections spaced 3-5 months apart
• Typically lasts 2-4 years
• Best combined with energy based devices

What is Profhilo & is it a good biostimulator for melasma patients?

Profhilo is a useful injectable for some cases of melasma pigmentation. It contains non-cross linked heat stable hyaluronic acid & comes in a 2 ml syringe. Herald as a do it all injectable that tightens-lifts-remodels-rejuvenates-a revitalizes, Profhilo has a narrow, but useful window of application. 

We employ Profhilo in the melasma patient to mainly hydrate the skin (deeper dermal & epidermal layer). Skin hydration improves the skin quality & reflects light, making skin appear fresher, more youthful with less pigmentation. Profhilo is not a standalone treatment for melasma as there are better treatment options. 

Here is the summary of Profhilo–

• Profhilo is useful in more mature patients
• Consists of 2-3 injections spaced 1-2 months apart
• Lasts 9 to 14 months
• Best used to hydrate the skin
• Does not reduce melasma pigment, but makes the skin healthier 
• Works better to improve skin turgor than to remodel the skin
• All patient over the age of 35 can benefit from Profhilo to improve water levels in the dermis 

What other methods do we employ to remodel the dermal layer of skin?

At The Melasma Clinic we employ the very latest remodeling techniques to reverse cellular aging in the dermis. Lasers & energy based devices do the best job. The ideal device depends on your skin type, age, expectations & clinical findings. Here is a quick guide-

Thulium 1927 lasers: this is one of the most valuable methods to remodel the dermis in lighter skin types, especially if you have significant sun damage contributing to melasma. A series of 5 to 12 sessions are recommended over a course of 12 to 18 months. 

Pico laser in fractional settings: can remodel fibroblasts & stimulate collagen in darker skin types. 5-10 sessions over 10 months. No downtime, however cellular remodeling is not as effective as thulium lasers, but flare ups are less likely (depending on settings).

QSL or nano lasers: this time tested treatment can reduce pigment as well as provide dermal remodeling which increases remission rates in chronic melasma patients. 8-14 sessions over 14 to 24 months. This method has the least amount of melasma flares & can be used in all skin types. 

HIFU MPT Ultraformer: provides upper dermal layer tightening with reduction in pore sizing, fine lines & wrinkles. We use tailored settings unique to the clinic to provide skin rejuvenation & dermal remodeling in melasma. 3-4 sessions over 6 to 14 months. Flares are uncommon using MPT HIFU. 

RF microneedling devices are useful in some, but not all cases. RFM devices we use include RF Genius, RF Potenza & Silfirm X. RF microneedling remodels the dermal layer of skin using heating from microneedles. 4-8 sessions over 8 to 14 months.