Biostimulators

What is the summary; 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
• Injectables are employed early in your melasma treatment course for late onset melasma
• Injectables are also used to increase the remission rate between laser sessions

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, & CAH.

The Melasma Clinic employs over half a dozen such ingredients to effectively reverse aging. Typically, injectables are used in mature onset melasma (stage 3 of your program) & or to increase the remission rate following laser therapy. 

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. Increases the remission rate between treatments 
4. Provide skin tightening & lifting (secondary, not primary effects)
5. 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. This is typically achieved in stage 3 of your melasma treatment program, the dermal remodelling phase. Biostimulators can also increase the remission rate between laser sessions. 

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. 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 at certain stages of melasma or in certain forms of melasma.

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. This is typically in stage 3 of your melasma treatment program, namely the dermal remodelling phase.
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
• HA Hybrid complexes: 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
• Injection technique & depth is critical for results

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

CAH is an injectable that has had a very successful & long lasting result when it comes to collagen remodeling & biostimulation. It works similarly to PLLA & can help volumize & tighten. A new form of  very low concentration CAH + HA has been introduced into the Australian market in 2025 & another form will be released in 2026. Due to TGA regulations, we can not mention or endorse the names of injectables. However if you perform a Chat GPT search you will understand more. 

CAH injectables are used for dermal rejuvenation in mature patients. 

Here is the summary of CAH –

• Contains CAH or calcium hydroxyapatite
• Can be mixed with hyaluronic acid
• Provides increases in dermal collagen over a course of 3-6 months
• Requires 3 injections spaced 3-4 months apart
• Typically lasts 2-4 years
• Comes in concentrations ranging from 0.001% to 30%

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

PLLA 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’. 

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 PLLA–

• 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
• Side effects include nodules
• Best combined with energy based devices

What are hybrid HA complexes & are they good biostimulator for melasma patients?

Heat stabilized HA hybrid complexes are 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, it has a narrow, but useful window of application. 

We employ this product 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. HAs are not a standalone treatment for melasma as there are better treatment options. 

Here is the summary of HA Hybrids–

• Useful in more mature melasma 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 HAs 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. 

How do exosomes compare with biostimulators & do we use them?

Yes we do use exosomes for pigmentation however as compared with mainstream pigment correctors, lasers & novel peels, the results are less predictable. The main problem with exosome therapy is to get these molecules into the deeper layer of skin as your skin has a very efficient barrier. The three ways to deliver exosomes include-

1. RF microneedling (best way, using Potenza Fusion RF)
2. Microneedling (not great as it has less remodeling capacity than RFM)
3. Injections (not TGA approved, but the most efficient). 

Here is the exosome summary-

• Exosomes are trendy in 2025
• They are useful in treating hair loss
• Many other treatments are more effective in the context of pigment treatments
• Exosomes can be considered as one of the last line therapies for melasma

What is better- Cosmelan Peel vs biostimulator injectables?

Cosmelan peel is a marketing exercise in melasma that addresses pigmentation, without any thought of dermal remodeling. Granted it is useful as a quick fix for melasma pigmentation with a hit rate of approximately 60%.

Biostimulators are the solution to longer term remission & can be considered for patients who have responded to Cosmelan peel. They are not used as an initial treatment for melasma.

What is better- tretinoin or biostimulator injectables?

Comparing an injectable to a cream is not fair, as injectables have a much higher collagen stimulating potential (well over 100 times). Injectables are delivered into the deeper layers of skin as they are designed to work there. Their anti-aging properties are infinitely higher compared to Tretinoin. Additionally injectables do not cause skin irritation, as seen with retinol & retinoid preparations.

Tretinoin summary (in the context of melasma pigmentation)

• Useful in some but not all patients
• Best employed as pulsed therapy as guided by your dermatologist
• Tretinoin is a weak pigment corrector 
• Tretinoin is a weaker biostimulator as compared to injectables
• Modulation of skin irritation is important, especially in melasma patients

What are other serums or creams- home skin care that can stimulate collagen?

We covered the hype of retinol & retinoids, however there are other ‘biostimulators’ that can potentially stimulate collagen production. As compared to injectables or energy based devices, skin care has an extremely low collagen stimulating potential.

Ascorbic acid works by pigment reduction, antioxidation as well as a very weak stimulator of collagen. Much like retinol & tretinoin it is overhyped, however we do employ vitamin C in its other roles for melasma. 

Glycolic acid & AHAs can stimulate collagen, however for home use the concentration is very low (5 to 18%) & the pH formation is higher. AHAs work best as chemical peels. 

Can I use pigment correctors with bio remodeling or biostimulatory injections?

Yes you can use combined therapy for melasma pigmentation, 

The ideal mix depends on your skin sensitivity & previous history. As a guide we prescribe retinol & tretinoin during the remodeling phase in addition to senolytics & pigment correctors such as- 

• Arbutin
• Azelaic acid
• Kojic acid
• Cysteamine
• Ascorbic acid
• Niacinamide

*The optimal combination of topicals are tailored for each individual.

What does a biostimulatory course of injectables look like?

It’s very complex as our clinicians take into account your pigmentation type, depth, response to treatment, skin age, expectations as well as your ethnicity & facial shape. As a very rough guide, it goes something like this-

Day one: injectable of PLLA, CAH or hybrid CAH-HA

Week 9: repeat of above. 

Week 12: reassess for treatment. 

In between sessions, consider PN such as Rejuran or HAs for skin hydration (over dermal remodeling). Repeat at intervals of 12 to 24 months.

Rejuran requires more frequent injections compared to biostimulators. Biostimulators are always combined with lasers & novel peels, together with matched skin care aimed at suppressing melasma pigmentation.

How to choose between biostimulator injections over devices to stimulate collagen production?

If pigment treatment  is all that you are after, consider pico laser treatments coupled with skin care. This is far more cost effective. In the ideal world (where cost is no issue), the combination of biostimulatory injectables & EBD (energy based devices) gives the best results as they work in different pathways to remodel collagen. 

The best type of biostimulatory & EBD depends on factors discussed above. The treatment algorithm is complex as the combinations are varied.

What are the possible side effects of biostimulators?

Side effects are rare & can be graded as –

1. Injector error; this is the most common. Lumps, nodules, bumps, uneven distribution, prolonged bruising. The skill set of your injector is important. 
2. Idiosyncratic (it happens because it just does). Infection is very rare, nodules are more common.

What other types of pigmentation can biostimulators treat?

Apart from melasma & dermal melasma, biostimulators are employed for ethnic skin rejuvenation. They are combined with devices such as pico or Ultraformer MPT. Excellent results are seen with a series of 3 sessions, spaced 4-12 weeks apart.

Biostimulators are also used to treat dark circles & pigmentation around the eyes.

What is the cost of biostimulatory injections?

Costs vary according to the injectables & who performs it. As a guide-

• PLLA or CAH: $1290 to $1590 
• Hybrid HAs, Rejuran: $990-$1190 

Factor in 2-4 injections over a course of one year, then repeated 1-2 sessions every year thereafter. 

If cost is an issue, here is our advice; for short term improvement of melasma, medical management will give you ‘bang for bucks’; namely pigment correctors in addition to pico lasers.

What are other biostimulators that we use?

This page covers biostimulators used for melasma pigmentation, acknowledging there are many other injectables in the market. Here are other injectables that are TGA approved (for skin rejuvenation).

PCL or polycaprolactone. This includes older PCL injectables (PCL +CMC),newer ones such as liquid PCL. PCL is not used to treat melasma because it is too inflammatory. 

PDLLA This is much like PLLA but has a different isomer (D compared to L). It produces more volume in the beginning, but is very similar to Sculptra (PLLA) with the results. 

PDLLA & HA will enter the Australian market in 2025. This is a hybrid filler combined with poly-D-lactic acid. It can potentially work better than PLLA as hyaluronic acid can improve skin quality, compounding the collagen stimulation effects of poly-D-lactic acid. 

CAH with hyaluronic acid: this novel mix will be available in Australia in early  2026. It is an Allergan product that combines 20 mg of cross-linked hyaluronic acid with calcium hydroxyapatite. Lower concentration of CAH (1% or lower) has entered the Australian market in 2025. 

*The ideal biostimulator depends on many factors including your age, volume depletion, facial structure, as well as your expectations. The most important factor is the expertise of your specialist dermatologist or plastic surgeon. We take into account ALL methods of biostimulation, from injectables through to lasers & energy based devices. The algorithm is complex. 

Can LED masks stimulate collagen?

LEDs have very limited value, apart from their healing potential & marketing value.
LED’s can accelerate wound healing from lasers. That is about it. They have very limited (if any) collagen stimulating potential. A simple glycolic acid peel is much more effective. 

It is not that we are against LEDs, we only employ them to aid wound healing after laser resurfacing. For melasma patients, LEDs often worsen pigmentation. There are far better treatment options compared to LED masks. Highly overrated.

Can microcurrent stimulate collagen & improve melasma?

In the context of what we do at The Melasma Clinic, microcurrent is classified as a ‘fluffy treatment’. Microcurrent devices are more of an exercise in marketing, compared to effective, efficient & reproducible collagen stimulation. Microcurrent can give short term ‘tightening’ in 20-25% of people that may last a day or two. Devices are highly commercialized, but in the scheme of melasma treatments, they do no harm. 

Fact on microcurrent devices

• Microcurrent is cost effective, ranging from $300 to $800 for a device
• They don’t stimulate any meaningful amounts of collagen
• Chances are, you will use them for 1-2 weeks, then forget about them
• They are highly overrated, but given the cheap entry point, you can try them for entertainment value

More on microcurrent devices.