Biostimulators

Biostimulators are injectables that remodel the deeper layer of skin. In melasma they function to stimulate collagen production in the dermis, which can lead to longer remission times. The ideal injectable depends on your skin’s age, pigment pattern, volume depletion as well as your expectations. 

Recovery

0-1 days

Results

Well suited

Treatment Time

5-15 minutes

Aftercare

SPF, pico lasers

Treatment science scoremelasma clinic

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
This concept is grasped by only a handful of patients as most melasma patients can not see beyond pigmentation itself. Those who get it will have a much higher probability of long term remission 💯
.
👉Rate limiting factors: ability to understand the cause of melasma beyond pigment, the time required to remodel the dermis, especially in skin of colour, financial constraints as dermal remodelling goes far beyond ‘retinol-retinoids’, RFM, lasers & EBDs or the ubiquitous & over-rated Cosmelan peel
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #melasmatips #photoaging #melasmaclinic #celluaraging #drdavinlim

This concept is grasped by only a handful of patients as most melasma patients can not see beyond pigmentation itself. Those who get it will have a much higher probability of long term remission 💯
.
👉Rate limiting factors: ability to understand the cause of melasma beyond pigment, the time required to remodel the dermis, especially in skin of colour, financial constraints as dermal remodelling goes far beyond ‘retinol-retinoids’, RFM, lasers & EBDs or the ubiquitous & over-rated Cosmelan peel
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#melasma #melasmatips #photoaging #melasmaclinic #celluaraging #drdavinlim
...

204 4
The use of antioxidants such as glutathione can lighten & brighten skin. Glutathione can be a useful adjunct in some cases of #melasma
.
🔫Pico lasers: can safely be used to treat various types of pigmentation. A series of 3-5 sessions produce the best results, however in this patient only one treatment was performed. Settings matter
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#sunscreen #picolaser #picosurepro #drdavinlim #davinlim #sydneydermatologist #themelasmaclinic #glutathione #skinlightening

The use of antioxidants such as glutathione can lighten & brighten skin. Glutathione can be a useful adjunct in some cases of #melasma
.
🔫Pico lasers: can safely be used to treat various types of pigmentation. A series of 3-5 sessions produce the best results, however in this patient only one treatment was performed. Settings matter
.
😎Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#sunscreen #picolaser #picosurepro #drdavinlim #davinlim #sydneydermatologist #themelasmaclinic #glutathione #skinlightening
...

69 4
If the proper amount of sunscreen is used, anything over an SPF of 40 is fine (in the context of melasma). Other than SPF factor (a measure of UVB), UVA ratings & attenuation of visible light is super important in the management of pigmentary disorders such as melasma & post-inflammatory hyperpigmentation, especially in skin of colour
.
👉Cosmetic elegance & colour matching: is often the rate limiting factor
.
👉Why tint? Iron oxides protect against visible light, this band of light stimulates pigment
.
👉How to use? Two fingerlengths, twice daily, regardless of exposure💯
.
👉Our pick? Elta MD, acknowledging there are many good brands with a wider range of colour matching
.
Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#sunscreen #melasmatips #bestsunscreen #spf #drdavinlim #davinlim #sydneydermatologist #themelasmaclinic #elta #eltaMD #eltasunscreens

If the proper amount of sunscreen is used, anything over an SPF of 40 is fine (in the context of melasma). Other than SPF factor (a measure of UVB), UVA ratings & attenuation of visible light is super important in the management of pigmentary disorders such as melasma & post-inflammatory hyperpigmentation, especially in skin of colour
.
👉Cosmetic elegance & colour matching: is often the rate limiting factor
.
👉Why tint? Iron oxides protect against visible light, this band of light stimulates pigment
.
👉How to use? Two fingerlengths, twice daily, regardless of exposure💯
.
👉Our pick? Elta MD, acknowledging there are many good brands with a wider range of colour matching
.
Dr Davin Lim
Dermatologist
The Melasma Clinic
Sydney, Australia🇦🇺
.
#sunscreen #melasmatips #bestsunscreen #spf #drdavinlim #davinlim #sydneydermatologist #themelasmaclinic #elta #eltaMD #eltasunscreens
...

45 2

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

CAH or Radiesse is an injectable that has had a very successful & long lasting result when it comes to collagen remodeling & biostimulation. It works similarly to PLLA or Sculptra & can help volumize & tighten. Best used for dermal rejuvenation in mature patients. 

Here is the summary of Radiesse

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

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. 

Dr Davin Lim

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How to treat PIGMENTATION

If I can identify the cause of pigmentation, chances are I can treat it. This can only be achieved with careful real time examination…

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A SummaryBiostimulators for melasma & pigmentation

Dr Davin Lim | Dermatologist
The Melasma Clinic, Brisbane | Sydney

It is a difficult concept to understand, namely we remodel the dermal layer of skin using injectables to indirectly treat melasma pigmentation. Pigmentation in mature age melasma is reactive, namely how the upper layers of skin respond to dysfunctional changes in the lower skin; ie. sun damage & chronological aging. By changing the structure of the dermal layers of skin, we indirectly slow down the production of melanin, which gives rise to melasma pigment. 

Ideally dermal remodeling is a combination of treatments, including EBD or energy based devices, injectables & a special class of topical serums called senotherapeutic agents (reverses cellular senescence). 

It takes time

Cellular remodeling using injectables, lasers, HIFU & topicals takes time. The most effective & efficient ways to remodel collagen with controlled heating inevitably results in melasma flare ups, hence treatments are tailored, precise & slow. On average it takes 12 to 18 months, sometimes longer, to achieve clinically significant reversal in cellular aging. 

Injections are interspersed with lasers & HIFU. Injectables are spaced 3-4 months apart, whilst lasers are performed every 4 to 10 weeks. 

The combination possibilities are tailored

I use a combination of over 4 bioremodelling injectables, over 6 EBD (energy based devices) as well as therapeutic agents coupled with medical therapy & pigment correctors. There are over 100 (common) combinations as I take into account factors such as – 

  • Skin age
  • Chronological age
  • Background elastosis or sun damage
  • Pigment output, depth, distribution. 
  • Facial volume, skin laxity 
  • Ethnicity
  • Previous treatment failures & success
  • Expectations
  • Timeline
  • Autoimmune history

Tretinoin is overrated

Though I do encourage the use of tretinoin (retinoids) as an anti-aging topical, its use in the context of melasma patients is somewhat limited. This is because tretinoin is irritating, meaning with enough use (frequency & or concentration), it can sensitize your skin, leading to contact irritant dermatitis, which can worsen melasma via cosmetic irritation or sensitization. The trick is to titrate this topical as tolerated. The ideal concentration, frequency & duration of use depends on the cycle of melasma treatment you are on, in addition to other topicals you are applying. 

Biostimulators & dermal melasma

There is no universally accepted method to treat dermal melasma, however novel use of biostimulators have, in my experience, helped in 30-50% of cases. Injectables are always combined with medical therapy as well as energy based devices.