An Introduction to Injectable Biostimulators with Dr Jemima Grant

2024 will be remembered as the year Biostimulators took hold of the aesthetic market. But what are they? How are they different to dermal filers, and what is their place for patients wanting to acheive beautiful skin as they age? Dr Jemima Grant give us her independent advice including why she uses them routinely in her practice.

What are Biostimulators?

Biostimulators (AKA Injectable Collagen Stimulators) are substances that are injected into the skin, causing a low grade inflammatory response, and inciting an increase in natural collagen production. After a few months, the injected material decays into carbon dioxide and water, leaving a matrix of your own collagen behind to support your facial structure.

The most well known Biostimulators are PLLA (poly - L- Lactic Acid “Sculptra” ), PCL (polycaprolactone “Ellanse” and some soon to land in Australia) and Calcium Hydroxylapatite (CaHA). 2024 will see a host of new kids on the block, notably Rejran ( a polynucleotide, based from salmon DNA), which I won’t be talking about today (but I’m excited by this product to fact that it’s a low risk treatment that can be used to improve skin quality on the forehead and under the eyes).

What do Biostimulators Do?

Collagen Stimulating treatments increase collagen in the skin, and in doing so improve concerns such as skin laxity, thinning skin and scarring. Used at different depths, and in different dilutions, these treatments can also improve facial volume and skin laxity on the neck, decolletage and body.

How are Biostimulators different to Dermal Fillers ?

Dermal fillers are comprised of Hyaluronic Acid, a gel like substance that attract water. These substances are injected into the skin, drawing water into the area and improving facial volume through hydration.

While dermal fillers have their place in aesthetics, it’s primarily for volume restoration, not improving skin quality. While I am a fan of fillers, I have a measured approach - I use HA fillers if indicated, matching the rheology (composition) of the product to my patients skin type and their clinical concern, and always in combination with home care and other procedures. Used in this way, the impact can be natural and long lasting.

However, in many instances, fillers are over used and inappropriately applied - this has lead to large amounts of filler being injected, leading to strange, alien looking and puffy faces - they have too much hydration in their skin.

This is why I now incorporate Biostimulators in my practice - as they not only improve volume, they increase collagen in the skin, leading to improvements such as thicker more resilient skin, improvements in skin laxity and reduced pore size and acne scarring.

How are Biostimulators Injected?

Biostimulators are injected with a needle or cannula. I predominantly use cannula technique as this reduces bruising risk and has an improved safety profile for my patients.

What are the Risks Associated with Biostimulators, and how is this differnt to HA Fillers?

Like most things in life, the greatest strength of Biostimulators (natural collagen induction) is also their greatest weakness.

Because Biostimulators increase in your own collagen, the results are not reversible (e.g. if you don't like the look of them). This is in contrast to Traditional Hyaluronic acid based Dermal Fillers, which can be dissolved with an enzyme (Hyaluronidase) if needed.

Moreover, in the rare case of a vascular occlusion (where the injected product blocks a n artery in the face), or causes an inflammatory lump post treatment, these concerns can be very difficult to treat. While these risks are uncommon, you need to accept them as part of the consent process, and this means understanding the risks, how they are treated, and what your injector is doing to mitigate these risks.

With more clinics starting to offer these treatments, I do urge patients to fully inform themselves about the risks and benefits of Biostimulators, and be aware of some important aspects of care such as the experience and medical oversight of the clinician performing the treatment, their background grasp of facial anatomy and their experience with Biostimulators. This is not a treatment you should undertake using a groupon voucher. Read my blog on Questions to Ask Before Having a Biostimulator Treatment to get some tips on choosing the right clinician to treat you.

What are the Benefits of a Collagen Stimulator Treatment?

While there are some increased risks with Collagen stimulators, there is also a host of benefits.

For one, these type of treatments address the most important root cause of ageing skin- which is a reduction of collagen in the skin. Fillers don't do this, and repeated use or overuse of fillers can lead to an overfilled, puffy face. The results of Collagen Stimulators are very natural, due to the fact they increase your own collagen levels in the skin, and do not cause puffy or overfilled look.

What is the Normal Treatment Plan for Injectable Collagen Stimulators?

In general, after a consultation with my patients, my approach is to start with 2- 3 sessions every 6 weeks, (depending on your age and the severity of your skin concerns. The older you are, or the more severe your skin laxity or concerns, the more treatment you will need, every 6 weeks. with a maintenance session of 1- 2 vials every year. Financially, Collagen Stimulators work out to be the most cost effective injectable treatment as they last up to 2 years and the impacts are cumulative.

For all the reasons above, I prescribe Collagen Stimulator Injections for most of my long term patients over time, in combination with medical grade home care, in clinic treatments, hormone therapy and lifestyle advice to provide a consistent and holistic approach to age management.

How does the face age?

How does the face age?

We all hear about ‘ageing’, but what does it really mean?

Although most of us think of wrinkles as the main culprit of ageing, the reality is far more complex. The entire structure of the face, including skin, subcutaneous fat, muscles and bones change over time.

Before you read on – this post is not meant to shock or shame. The reason it’s important to understand the science behind ageing is because once understood, it allows clinicians to tailor clinical interventions to the root cause.

By using a scientific approach to ageing and combining synergetic modalities, we are getting vastly better outcomes and can achieve natural-looking results non-surgically.

What causes ageing skin?

Collagen

Collagen is the mesh-like component that makes up around 75% of the skin. It gives skin structure and support and holds the landmarks of the face in position. With age, the number of collagen fibres decreases, and the ones that remain become less organised, weakening the tissues. This results in stretching of the skin, pores become larger, wrinkles, and sag.

For women, collagen loss is accelerated in the years around menopause, when up to 30% of collagen is lost. This is compounded by the a tendency of skin to thin out and become more dry in the latter stages of perimenopause, due to reduced oestrogen This is why some women come to us feeling they have “aged overnight”, and why having a collagen inducing treatment in perimenopause is so important.

Clinical interventions that increase collagen include: wearing sunscreen, using retinol, peels, and collagen induction therapies such as dermal needling, Tixel (for skin), and High-Frequency Ultrasound (for skin sagging and laxity). Last on the list are surgical modalities such as a facelift or neck lift. surgery, make sure you see a qualified plastic surgeon, not a cosmetic surgeon, as plastic surgeons are regulated and recognised as specialists (anyone can call themselves a cosmetic surgeon - beware!)

Fat

All faces have fat, and these areas of volume help support the skin and keep us looking healthy, particularly in the midsection (cheek and lower eyelid regions) of the face.

Unfortunately, as we age, or due to other factors such as weight change, medical illness, or medications, these fatty areas reduce in volume which leads to deflation, and sunken, tired-looking eyes.

Don’t ask me why we lose fat on the face and put it on in the middle! There is no justice! Catherine Deneuve famously quipped that “at a certain age, you have to choose between your face and your arse” …and to some degree this is true!

Clinical treatments that improve fat pad loss include judicious use of dermal fillers, fat grafting, and plastic surgery. These procedures should be done AFTER skin tightening (the adage “lift then fill”) to minimise overfilling and bloating the face. Despite what the filler companies may tell you, fillers do not lift… they fill.

Ligaments

Skin is anchored to the facial skeleton via ligaments. As we age, these ligaments slacken and gravity pulls them down, causing the face to descend, forming jowls and an uneven jawline.

Currently, the best non surgical intervention to improve ligament laxity is HIFU (High Frequency Focused Ultrasound). This where the Ultraformer 3 is in its element, and the reason why we love it so much. The Ultraformer 3 has revolutionised the HIFU world with the introduction if the 4.5mm cartridge, that heats and tightens the aponeurosis and ligaments that sit above our above our facial muscles,

Although the gold standard treatment for laxity is a surgical facelift, for most people, this is not attainable due to the cost. However, the Ultraformer 3 is a viable alternative for mild to moderate skin laxity, especially when used early and regularly. Most plastics surgeons have a device like Ultraforrmer, which again is a testament to the validity of the technology, and many surgeons will advocate an annual treatment to maintain surgical results.

Bones

Just like the bones in our hips and back, our facial bones shrink and become more porous with age.On the face, this is most notable around the eye socket, the base of the nose, and the chin. This contributes to the look of “tired eyes”, drops the tip of the nose, and pulls the mouth and chin downward.

There are several interventions to manage these issues such as dermal fillers to disguise volume loss, and neuromodulators (“Botox” or “Dysport”) to reduce overactive muscles in the lower face. Make sure you see someone who knows what they are doing if they are treating the lower face as these are tricky areas.

If you want to talk or learn more about your skin and ageing, please book a consult. Having a consultation with an experienced practitioner is THE most important aspect of any treatment, as it will allow us to formulate a bespoke plan based on your concerns, your clinical issues, and your budget.