What medications can be injected for biostimulation?

Medications for Biostimulation Injections

For biostimulation, inject autologous platelet concentrates (PRP/PRF), hyaluronic acid, or combinations thereof using 27-30 gauge needles with intradermal technique. 1, 2

Primary Injectable Agents for Biostimulation

Autologous Platelet Concentrates (APCs)

• Platelet-Rich Plasma (PRP) is injected intradermally at 0.2-0.5 mL per quadrant using 27-30 gauge needles or 25 gauge cannula, positioned above the orbicularis oris muscle for facial applications 1, 2
• Platelet-Rich Fibrin (PRF) in liquid injectable form (i-PRF) provides sustained release of growth factors and demonstrates superior collagen synthesis compared to PRP 3
• APCs provide biostimulation effects including natural collagen production, tissue regeneration, improvement in skin moisture, dermal structure, and color enhancement 1, 2
• Treatment protocols typically involve 3 sessions at monthly intervals for optimal results 1

Hyaluronic Acid (HA)

• HA fillers serve dual purposes: volumization (lasting 6-18 months) and biostimulation when used in diluted forms 1, 2
• Dilute HA (1:1 dilution) or hyperdilute HA (1:4 dilution) can be injected for biostimulatory effects rather than volumization 4
• HA can be combined with PRP in a 50:50 mix, showing superior facial rejuvenation results compared to either agent alone 1

Calcium Hydroxylapatite (CaHA)

• Dilute CaHA (1:1 dilution) for facial biostimulation or hyperdilute CaHA (1:4 dilution) for neck applications provide collagen stimulation 4
• CaHA injections demonstrate enhanced results when preceded by topical exosome "priming" 4

Adjunctive Injectable Formulations

Glucosamine-Based Protocols

• Injectable glucosamine sulphate (400 mg/3 mL) combined with polideoxyribonucleotide (5.623 mg/3 mL), 1 mL lidocaine, and 0.5-1 mL sodium bicarbonate 5
• Administered as multiple intradermal injections (0.05-0.1 mL each) at 7,14,21, and 28-day intervals 5
• Glucosamine acts as both a building block for glycosaminoglycan synthesis and upregulates hyaluronan synthase 1 5

N-Acetylcysteine (NAC) Protocol

• NAC plus amino acids injected intradermally enhances expression of genes related to tissue growth and elasticity (FBN1, ITGA1, ITGB1) 6
• This "Bio-NAC procedure" activates elastin and desmoplakin genes in dermal fibroblasts 6

Combination Formulations

• PRP mixed with HA (0.5 cc of 3.5% HA) plus 0.5 cc procaine, injected into deep dermis and hypodermis with 30G, 13-mm needle 7
• Improvements increase with injection number, with mean of 3.6 ± 2.0 injections showing statistically significant results 7

Technical Administration Guidelines

Injection Technique

• Use 27-30 gauge needles for precise intradermal injections or 22-25 gauge cannula for reduced bruising risk 1, 2
• Inject in retrograde fashion into each quadrant, positioning above the orbicularis oris muscle to avoid vascular complications 1, 2
• Volume per quadrant: 0.2-0.5 mL for facial applications 1, 2

Depth and Placement

• Target deep dermis and hypodermis for optimal biostimulation 7
• Maintain injection depth above the orbicularis oris muscle to prevent vascular injury 2
• Avoid superficial injections in delicate perioral areas to minimize complications 2

Common Pitfalls to Avoid

• Do not use APCs when significant volumization is the primary goal, as the 3D volumizing effect does not persist beyond 3 months despite ongoing rejuvenation effects 1, 2
• Do not inject too superficially in perioral areas—maintain proper depth above the orbicularis oris muscle 2
• Do not combine glucosamine sulphate and polideoxyribonucleotide expecting synergistic effects, as negative synergism on catabolic genes (particularly IGF1 and MMP13) has been demonstrated 5
• Do not dismiss patient concerns about bruising and swelling—these are the most frequent treatment-related effects and require realistic preoperative counseling 2

Expected Outcomes and Duration

• APCs provide rejuvenation lasting 3+ months with improvements in color, texture, moisture, and fine lines, but limited volumization 1
• HA fillers provide volumization lasting 6-18 months with concurrent biostimulatory effects 2
• Results become more significant after the third session with most protocols 1
• Patient satisfaction scores average 4.4/5 (good result) with proper technique and appropriate patient selection 1