What skin boosters with a basis in studies are available for improving skin hydration and elasticity?

Skin Boosters with Evidence-Based Support

The most well-studied skin boosters for improving skin hydration and elasticity are non-crosslinked hyaluronic acid (HA) injections and platelet-rich plasma (PRP), with the combination of both showing superior outcomes compared to either treatment alone. 1, 2

Hyaluronic Acid-Based Skin Boosters

Clinical Evidence and Efficacy

• Non-crosslinked HA injections demonstrate significant improvements in skin elasticity and hydration with effects lasting up to 4 months after treatment 3, 4

• A 2024 study showed intradermal HA micropuncture injections resulted in a 40% reduction in wrinkle severity at 8 weeks, with 33% improvement maintained at 12 weeks 4

• Skin firmness (R0) and skin fatigue (R3) showed significant improvement both at 1 week and 4 months post-treatment, while gross elasticity (R2) and net elasticity (R5) increased significantly at 4-month follow-up 3

• Multiple objective parameters improved significantly: wrinkle height (Rz), skin roughness (Ra), elasticity (R2), pore size, hydration, and transepidermal water loss (TEWL) 4

Treatment Protocol

• Standard regimen consists of 3 injection sessions at 2-3 week intervals using 1-2 mL of non-crosslinked HA per session 3, 4

• HA is injected into the superficial dermis and epidermis for hydration and rejuvenation, not as a volumizing filler 5

• Products like Restylane and similar stabilized non-animal HA gels have been used since 1996 with extensive safety data 5, 6

Safety Profile

• Adverse effects are predominantly transient and mild, including temporary subcutaneous nodules, localized reactions, and minor bruising 3, 4

• No skin testing required as HA has no species specificity and theoretically carries no allergy risk 5

• Long-term histological studies demonstrate the material is well-tolerated with no major systemic side effects 6

Platelet-Rich Plasma (PRP) and Platelet-Rich Fibrin (PRF)

Clinical Evidence

• PRP injections produce statistically significant skin rejuvenation with improvements in brown spots, wrinkle count and volume, skin firmness, and redness 1

• Histopathological studies confirm increased dermal thickness, neocollagenosis, enhanced collagen bundle deposition, and increased fibroblast activity 1, 7

• PRF demonstrates clinically significant effects for lower face rejuvenation with satisfaction rates exceeding 90% when combined with other modalities 1

Treatment Protocols

• Typical PRP protocols involve 2-3 sessions at monthly intervals with follow-up evaluation at 3-6 months 7, 8

• PRP can be administered via intradermal injection alone or combined with microneedling for enhanced delivery 1

• Novel albumin gel formulations created by heating plasma extend duration to 4-6 months while simultaneously building collagen 1, 8

Delivery Methods

• Microneedling with PRP offers superior results compared to microneedling alone for facial rejuvenation 1

• Automated microneedling devices create microchannels at depths of 0.25-2.5 mm, allowing optimal PRP penetration 1

• Fractional radiofrequency microneedling combined with PRP shows enhanced efficacy for skin laxity 1

Combination Therapy: HA + PRP (Superior Option)

Evidence for Synergistic Effects

• A randomized controlled trial of 93 patients demonstrated that 50:50 PRP/HA combination resulted in highly significant improvement (p<0.0001) in overall facial appearance compared to either treatment alone 2

• The combination showed 20%, 24%, and 17% increases in FACE-Q scores at 1,3, and 6 months respectively, compared to only 9%, 11%, and 8% with PRP alone 1, 2

• Skin elasticity improved significantly more with combination therapy than with either PRP or HA monotherapy 1, 2

Practical Implementation

• Mix PRP and non-crosslinked HA in a 50:50 ratio immediately before injection in a single syringe 2

• The combination extends therapeutic benefits beyond what non-crosslinked HA alone provides, as PRP delivers ongoing tissue regeneration through growth factors 2

• No serious adverse events reported with combination therapy, demonstrating excellent safety profile 1, 2

Mechanism of Action

• PRP provides multiple growth factors (PDGF, TGF-β) that stimulate collagen production (COL1) and fibroblast proliferation 1

• HA contributes moisturizing properties and structural support while PRP drives regenerative processes 2

• The combination offers cost-effectiveness compared to commercial crosslinked fillers while providing natural cellular components 2

Alternative Modalities with Supporting Evidence

Photodynamic Therapy (PDT)

• PDT addresses fine lines and skin texture rather than deep wrinkles, with protocols using photosensitizers followed by red light exposure 7

• Efficacy demonstrated for improving fine wrinkling and color homogeneity in photoaged skin 7

• Adverse effects include pain, erythema, edema, and rarely pigmentation changes 7

Combination Approaches

• Red light therapy combined with PRP or fractional RF microneedling provides enhanced benefits for cutaneous spots, wrinkles, pore reduction, and texture 7

• Combined therapy shows improvements observable as early as 1 week for pore reduction, with wrinkle and texture improvements at 8 weeks 1

Clinical Pitfalls and Considerations

• Avoid using high-concentration keratolytics (urea ≥10%, alpha-hydroxyacids) on the face or areas of fissuring as they may cause irritation, though these are appropriate for body skin hydration 1

• Patient compliance is critical for topical adjunctive therapies, as application is time-consuming; choose formulations based on patient preference to maximize adherence 1

• While moisturizers containing HA, telmesteine, and other active ingredients show statistical improvements in skin scores, the vehicle alone often performs nearly as well as vehicle plus active ingredient 1

• For optimal results, prioritize the PRP/HA combination over monotherapy based on the strongest available evidence showing superior outcomes across all measured parameters 1, 2