Injectable and filler innovations are always on the up and up, but these magic age erasers usually land on U.S. soil last. Why? The FDA’s robust and stringent rules, requirements and regulations make the approval process long. Here’s the scoop on injectable exosomes and other treatments available overseas that you may soon find at your dermatologist’s or plastic surgeon’s office.
Featured Experts
- Elaine Kung, MD is a board-certified dermatologist in New York
- Olga Bachilo, MD is a board-certified plastic surgeon in Houston
- Kenneth R. Beer, MD is a board-certified dermatologist in West Palm Beach, FL
- Elizabeth Bahar Houshmand, MD is a board-certified dermatologist in Dallas
What to Expect Next
Polynucleotide Gel Injections (aka ‘Salmon Sperm’)
Biocompatible polynucleotide gel injections are derived from the DNA of salmon semen. These injections are packed with minerals, vitamins, proteins and amino acids. According to a study published in Scientific Reports, the injections have been shown to induce tissue regeneration and stimulate collagen synthesis in human and mouse fibroblasts. One reason for the recent salmon sperm craze, according to New York dermatologist Elaine Kung, MD, is that the gel stimulates new collagen, and therefore, also improves skin texture.
A few injectable polynucleotide brands are available in Europe, Asia and South America, including Rejuneron, Nucleoskin, Ameela, PhilArt, Pluryal Silk and Nucleofill. Yet none of the brands—or any polynucleotide gel, for that matter—are FDA-approved in the United States. Dr. Kung explains that although these injections are trending, be aware of medspas that use products or perform techniques that the FDA does not sanction.
Injectable Exosomes
Since exosomes made a name for themselves a few years ago, they’ve become the talk of the aesthetic world. “Exosomes are tiny cellular structures that play a crucial role in cell-to-cell communication, carrying proteins, lipids and nucleic acids to influence several biological processes, like stimulating tissue repair, regeneration and immune system modulation,” Dr. Kung shares. “Exosomes are promising for a wide range of aesthetic and regenerative applications.”
Some dermatologists and plastic surgeons apply exosomes topically after microneedling and lasers to reduce inflammation and speed healing. Injecting exosomes, however, remains controversial, as it’s not FDA-approved. “Injectables require a higher safety and sterility standard than topical products. There are no exosome products currently on the market that are FDA-approved for injections,” says Houston plastic surgeon Olga Bachilo, MD.
“Exosomes are excellent delivery trucks, loaded with ingredients like hyaluronic acid and niacinamide to enhance results,” adds West Palm Beach, FL dermatologist Kenneth R. Beer, MD. He envisions a future where injectable exosomes are custom-designed for specific patient needs, but for now, topical use remains the safest option.
Platelet-Rich Fibrin (PRF)
If the idea of injecting filler doesn’t appeal to you, rest assured there’s a more natural approach. Enter: PRF. Though platelet-rich fibrin isn’t new, its use as a filler alternative is gaining traction. Derived from plasma in your blood, Dr. Kung calls PRF a promising versatile biomaterial for aesthetic regenerative medicine. “Unlike platelet-rich plasma (PRP), a liquid component, PRF incorporates a three-dimensional fibrin matrix that provides a structural scaffold for tissue regeneration.”
First, blood is drawn and separated in a centrifuge to extract the fibrin from the plasma to make PRF into an injectable form. “PRF is thicker because it does not involve the addition of anticoagulants into the collection tubing; it causes fibrin clots so that we can use it more like filler,” explains Dr. Bachilo.
PRF is rich in growth factors and cytokines, which play vital roles in tissue repair and regeneration. That’s why Dr. Kung calls PRF “valuable in various procedures,” including facial rejuvenation, hair restoration, scar treatment and soft tissue augmentation of the lips, cheeks and other facial features.
Evolysse
Unlike traditional hyaluronic acid fillers, which have been part of dermatologists’ and plastic surgeons’ toolboxes for years, Evolus’s upcoming Evolysse is a more specialized form for aesthetic use. “It differs from conventional hyaluronic acid injectables in several ways,” Dr. Kung says. “Its crosslinking process enhances durability and longevity, which means the hyaluronic acid molecules are linked together tightly for a more resilient, longer-lasting product.”
Evolysse has a smaller particle size, which allows for smoother, more natural-looking results, says Dr. Kung. “It integrates more seamlessly into the skin. Evolysse’s viscosity makes it ideal for injecting into deeper layers of the skin for volume and lift and treating facial wrinkles and folds.”
Restylane SHAYPE
The anticipated launch of Restylane SHAYPE, a unique type of hyaluronic acid, is already earning buzz as a next-generation HA filler. Powered by NASHA HD (non-animal stabilized hyaluronic acid) technology and highly viscous, this yet-to-be-released filler is firmer and more robust to give areas like the chin better structure, says Dallas dermatologist Elizabeth Bahar Houshmand, MD. Dr. Beer expects to use Restylane SHAYPE for jawline definition and deep tissue or bone loss. “I think it will be popular with patients on Ozempic, too.”
HArmony CA
HArmonyCa falls under the category of a hybrid filler because it comprises two different components: hyaluronic acid and calcium hydroxyapatite. “The hyaluronic acid gives an instant lifting effect with longevity of over a year,” Dr. Houshmand says. Even though HArmonyCa was FDA-approved in 2022, it is still not available in the United States. “However, I have seen beautiful results from colleagues in Brazil.”
Belotero Revive
Belotero Balance has been FDA-approved to treat wrinkles and nasolabial folds since 2011 (it later received indications for the under-eyes, too). The next star of the Belotero bunch is the Revive variation. It is said to be more of a skin booster than a traditional injectable (think Skinvive rather than Restylane) and leaves skin with a healthy, natural glow and plumpness. “Revive, like Skinvive, rehydrates the skin, improves elasticity and reduces the look of fine lines, but it’s made of different ingredients,” explains Dr. Houshmand. “Revive contains glycerol, a hydrating agent, and cohesive poly-densified matrix technology for homogeneous dermal integration. On the other hand, Skinvive contains 1,4-butanediol diglycidyl ether (BDDE), a chemical that is cross-linked with the hyaluronic acid and lidocaine to help reduce pain during injection.”
DISCLAIMER: These doctor quotes are statements based on individual preference. Valid scientific evidence is still needed on usages that are not FDA-approved.
