#SkinSchool: How polynucleotides are changing the injectables scene

“It is an exciting time in the aesthetic industry,” Dr Ashwin Soni, a plastic and reconstructive surgeon tells me when asked about polynucleotides, the buzzy injectable treatment that kickstarts regeneration in the skin. “The innovation behind this is incredible,” the founder of The Soni Clinic continues. “It really is a natural way to improve our skin and tissues on a cellular level”.

Alongside other non-surgical tweakments such as anti-wrinkle injections, dermal fillers, and skin boosters (think Profhilo), he is now performing large numbers of polynucleotide treatments (using the brand Ameela) in his practice. The appeal includes cosmetic benefits that are both short- and long-term. “I think this is a treatment that will take the world by storm,” he adds.

Intrigued (and a little irked by my hollowing under-eyes as I approached my 40s), I decided to try a targeted Ameela treatment with Dr Soni at his London residency within the Chuan Spa at The Langham. As someone more interested in enhancing skin quality over editing my appearance, I have only ever experimented with Profhilo in terms of aesthetic injectables. Thankfully, I loved them both, and found the results of the polynucleotides (directed to the under-eyes) to look entirely natural.

In addition to my personal experience, below, Dr. Soni, as well as Dr. Johanna Ward—The Cosmetic Skin Clinic's award-winning cosmetic doctor—explain everything you need to know about injectable polynucleotides for the skin. Plus, Dr. Thivos Sokratous of superclinic Ouronyx tells me how he's now utilising polynucleotides for hair growth.

What are polynucleotides, and the benefits of these injectable treatments?
“Polynucleotides are an injectable bio-stimulator,” Dr Soni explains. The stretchy molecules are made from fragments of fish which mirror human DNA.” (Heard of the 'salmon-sperm facial'? This is what the headlines are referring too...) 

“The purpose of injecting the product is to stimulate our own cells to produce some of the things that we lose with ageing,” he explains. Essentially, it “can change the expression of DNA,” Dr Ward adds. “Polynucleotides boost collagen and elastin by up-regulating the fibroblast cells, as well as improving tissue regeneration and restoring skin tone and elasticity. It has an antioxidant and hydrating effect in addition to the bio-remodelling, therefore resulting in skin that looks and feels healthier,” Dr Soni continues.

In addition to Ameela, there are various brands producing the injectable product for aesthetic purposes, including Nucleofill, Pluryal Silk, and Mastelli.

How do polynucleotides differ to injectable skin boosters, like Profhilo?
“They are similar in terms of the effects,” Dr Soni says, but rather than just providing hydration like hyaluronic acid skin boosters (such as Profhilo, Teoxane Redensity 1, Belotero Revive, and Sunekos Performa), polynucleotides communicate with the cells to make them produce collagen and elastin. 

Also, “they work in all the areas many skin boosters can’t; like the eyes, lips, and forehead,” adds Dr Ward. This was one of the key factors that appealed to me, given that my Profhilo treatments couldn't reach my under-eye area and I wasn't keen on the idea of exploring dermal filler.

In the below Instagram video I discuss the key differences with Dr Soni:

Where are polynucleotides typically injected?
“They can be used effectively under the eyes, for the face and neck, and even for the jawline and cheekbones,” explains Dr Soni. Currently, most requested tends to be the eye area.

Indeed, polynucleotides for the under-eye area are changing the way cosmetic doctors work. “I have a huge cohort of patients who are bothered by their under-eye area but would not be candidates for tear-trough filler, given the presence of under-eye bags or lack of elasticity of the tissues,” says Dr Soni. “Now, I have polynucleotides, which have been shown to really improve this area in my patients of all ages.” And, for those already partaking in tear-trough filler for hollowing, “they can often space out the need for filler treatments a little more, with the addition of polynucleotides in a treatment plan”.

Who are suitable candidates for polynucleotide treatments?
It’s an animal product; so it’s not suitable for vegetarians, vegans or those with fish allergies. It’s also not appropriate for use during pregnancy or while breastfeeding—as with any injectable procedures. “I would not advocate someone too young getting the treatment either, unless there was something they were being specifically treated for,” adds Dr Soni. Otherwise, “the natural element of this treatment, and the fact that you can inject it into any type of anatomy, means that almost anyone is a candidate”. At his clinic—and, ideally, as standard wherever cosmetic procedures are performed—a thorough medical history is taken prior to the treatment being performed. “A provider must also screen for any psychological disorders or red flags before any aesthetic treatments,” Dr Soni adds.

What do polynucleotides treatments involve?
The treatment requires two-to-three sessions depending on the patient, spaced out by roughly two weeks, Dr Soni explains. “I apply local anaesthetic cream to the patient prior to injecting, and then administer the product to the desired area of the face or neck. For the under-eyes, I personally do not use any needles and use a blunt-tipped cannula through one point in the cheek, which minimises bruising and swelling to that area. Depending on your provider’s experience, the procedure itself is quick, and stings a little when you inject, but is tolerated well by patients.”

I found my treatment very bearable, despite the sensation being a little odd. It took around five minutes per eye and after my treatment, Dr Soni used an ice pack on the under-eye and cheek areas to help minimise subsequent mild swelling (which I only noticed for a few hours post-treatment) and bruising (which I didn't experience at all).

When do you see the results of polynucleotides, and how long do they last?
“You start to see the results quite quickly after the first session,” says Dr Soni, “but the second session will really kickstart that remodelling process. The product continues to work for the first 12 weeks, so it continues to improve with time—however, you do get an improvement and lift early on after the first session.” Six weeks on from my first appointment with Dr Soni I noticed a subtle reduction in the hollowing of my under-eyes and fewer fine lines.

To enhance under-eye results, post-procedure Dr Soni recommends using the Alastin Restorative Eye Complex (available in-clinics). The innovative formula "recycles old fragments of collagen and elastin," he tells me, "optimising the function of fibroblasts (which produce collagen) and up-regulating anti-ageing genes in the skin".

On average, results of polynucleotide treatments last around six months before a patient would require one maintenance session.

Can you combine polynucleotides with other cosmetic treatments?

At the Cosmetic Skin Clinic, Dr Ward performs polynucleotide treatments alone as well as in combination with other tech treatments. “The brilliant thing about polynucleotides is that they can be combined with any type of energy treatment,” she says, which is why she favours a double eye treatment using Thermage Eyes (a radiofrequency skin tightening procedure) with Ameela (the polynucleotides injectable treatment). “This is particularly good for dark circles, soft hollowing under the eye and addressing the crepey tissue around the eye,” she says.

Polynucleotides are commonly used in tandem with dermal filler treatments, too, “however, always this needs to be approached on a case-to-case basis,” confirms Dr Soni. He prefers to stagger these treatments, he explains. “For example, if someone has an extremely hollow under-eye area, my preference would be to inject tear-trough filler first, let it settle, and then come in with the polynucleotides to really improve that skin quality. However, there is no set algorithm for this, and you would need to make that assessment after examining a patient at the time of the consultation, and also making sure that the patient’s goals and expectations are realistic and can be met safely and effectively.”

How do polynucleotide treatments for hair loss work?
Dr Sokratous says that the regenerative and reparative properties of polynucleotides are also effective in addressing various hair and scalp issues. Working with the brand Chroma PhilArt when administering treatments at Ouronyx in London, he explains that it creates an environment to allow for healthier and stronger hair growth. “By enhancing collagen production and promoting cellular turnover, polynucleotides contribute to a robust and prolonged regenerative effect on hair follicles and scalp tissue without relying on your own regenerative ability.” The treatment is suitable for those experiencing hair loss or shedding, he adds, and specifically good for perimenopausal women as it helps with hair regeneration.

In terms of results, “published case studies have shown an average of a 16.5 per cent increase in the sum of hair width per cm squared, and an average two-fold increase in vellus hair,” he shares, advising a total of six treatments performed fortnightly, with the option to assess progress mid-way.

What are the risks associated with injectable polynucleotides?
As with any injectable treatment, there are risks to be aware of. “There are many providers on their social media who are saying there are no risks associated with polynucleotides, but that is not true,” confirms Dr Soni. “The risks can be much less than those carried by other injectable procedures, however it all depends on the provider, their experience, and their technique.”

Another thing to note is that if you did have any issues with polynucleotides, the treatment cannot be reversed like dermal filler can as “the product cannot be dissolved,” explains Dr Soni. “But again, the risk is much lower as the product is not a gel.”

The most common risks with injectable treatments such as polynucleotide treatments include bruising and swelling, “but in my practice I can tell you that I have hardly seen much of either,” he adds. I had no bruising and my swelling was very mild, and likely not noticeable to others seeing me.

How can you choose a trusted practitioner for injectable polynucleotides?
“Firstly, I would research your chosen practitioner very carefully, and ensure you know their training, experience, and how long they have been doing this for. This isn’t something that just any provider or practitioner should be injecting,” says Dr Soni. As with all cosmetic procedures, safety is paramount. “Search the General Medical Council Register if they are a doctor, and make sure that they have a full licence to practice in the UK. The same applies for other types of practitioners and checking their respective governing bodies.”

You should also see a practitioner’s ‘before-and-afters’ to ensure their results are to your liking, and make sure that during a consultation you feel as though you can trust them cautions Dr Soni. “Please do not simply go based on cost, or social media following, because this does not correlate with experience. High quality practitioners using the best quality products will cost, but it is worth it.”

How much do polynucleotides treatments cost?
Prices can vary from between £350 to £700 (₹38,600 approx. to ₹77,200 approx.) per session, depending on how big an area you’re having treated, and the clinic you’re visiting.

Lead image: Amie Milne for Harper's Bazaar

This article originally appeared on Harper's Bazaar / UK in August

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