Every time you look in the mirror, don't you remember how your skin used to be?
You've tried expensive skincare, layered serums on top of each other — yet nothing changes. That experience must have brought you here.
Actually, the reason your effort isn't rewarded is simple.Skincare only reaches the "surface."The real battlefield of skin aging lies much deeper.
- The Scientific Mechanism of Skin Boosters That Fundamentally Improve Skin Quality
- The system that injects a fixed amount uniformly (the principle of skin booster injections) and continuous injection (manual hand-injection)The decisive difference
- The duration of effects for each ingredient and the scientifically proven optimal treatment schedule at the cellular level
After finishing this, you will no longer wonder "which treatment should I choose," but rather understand "why that treatment works." That understanding leads to choices without regret.
Before you give up thinking "expensive skincare doesn't work…" know the truth about medical technology that directly approaches the deep layers of skin.
Skin Booster Approach to Skin Aging and Scientific Evidence
First, there is an inconvenient truth you need to know.
Skin aging is a complex biological process affected by both genetic and external factors. The most important structural components of the dermis are collagen, elastin, and matrix, all of which are primarily produced by fibroblasts. Approximately 90% [3] of the dry weight of human skin is composed of type I collagen.
This is the crucial point —
For fibroblasts to normally produce connective tissue components, they need a stable collagen scaffold to bind to. This binding occurs through specific receptors called integrins on the surface of fibroblasts. Adhesion to a stable extracellular matrix acts to spread the cell, and increased mechanical tension within the fibroblast stimulates the generation of new collagen.
So what happens with aging?
When the scaffold becomes fragmented with age, fibroblasts collapse and their function to produce collagen declines. In other words, no matter what you apply from the outside, it's meaningless if the "factory" inside has stopped.
However, when skin boosters such as stabilized hyaluronic acid are injected into thinned skin, a stable scaffold is restored, fibroblasts are stretched and activated, and the appearance and function of the skin improve.
"Will the effects really last?" — Numbers answer this pressing question.
In a study where stabilized hyaluronic acid was injected into the subdermis of the lower cheeks of 19 female patients, microneedle injection was found to significantly enhance skin elasticity and have a positive impact on skin surface roughness. The maximum improvement appeared24 weeks afterthe final injection session [1,5] — meaning regeneration occurs from the dermis over time, not immediately after the procedure.
Differences in Injection Methods: Uniform Injection (Skin Booster System) and Continuous Injection (Manual Hand-Injection)
"Skin booster injections" and "manual hand-injection" — what's the difference between these two? You might think they're the same, just with different names.
Actually,The purpose and mechanism of action on the skin are fundamentally different.
There are two methods for delivering skin boosters to the skin: precise micro-puncture based on accurate measurement (the principle of hydra facials) and conventional continuous manual injection. Certain dedicated injectors used in Europe employ a mechanism called the Smart Click System. This system accurately measures the formulation and delivers a uniform dose of 0.01 (Landau 2015) mL with each click.
The treatment protocol is as follows—
Repeat one session per month for 3 months. During each session, multiple micro-puncture injections into the dermis or subcutis are performed on the target area, spaced approximately 1 cm apart from each other. Injections are performed perpendicular to the skin surface or executed as linear, repetitive clicks along the intradermal pathway, leaving deposits of 0.01 mL of product at 2 to 3 (Landau 2015) sites. This uniform distributionis the key to simultaneously activating fibroblasts across a wide area.
On the other hand, what about manual injection (continuous injection)?
It is also possible to use the device in normal continuous mode without using such a dedicated click system. However, in research, this continuous mode is clearly distinguished as being used not for broad skin quality improvement as a skin booster, but ratherfor correcting localized skin defects and wrinkles (use as a filler)in that case.
To summarize: Mesotherapy injection system = elevating the overall quality of the entire skin. Manual continuous injection = locally filling specific areas. The purposes are fundamentally different.
Effects and duration based on differences in booster ingredients (comparison of PCL and PDRN)
The choice of ingredients significantly changes how long the effects last. Here we compare 3 ingredients.
Tissue regeneration comparison: Polycaprolactone (PCL) and Hyaluronic Acid (HA)
Even with the same "skin booster," hyaluronic acid and PCL behave completely differently within the body.
PCL-based products are composed of 30% PCL microspheres and 70% carboxymethyl cellulose (CMC). In a rat model study, 20 male rats at 6 weeks of age were used, with 0.5 mL of filler injected onto the periosteum. To ensure even distribution, the total volume was divided across 5 different injection sites, with exactly 0.1 (Chu 2026) mL injected at each site.
Results from a comprehensive 4 (Chu 2026) month study——
Tissue staining revealed significant cellular infiltration around PCL microspheres, demonstrating robust cell proliferation and integration with surrounding tissue. In contrast, HA implants maintainedempty cavities, while minimizing collagen formation.
An even more decisive difference emerged with vasculature. In a 1 (Chu 2026) month study, HA fillers were surrounded by a dense scar layer with minimal cellular infiltration and limited degradation, whereas PCL fillers demonstrated substantial internal tissue growth. Vascular ingrowth was limited to the periphery of HA fillers, but PCL fillers showedextensive neovascularizationthroughout the tissue.
Neovascularization = new blood flow = sustained nutrient supply. This is the source of PCL's long-lasting effects.
Effects of marine-derived polydeoxyribonucleotide (PDRN)
There is one more ingredient worth noting——PDRN (polydeoxyribonucleotide).
PDRN is a family of drugs derived from DNA, primarily extracted from the sperm cells of salmon and trout, with molecular weights ranging from 50 to 1500 kDa. Among 70 studies evaluating extraction sources, 40 were from rainbow trout, 29 from chum salmon, and 3 from sturgeon. Regarding study types, 30 were in vivo models and 27 were clinical studies, with wound healing (17 studies) and anti-inflammatory effects (14 studies [Kim 2021]) being the primary focus areas.
In animal experiments, a dose of 8 mg per kilogram of body weight is often used. In clinical studies on humans, intramuscular or perilesional injection of 3 ml (5.625 mg [Veronesi 2016]) of PDRN is the most commonly employed route.
Real patient data is also compelling—in a study of 32 patients (ages 30 to 75) with chronic tendon disorders, up to 5 PDRN injections resulted in significant pain reduction. Additionally, in a study of 21 male patients (ages 34 to 77) with genital disorders, PDRN injections over 10 weeks [Kim 2021] improved overall quality of life without adverse effects.
Synergistic effects and clinical data of microneedle therapy
Comparison of treatments combined with radiofrequency (RF)
"Is it worth enduring pain for treatment?"—the numbers provide the answer.
There is research comparing the efficacy of fractional microneedle radiofrequency (FMR) and bipolar radiofrequency (BR) in treating acne and acne scars. Twenty-three patients were enrolled, with 20 (11 male, 9 female) completing the study. The mean age was 22.8 years [Min 2015].
FMR used a tip consisting of 49 insulated needles over an area of 1 square centimeter, applied at levels 2 to 3 for 50 to 70 milliseconds. BR was applied at 100 Hz with a power of 100 mJ/cm² and patients received 2 sessions [Min 2015] at 4-week intervals.
Look at the results—
Acne grades on the FMR-treated side decreased to 1.9 at 4 weeks after the initial treatment. The proportion rated as grade 1 at the final visit was90% (18 people) for FMR, and 25% (5 people [Min 2015]) for BR—a 3.6-fold difference.
The number of inflammatory lesions was significantly reduced by 59.67% with FMR, and non-inflammatory lesions also decreased by 34.86% at 84 days post-treatment. In contrast, the average lesion count on the BR-treated side increased by 115.38%. Regarding sebum secretion rate, a significant reduction was observed on day 56 [Min 2015] on the FMR-treated side.
On the objective assessment score (ECCA), FMR improved from 124.06 at baseline to 104.06 (P=0.001), surpassing BR's improvement from 124.38 to 116.88 (P=0.02 [Min 2015]).
Regarding pain, let's be honest—the pain score during the procedure was higher for FMR at 5.56 compared to BR's 1.93, with associated discomfort. However, the final patient satisfaction score at 84 days post-treatment was higher for FMR at 7.41 compared to BR's 6.35 (P=0.004), and in assessment of improvement, FMR scored 3.82, exceeding BR's 3 [Min 2015].
Temporary discomfort or long-term satisfaction—which would you choose?
Safety and efficacy of microneedle therapy as monotherapy
"But I'm worried about side effects..." For those concerned, let's check the numbers from a large-scale meta-analysis.
In a large-scale meta-analysis of safety regarding treatment using microneedle therapy alone, 171 relevant articles were identified, with 26 being randomized controlled trials. Ultimately, 12 papers were included in the quantitative analysis, evaluating 414 participants [Shen 2022].
Regarding objective scar improvement, the pooled estimate for microneedle without radiofrequency showed a mean difference of 0.42 (95% confidence interval: 0.12 to 0.73%), demonstrating statistical significance. In contrast, the treatment group with radiofrequency showed a mean difference of 0.02 (95% confidence interval: −0.85 to 0.90 [Shen 2022]), which did not demonstrate significance.
The particularly notable point in adverse event data—cases of secondary scarring or infection were0 cases. Post-inflammatory hyperpigmentation following microneedle therapy without radiofrequency was also reported as0 cases [Shen 2022]across 5 studies.
Regarding satisfaction, 9 trials involving 292 participants were analyzed, and the overall treatment effect compared with laser therapy showed a mean difference of 0.03 (95% confidence interval: −0.53 to 0.59%) in 158 participants. In 4 studies (134 participants) of the non-laser group, the mean difference was 0.44 (95% confidence interval: −0.36 to 1.24% [Shen 2022]).
In adverse event tallies based on other literature, erythema was reported in 26 studies, pain in 16 studies, and edema in 16 studies following microneedle treatment. Additionally, post-inflammatory hyperpigmentation was recognized in 14 studies and acne flare in 2 studies [Mujahid 2019].
Furthermore, efficacy has been demonstrated in skin of color. In a study of 31 patients with moderate to severe acne scars, after 4 treatments,81% of patients showed 2-grade improvement, and 19% showed 1-grade improvement—meaning all patients experienced some improvement. All patients (100%) experienced temporary erythema and edema, 16% reported post-inflammatory hyperpigmentation, and 6% reported linear scarring. In a trial of 20 patients with melasma, the serum-alone group showed a 7.1-point improvement in score, whereas the group using microneedling concurrently showeda significant 10.1 (Cohen 2015) point reduction.
Long-term sustained effects and recommended treatment schedule
Finally, answering the most important question—"How long do the results last?"
After repeated microneedling procedures, collagen and elastin levels in the skin increased by400%at 6 months post-treatment, and the granular layer was proven to be significantly thickened 1 (Pajak 2022) year later.
This is not a temporary "plumping" effect. It is true, essential regeneration—a structural change in the skin itself.
To achieve optimal tissue remodeling effects, an interval of 2 to 4 weeks between sessions, or in some cases up to 8 (Pajak 2022) weeks, is recommended. Planning that doesn't rush the process and aligns with the skin's regeneration cycle is key to maximizing long-term results.
Summary of this article
- The principle of aqua facial injection systems：By constructing a stable scaffold within the skin through fine, uniform injection and physically stretching fibroblasts, collagen production is directly promoted. Unlike hand-injection (continuous injection) aimed at locally filling wrinkles, this is an approach to improve the overall quality of the entire skin.
- Characteristics by ingredient：Hyaluronic acid excels at scaffold restoration, while PCL induces long-term angiogenesis and sustained collagen production. Additionally, PDRN derived from marine organisms possesses powerful anti-inflammatory effects and wound-healing capacity, accelerating tissue repair.
- Long-term effects proven by science：Treatment using microneedles or radiofrequency, while accompanied by discomfort, demonstrates exceptionally high long-term patient satisfaction, with collagen and elastin scientifically proven to increase by 400% (Pajak 2022) from several months to one year after treatment.
If you're thinking, "What about my case?"
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About the author of this article
Hiromitsu NakamuraPhysician, Ginza Clinic
Zetith Beauty Clinic Ginza, Shinsaibashi Osaka, and Fukuoka locations
With a track record of research presentations at domestic and international academic conferences, he is involved in technical guidance and education across Zetith Beauty Clinic. He specializes in precision aesthetic medicine based on anatomical evidence, pursuing natural results tailored to each individual's skeletal structure and tissue characteristics.