Polynucleotides and "Skin Priming": Reading the Consensus

A 2024 paper from an Italian expert panel proposed using polynucleotide injections to "prime" the skin a few weeks before treatments such as laser, peels, microneedling or filler. The idea is that better-conditioned skin may respond and recover better. However, the paper is a consensus of opinion with limited supporting data and strong ties to the manufacturer, so it should be read as a research proposal. Polynucleotide products are experimental in many settings, their Health Canada authorization status varies, and If you are curious about it, ask a physician whether it is authorized in Canada and appropriate for you.

What are polynucleotides?

Polynucleotides are chains of building blocks of DNA. The injectable products discussed in aesthetic medicine are purified from fish sources and placed in the skin in many small amounts. Laboratory work suggests they may support the cells that make collagen and help with tissue repair, but much of that evidence comes from cell and animal studies rather than people. They are sometimes grouped with "skin boosters," which our article on skin booster injections describes.

What the panel did

An eight-member board of Italian dermatologists, plastic surgeons and aesthetic physicians met in 2019 or 2020 and again in 2023. They also ran a 16-question survey of 51 Italian practitioners. Using a modified version of a structured expert-agreement method, statements reaching at least 80% agreement became recommendations, and those reaching 60% to 80% became consensus statements.

The panel proposed that a short course of polynucleotide injections, usually starting at least a month beforehand, could prepare skin before resurfacing laser, chemical peels, microneedling, radiofrequency and ultrasound devices, light therapy for the scalp, and filler. Suggested numbers of priming sessions ranged from about two to four for most procedures, with more for stretch marks and scars. Expected side effects were bruising, redness and burning, with occasional persistent bumps at the injection points reported with more concentrated formulations.

Almost every statement reached the recommendation level. Panel members also said the approach did not need to be rigidly sequential, and that injecting at the same visit might sometimes be acceptable.

How strong is this evidence?

A consensus statement records what a group of experienced clinicians agree on. It is useful when research is thin, but it is the lowest rung of evidence for showing that something works. Several features of this paper call for extra caution:

• Little clinical data. The panel itself describes its proposals as tentative while trials are ongoing. The human studies cited are few and small, and the proposed "priming" effect has not been confirmed in controlled trials.
• Reliance on laboratory and internal reports. Much of the explanation of how priming might work comes from preclinical work, company reports or trade publications.
• Strong industry ties. Panel members reported fees or grants from aesthetic companies, and the product's manufacturer funded the meetings and publication costs.
• Narrow scope. The survey was limited to Italian practitioners and focused on one product line. The paper does not report the number of agreement rounds, and contains some internal inconsistencies.
• Agreement is not proof. Even unanimous expert opinion can be wrong when the underlying studies have not been done.

To show that priming works, researchers would need trials that compare people who receive priming injections before a procedure with similar people who do not, ideally with assessors who do not know which group each person is in. They would also need to measure clear outcomes, such as healing time, side effects and results months later, and to be run or checked by researchers independent of the manufacturer. The panel itself points toward this kind of research as the next step, which is a sensible conclusion.

It is also worth noting that adding extra injection sessions before another treatment means more visits, more needle sticks, more chances of bruising, and more cost. Without proof of benefit, those trade-offs are hard to justify.

What it means for you

Polynucleotides are an area of active research, and it is reasonable to be curious. At this stage, though, there is not enough independent evidence to say whether priming improves results or recovery from other treatments. Please keep these points in mind:

• Availability and authorization vary. Products sold in Europe or Asia may not be authorized by Health Canada. Do not seek these injections from unregulated sources, online sellers or non-medical settings, where product origin, sterility and handling cannot be verified.
• Fish-derived products may raise questions for people with fish allergies or dietary and religious concerns, which should be discussed with a physician.
• Proven preparation steps exist. Before laser or peels, consistent sun protection, appropriate skincare and pausing certain products are well-established ways to prepare skin. Our article on skincare before and after laser covers this.
• Healthy skin habits matter. Not smoking, sleeping well and treating conditions like eczema or rosacea before procedures all support healing.

Questions to ask at your consultation

• How should I prepare my skin before the treatment I am considering?
• Is there anything about my skin or health that could slow healing?
• Is a product I have read about authorized in Canada, and what is the evidence behind it?

Frequently asked questions

Are polynucleotides the same as hyaluronic acid boosters?

No. They are a different substance with a different proposed mechanism, although some products combine the two. The evidence base for polynucleotides is smaller.

Does skin priming make laser results better?

That has not been shown in good-quality independent trials. The idea is a proposal from an industry-supported expert panel.

Can I buy these injections online?

Please do not. Injectables from unregulated sources may be counterfeit, contaminated or incorrectly stored, and self-injection carries serious risks.

If you have questions about new products you have seen online or abroad, a consultation at HealthPark Medical Aesthetics is a place for a balanced discussion of what is known, what is not, and which established options may suit you.

Source

Cavallini M, Bartoletti E, Maioli L, Palmieri IP, Papagni M, Priori M, Trocchi G. Value and benefits of the polynucleotides HPT dermal priming paradigm: a consensus on practice guidance for aesthetic medicine practitioners and future research. Clinical and Experimental Dermatology and Therapies, 2024. Read the study