11 September 2020
Needleless Profhilo– One of the most exciting skin treatments to be launched in Singapore is Profhilo; an injectable moisturiser that reverses signs of aging in the skin. Profhilo contains a combination of high and low molecular weight hyaluronic acid molecules which hydrate the dermis of the skin and build collagen and elastin in the skin. So although Profhilo is not a dermal filler (and certainly does not behave like one), it is able to plump the skin and lift the skin.
Although Profhilo was launched in Singapore in late November 2019, the popularity of this injectable moisturiser has been growing steadily. Its effects of younger looking skin and minimal recovery time required (5 injection points on each side of the face) are huge draws for my patients in Singapore. You can read more about how Profhilo works and see how it’s injected in this blogpost Is Profhilo the Injectable Skincare of the Future?
Hyaluronic acid is naturally present in our skin. It is mostly located in the dermis of the skin. Hyaluronic acid maintains skin hydration, regeneration, repair and immunity. As we age, hyaluronic acid in the dermis is gradually depleted, causing dryness, wrinkling and thinning of the skin. Replenishing hyaluronic acid in the dermis helps to reduce these signs of aging in the skin.
As I’ve shared in my blogpost Everything You Need to Know About Hyaluronic Acid, hyaluronic acid acid applied to the epidermis does not enter the dermis as it is a large molecule. The stratum corneum and the basement membrane (that separates the epidermis from the dermis) are barriers to absorption of large molecules like hyaluronic acid. These challenges limit the efficacy of applying hyaluronic acid to the stratum corneum or epidermis of the skin.
Directly injecting hyaluronic acid into the dermis with injectable moisturisers overcomes this problem and directly delivers hyaluronic acid to the dermis and sustained results. Currently trending on social media is Profhilo treatments without injections i.e. Needleless Profhilo. Let’s look at the technology and delivery devices of needleless Profhilo and see if these offer an alternative to injections.
The two most common ways of Needleless Profhilo treatments are Transdermal Electroporation and Plasma Delivery. Both delivery systems increase skin permeability without involving injections.
Needleless Dermoelectroporation (Transdermal electroporation) of Profhilo
What is dermoelectroporation (transdermal electroporation)?
One method of administering needleless Profhilo is dermoelectroporation. In electroporation, electrical pulses are passed into the skin. This opens up the ionic channels in the cell membrane to allow the passage of large molecules for drug delivery through the epidermis. Although dermoelectroporation is uncommonly performed in Singapore, transdermal drug delivery using dermoelectroporation is more commonly used in the US for mesotherapy of vitamin cocktails.
Dermoelectroporation involves a two stage treatment that first includes microdermabrasion to remove dead skin cells. This is followed by passage of electrical currents through the epidermis through a tip to improve the permeability of the epidermis and the product (Profhilo) is applied to the skin.
One dermoelectroporation device has received US FDA approval for transdermal drug delivery (Transderm Ionto Device). Transdermal electroporation (i.e. dermoelectroporation) of hyaluronic acid has been described in 2005 for the treatment of superficial wrinkles in a group of 10 patients.
Using transdermal electroporation for needleless delivery of Profhilo is novel; and may be an alternative to the correct way of administering Profhilo- if the hyaluronic acid complexes can be delivered into the deep dermis of the skin. The skin hydrating and bioremodelling benefits of Profhilo have been shown to be apparent if the hyaluronic acid complexes are injected in the correct layer of the skin i.e. the deep dermis.
Does needleless transdermal electroporation of Profhilo work?
There are no published studies on needleless Profhilo available (I could not locate any; and if you do find any, please share them with me).
Based on what we know about Profhilo and how transdermal electroporation works, I am doubtful about its effectiveness. Transdermal electroporation improves the uptake of skincare in the epidermis; not the dermis which is the correct layer for Profhilo injections. Most of the studies that looked at drug delivery using transdermal electroporation demonstrated increased uptake in the epidermis; not the dermis.
These hyaluronic acid complexes in Profhilo will not be able to enter the dermis as there is a basement membrane that separates the epidermis and dermis. Based on this, patients who undergo needleless Profhilo may experience some skin hydrating benefits in the epidermis. The collagen and elastin building benefits which arise in the dermis of the skin are unlikely to occur with needleless transdermal electroporation of Profhilo.
The reported side effects of transdermal electroporation are pain redness, edema and burns on the skin. These occurrences of these side effects are related to the strength of currents/charges for transdermal electroporation. Reducing the current/charge of therapy can reduce these side effects, but the transdermal transport of molecules into the epidermis is also reduced. The challenges of side effects and limited efficacy of transdermal electroporation will affect the effectiveness of needleless Profhilo.
Plasma Shower of Profhilo
Another needleless delivery system commonly found in beauty spas is called Plasma Shower. Similar to electroporation, Plasma Shower is said to increase delivery of molecules into the epidermis.
What is Plasma Shower?
Plasma Shower is another method of delivering drugs into the epidermis of the skin, using Plasma. Plasma is also known as the fourth state of matter; distinct from solids, liquids and gases. When a gas becomes ionised (it becomes positively or negatively charged), plasma is formed. The development of Plasma Physics began in the 1950’s.
As the gas particles are charged, plasma emits electromagnetic waves for a variety of applications in physics. The development of Plasma Physics in the speciality of dermatology is still in its early stages. There are preliminary studies that suggest that plasma may have mild anti-wrinkle and anti-inflammatory effects on the skin. There are ongoing studies that look at the role of plasma for wound healing, tissue regeneration, therapy of skin infections and cancers. Plasma therapy may also hold promise for the adjuvant treatment of cancers; as reactive oxygen species generated by plasma can destroy cancer cells.
How does Plasma Shower of Profhilo work?
Back to Physics class for this! Plasma particles have an electric charge and excite the molecules of the skin. The molecular pathway ignited by Plasma is still unclear, but some reports show that the stratum corneum (top layer of the skin) becomes more permeable. A few manufacturer reports suggest that Plasma may break down cell adhesion molecules between cells. Think of cell adhesion molecules as substances that hold neighbouring cells together to maintain the framework of the skin. When the cell adhesion molecules are broken down, large molecules can penetrate the epidermis.
What does Plasma Shower of Profhilo involve?
Most devices for Plasma Shower comprise a handpiece that the beautician applies to the skin. This handpiece emits Plasma. Profhilo is next applied to the skin.
Does needleless Plasma Shower of Profhilo work?
Plasma medicine is a relatively new field in medicine. Although there are a few reports for Plasma assisted delivery of medications into the skin; there is no published study for hyaluronic acid delivery using Plasma devices (at time of publication of this blogpost).
Key to assessing the effectiveness of Plasma Shower of Profhilo is whether Plasma can allow the hyaluronic acid complexes to reach the dermis. If the Plasma Shower device can increase the permeability of the basement membrane, the hyaluronic acid complexes may be able to reach the dermis of the skin. Until these findings can be confirmed or refuted by studies, I’ll withhold judgement.
Profhilo is a popular anti-aging skin treatment that hydrates, lifts and reverses signs of aging in the skin. Studies have shown that when the hyaluronic acid complexes are injected into the correct layer of the skin i.e. deep dermis, Profhilo also enhances stem cell, elastin and collagen viability in the skin.One of the big draws of Profhilo treatments is that each treatment requires only 5 injection points in the face, as compared to traditional injectable moisturisers like Skinboosters, which require 100-150 injection points in the face.
Riding on the popularity of Profhilo treatments in clinics are beauty spas in Singapore offering “Needleless Profhilo” treatments. Needleless Profhilo treatments involve a delivery device which increases permeability of the skin. The two common methods of needleless Profhilo Treatments in beauty salons are transdermal electroporation (DEP) and Plasma Shower.
The key to achieving best results with Profhilo treatments is your doctor getting the hyaluronic acid complexes into the deep dermis of the skin. Transdermal electroporation and Plasma Shower can improve permeability of the epidermis, but are unlikely to get Profhilo into the dermis. Studies on these delivery systems have shown increased delivery of drugs into the epidermis but not the dermis of the skin.
I might be biased, but my recommendation for any treatment is to maximise your results by choosing the most effective method. For Profhilo, the most and effective treatment administration is with injections into the deep dermis. You will find that in Singapore, almost all doctors prefer direct injections of Profhilo into the correct layers of the skin for best outcomes and less wastage of product. Especially since Profhilo requires 5 injection points on each side of the face, keeping treatment duration, discomfort and recovery to a bare minimal. In comparison, the results of Needleless Profhilo are less certain. What is your take on this?
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