Skin Boosters

What Are Skin Boosters?

‘Skin booster’ is the umbrella term for injections that target the skin itself: its hydration, radiance and surface quality. The dullness, loss of hydration and reduced elasticity that come with ageing are the main reasons these injections are considered. However, a skin booster is not a single substance; it is a group made up of different biological materials. For this reason, how each type works and what scientific data support it are assessed separately.

The best-known member of the group is hyaluronic acid. The hyaluronic acid used here differs from the highly cross-linked gel used in fillers; skin boosters mainly use non-cross-linked or lightly cross-linked forms. In a laboratory study comparing 28 commercial gels, non-cross-linked products behaved clearly differently from cross-linked ones under mechanical stress. The researchers considered these products better suited to structural support in the middle layer of the skin (the dermis), and cross-linked products better suited to deep, volumising injections.

The way it is given also differs from a filler. When a small-particle hyaluronic acid product is used as a skin booster, it is injected in small amounts at many points into the middle layer of the skin; the aim is to renew the skin gradually. The face and hands are examples of areas treated in this way. In a laboratory study comparing skin booster and filler products made with the same manufacturing technology, the two groups also differed mainly in how fluid they were and in the force needed to push them out of the syringe. The researchers interpreted this as a finding that supports the existence of two separate product categories.

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What Does ‘Gençlik Aşısı’ Mean, and Where Does the Name Come From?

‘Gençlik aşısı’ (Turkish for ‘youth vaccine’) is not a medical term; it is a name that has become established in everyday language and in advertising. This treatment is not a vaccine: it does not prepare the immune system against a disease, it does not provide protection and it does not stop ageing. The name describes a treatment given into the skin with a needle in a way that evokes a vaccine; this association can make the treatment seem to do more than it really does.

‘Skin booster’ is an English name that has also passed into Turkish; it roughly means something that strengthens the skin. It does not refer to a single substance but to a group of injections made from different biological materials. So if two people say ‘I’ve had a skin booster’, it does not mean the same substance was injected into their skin.

That is why three questions matter more than the name itself: which substance is given, at what depth in the skin and for what purpose? When the clinic assesses products classed as medical devices, approval by the US Food and Drug Administration (FDA) is not, on its own, the deciding criterion; the assessment is based on the product’s CE marking, its registration and conformity status in Türkiye and the manufacturer’s intended purpose.

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What Substances Are Used as Skin Boosters?

The substances used as skin boosters fall into several groups, and the scientific evidence behind each group is not equally strong. The first and most researched group is hyaluronic acid; it is used on its own or mixed with other ingredients. For example, the mixture used in one of the randomised trials (trials in which participants are randomly assigned to groups) contains the amino acids glycine, proline, leucine and lysine alongside sodium hyaluronate.

A systematic review is a review that searches the studies on a topic using set rules and assesses them together. One such review of hyaluronic acid injections for facial skin quality included 13 studies: eight used hyaluronic acid alone and five used it together with other active ingredients (as a cocktail). The effect of hyaluronic acid alone was found to be more marked than that of the cocktails; in other words, adding more substances to a mixture does not mean the effect increases too.

The second group is polynucleotides (PN), molecules obtained from fragments of DNA. The data on this group are still limited. In a systematic review of nine studies of polynucleotides in aesthetic medicine, covering 219 patients in total, the quality of the studies was rated low to moderate. Another review that searched for randomised trials found seven studies with 183 participants; it concluded that the evidence remains limited because of small samples, differing treatment protocols and inconsistent measurements.

The third group is collagen stimulators. A double-blind randomised trial (neither the participants nor the assessors knew who received which treatment) gave poly-L-lactic acid (PLLA) three times and compared it with saline; in 40 women, a significant increase in elasticity and hydration was reported at a check-up 12 months after the last treatment. Poly-D,L-lactic acid is also counted among the substances commonly used for this purpose. These substances work differently from hyaluronic acid, through the tissue’s own response, and are covered separately on the PLLA (Poly-L-Lactic Acid) and Collagen Stimulator Treatments pages.

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How Is It Different from Fillers?

A skin booster and a filler can be made from the same substance, but they do not do the same job. A filler adds volume by taking up space in the layer where it is placed, and it gives shape to the contours of the face; a skin booster spreads within the skin and works on skin quality. In the laboratory study comparing skin booster and filler products made with the same manufacturing technology, the two groups differed mainly in how fluid they were and in the force needed to push them out of the syringe. According to the researchers, these are two separate product categories that correspond to different clinical uses.

The study comparing the flow and elastic properties (rheology) of non-cross-linked and cross-linked hyaluronic acid gels supports the same distinction: non-cross-linked products were considered better suited to structural support in the middle layer of the skin and to use just under the skin, and cross-linked products to deep-tissue volumising injections.

In practice, this means the following: if there is volume loss in the cheek, temple or under-eye area, a skin booster does not fill that hollow. Conversely, if the skin is dry and dull but the volume is still in place, a filler does not address this surface problem. Both can also be present in the same person; which one is more prominent is determined at the consultation.

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How Is It Different from Facial Mesotherapy?

The difference between a skin booster and facial mesotherapy lies not in the needle but in the substance given and the aim. In both, the substance is delivered into the skin through many small injections, and the boundary between the two is not sharp in the scientific literature either. A multicentre randomised trial states clearly that the skin booster was given into the middle layer of the skin using the mesotherapy technique. Another placebo-controlled study with hyaluronic acid (one comparing it with a dummy treatment) is even titled ‘mesotherapy with hyaluronic acid’.

Mesotherapy is the delivery of ingredients such as vitamins, minerals and amino acids into the middle layer of the skin by micro-injections. The name ‘skin booster’, on the other hand, is mostly used for hyaluronic acid-based products that target hydration and skin quality. In short, mesotherapy describes a technique and a family of ingredients, while ‘skin booster’ describes one use of that technique, mostly with hyaluronic acid.

The distinction also matters for the evidence. In the systematic review of hyaluronic acid injections for facial skin quality, the effect in studies using hyaluronic acid alone was more marked than that of cocktails mixed with other active ingredients. This does not mean that cocktails are ineffective; it shows that you cannot assume every ingredient added to a mixture makes its own contribution to the result. Which ingredient suits the concern in your skin is discussed at your consultation.

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How Is Skin Quality Measured?

Skin quality cannot be expressed with a single measure; even scientific studies have no shared definition of it. A systematic review of 903 studies in aesthetic medicine found that 87% of observations were based on subjective assessments. Even for a single skin feature, between 7 and 17 different definitions were used, and no agreed definition was found. As the researchers point out, this makes it hard to compare treatments with one another.

According to the consensus of an international expert panel, skin quality comes down to four visually perceived categories: evenness of skin tone, smoothness of the skin surface, firmness and glow. According to the same consensus, these features can be affected not only by the surface of the skin but also by deeper tissues, so approaches aimed only at the surface may not be enough. A treatment algorithm (a step-by-step decision chart) built on these four categories through expert consensus also lists the suitable methods for each category separately.

Skin booster studies usually measure the following: hydration and elasticity measured with a device; aesthetic improvement scales on which the doctor or the participant rates the overall appearance; and roughness and fine-line scores. For example, a randomised trial of 448 people used two objective and three subjective measures together. When reading a result, it is worth checking what was measured: an increase in hydration measured by a device is not the same as the change you see in the mirror.

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What Does the Evidence Show?

The most consistent finding is an increase in hydration; results on elasticity are mixed. A meta-analysis – an analysis that pools data from several studies – of the effect of hyaluronic acid injections on skin ageing included 12 studies, and data from six of them could be pooled. Significant improvement was seen in hydration and radiance; no significant difference compared with control groups was found in elasticity or in the melanin index (a measure related to skin pigment). The researchers state that more research is needed.

Another systematic review, of 13 studies, also reported that hyaluronic acid improved hydration, firmness, radiance, texture and elasticity. However, the researchers described the evidence as ‘promising’ and stressed the need for large randomised controlled trials.

There are also newer and larger randomised trials. In a study of 448 people, non-cross-linked hyaluronic acid was compared with a control group that received no treatment; the person assessing the results took measurements without knowing which group the participants were in. In the treatment group, hydration was higher than in the control group at every measurement point, and a significant difference in elasticity was also seen in the measurements after the last injection; no serious side effects were observed. In a randomised trial of 456 people using a hyaluronic acid mixture with amino acids, the improvement in hydration and elasticity lasted up to three months after treatment.

These studies also have limitations. In the two large studies, the control group received no treatment at all; in other words, the results were not compared with a placebo injection, and the follow-up periods are short. Results in smaller studies are more variable: in a study of 20 people, the increase in hydration was not statistically significant, while elasticity increased significantly at four months. The authors of a 24-person study with no control group also state clearly that their findings are limited by its small, uncontrolled design.

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Neck and Décolletage

Some skin booster studies extend beyond the face to the neck and décolletage. In a multicentre randomised trial that looked at the outer corners of the eyes, the neck and the décolletage together, 146 people were divided into two groups: one group had three sessions of treatment with a hyaluronic acid-based solution and also used a moisturising cream; the other group used the cream only. In the treated group, superficial wrinkles decreased significantly in all three areas compared with the cream-only group, and radiance scores for the face also improved.

Two points need to be taken into account when reading this result: the comparison was made with an everyday skincare cream, not with a placebo injection, and the study was funded by the manufacturer. Most adverse effects were mild, resolved within 48 hours and were found to be related to the injection procedure.

At the clinic, treatment of the décolletage is assessed individually, with the aim of improving skin quality, fine wrinkles and tissue support rather than adding volume; besides hyaluronic acid, collagen stimulators such as calcium hydroxylapatite (CaHA) or poly-L-lactic acid (PLLA) can also be considered separately. Not every change you see in your neck is related to skin quality; this distinction is made at the consultation.

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Backs of the Hands

The back of the hand is one of the areas outside the face where skin booster treatments have been studied; here too, the target is skin quality, not volume. In the technique of injecting small-particle hyaluronic acid in small amounts at many points into the middle layer of the skin, the hands are given as an example area alongside the face.

There is a placebo-controlled study in this area: participants received hyaluronic acid in one hand and saline in the other for comparison. Hyaluronic acid mesotherapy was given to 22 women with moderate photoageing (skin ageing caused by the sun); the change was measured with high-frequency ultrasound by looking at the appearance of the low-density band just beneath the upper layer of the skin. Of the 18 people who completed the study, 13 showed an increase in density on ultrasound by the end of the first four weeks. In these people, a significant increase from the starting value was measured in the treated hand, while the increase in the hand given saline was smaller.

The limitations of this study are clear: the group is small; some people responded and some did not; the reported statistical comparison is against the starting value; and what was measured was density on the ultrasound image, not the change seen in the mirror. If there is marked volume loss on the back of the hand, that is a different issue from skin quality and is covered separately on the Hand Rejuvenation page.

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Limits of This Treatment

Skin boosters target the skin’s hydration and surface quality; they do not add volume, lift sagging skin or stop lines caused by muscle movement. This limit comes from the material itself: according to laboratory findings, non-cross-linked products were considered better suited to structural support in the middle layer of the skin, and cross-linked products to deep, volumising injections.

In concrete terms, this means the following. In the meta-analysis of hyaluronic acid injections, hydration and radiance improved, but no significant difference was found in elasticity or in the measurement of skin pigment. So this evidence does not support expecting results for pigmentation from a hyaluronic acid-based skin booster. Nor is the effect permanent: the authors of a recent study using lightly cross-linked hyaluronic acid note that the effect of non-cross-linked skin boosters is often short-lived. The protocols in the studies also consist of a series of several sessions, not a single treatment.

According to the expert consensus on skin quality, the quality seen on the surface can also be affected by deeper tissues, and an approach aimed at a single layer may not be enough. If your concern stems from volume loss, sagging or changes in bony support, a skin booster does not reach that source. It is not a substitute for a surgical facelift either.

The name ‘gençlik aşısı’ (‘youth vaccine’) does not mean that a vaccine is given, or that ageing is stopped or reversed. The aim of this information is not to put you off but to help you set your expectations at the right level; deciding to have no treatment at all is also a valid outcome.

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Known Risks

The most common effects are temporary reactions at the injection points: swelling, tenderness, bruising, pain and redness. For a small-particle hyaluronic acid product used in various ways, including as a skin booster, it has been reported that side effects are usually temporary and mild and that these reactions are the most common. In the randomised trial of 456 people using a hyaluronic acid mixture with amino acids, the rate of adverse events was 1.67%; all were mild or moderate in severity.

Because the treatment involves many needle entry points, pain is an issue that needs to be considered separately. In a double-blind randomised trial with poly-D,L-lactic acid in 21 participants, injections into the middle layer of the skin were found to be significantly more painful than injections under the skin. The doctor chooses a needle or a cannula (a fine tube with a blunt tip) for each person, depending on the treatment area and the anatomy.

Small lumps you can feel (nodules) have also been reported: in a study of 20 people, one person developed a temporary nodule under the skin. According to a systematic review of randomised trials with hyaluronic acid fillers, most events are injection-site reactions that go away on their own; for persistent symptoms, steroids applied to the skin, anti-inflammatory medicines or hyaluronidase (an enzyme that breaks down hyaluronic acid) were used. It should be noted that these data relate to fillers, not to skin boosters. Hyaluronidase is kept at the clinic.

Infection is a serious issue, but how often it occurs cannot be determined from these sources. According to a review of mesotherapy complications, side effects of varying severity have been described in case series and individual case reports; a lack of standards can pave the way for unwanted reactions. A systematic review of non-tuberculous mycobacterial (NTM) infections after mesotherapy (mycobacteria are a group of bacteria) covered 423 patients in 30 publications. These infections were mostly seen on the abdomen, buttocks and thighs and were linked to injections contaminated from the environment; it was reported that treatment can take a long time and that scars can remain.

Before the procedure, you will be asked about blood thinners, antiplatelet medicines (which prevent blood platelets from clumping together) and supplements that can affect bleeding. Do not stop any prescribed medicine on your own. If needed, the procedure is planned or postponed after consulting the relevant doctor.

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