Injectables Trends From Around the World

Kara Nesvig
·15 min read
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Travel is magical. It opens doors, takes us out of our comfort zones, exposes us to new worlds, and—wait, why does your skin look so good? Did you get something done on that trip to Europe?

Traveling to get a little something-something done is nothing new. People have been going abroad for cosmetic surgery procedures and fancy-spa visits for decades, accessing treatments that aren’t available in the United States. Some of these innovations do eventually make their way stateside, like Restylane, which came from Sweden, and RHA, which hails from Switzerland. But others never take hold in the US, or will take years to go through the FDA-approval process and get into doctors’ hands.

So why don’t we get all the good stuff right away, if at all? Well, just because a new British or Brazilian filler is buzzy, that doesn’t mean US dermatologists can start buying it and injecting it into your face. The FDA has stringent requirements for drug approvals, making it difficult for new aesthetic treatments, such as injectables created overseas, to pass FDA trials for safety and efficacy and become available in the US.

Wait, why does your skin look so good? Did you get something done on that trip to Europe?

In the EU, for example, products are also tested for safety and efficacy; but the FDA’s requirements for a comprehensive slate of studies, tests, and trials on a large number of subjects over time is as costly as it sounds. Ava Shamban, MD, a board-certified dermatologist in Beverly Hills, also works as an investigator for clinical trials. In her experience conducting clinical trials on products seeking FDA approval, testing typically involves around 1,000 total subjects, she says.

Also, data from overseas studies isn’t always accepted by the FDA. “​​The FDA wants better studies, or more studies,” says Roy Kim, MD, a board-certified plastic surgeon in San Francisco. “So there's nothing wrong, per se, with the studies that have been done overseas or even published in American papers about these non-FDA approved products…. The problem is [often] that the numbers of patients are very low.”

To date, says Dr. Shamban, there are about 140 injectables approved in the EU vs. about 22 in the United States.

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Many overseas injectables are safe and well-regarded, but that doesn’t mean they all are, or that a dermatologist in the United States would even be familiar with the ins and outs of a lesser-known product, not to mention how to address complications (such as an asymmetrical result or swelling, called edema) should something go wrong after you get back home. Says Dr. Shamban, “Some [injectables] have been approved in Europe, and people come in with these mysterious items injected into their face, and then you have to figure it out. Some of them are not dissolvable, and it can be a huge problem.”

But there are also many promising injectables going to market globally; some you may have heard of, like the UK’s popular Profhilo, while others are still emerging. During a recent trip to an international dermatology conference (the Merz Aesthetics Expert Summit), Allure editor in chief Jessica Cruel chatted with dermatologists from Germany, Australia, and Brazil, among others, and found that many of their patients are looking for products that will make them look fresh but not “done.”

Ahead, learn more about new injectable innovations that could land in the United States—and the ones some people are booking trips to get.

In this story:

Profhilo for Dewy Skin

Where you’ll find it: Europe

Profhilo launched in Europe in 2015, but this intriguing injectable didn’t get much attention in the US until more recently.

Thought of as “injectable skin care,” Profhilo, a hyaluronic acid injectable, is more of a glowifier than a traditional volumizer. Essentially, it flows and expands throughout the face to create a hydrated, dewy, “I just got 18 hours of sleep” radiance. Some doctors recommend a top up every six months, after patients get at least two treatments over the course of several weeks.

Profhilo is probably the most famous in a new class of injectables called “skin boosters,” which “give a nice glow to the skin and could also help treat very fine wrinkles,” explains Theda Kontis, MD, a board-certified plastic surgeon in Maryland and immediate past president of the American Academy of Facial Plastic and Reconstructive Surgery, “but it is not being marketed for wrinkles, just for hydration.”

It's more of a glowifier than a traditional volumizer.

Skin boosters are injected into the dermis, the second layer of skin where collagen and elastin fibers are present, so they go deeper than a topical moisturizer but not as deep as filler. Dermatologists in the US already administer shallow injections of diluted hyaluronic acid into the skin to get a similar radiant-but-not-filled effect.

Given that Profhilo is made with hyaluronic acid and should be relatively simple to test, Dr. Kim thinks it’s only a matter of time until the injectable makes its way to the US and gets FDA approval. Until then, companies in the United States are working on making their own skin boosters. For example, Juvéderm’s skin booster, Skinvive, was granted FDA approval in May 2023 for improving smoothness in the cheeks.

But Skinvive and Profhilo are like sisters, not twins. They promise similar glow-enhancing results, but have different compositions. Jason Diamond, MD, a double board-certified facial plastic surgeon in Beverly Hills, says his most jet-setting patients tend to prefer Skinvive to Profhilo. They come home after getting Profhilo on vacation and say they liked the radiant effect, but that it didn’t last as long as they hoped. To be fair, though, some doctors recommend two Profhilo treatments over several weeks to see the most radiant results, and you’re probably not going to be in London long enough to complete the course.

“You may start to see an increase in radiance and [an improvement in] texture at about three weeks after the initial treatment, but you won't see the [full] benefits until two or three weeks after your second treatment,” Yannis Alexandrides, MD, an American and European board-certified plastic surgeon based in London, previously told Allure.

MesoEye C71 for the Undereyes

Where you’ll find it: UK

The undereyes are tricky: They’re one of the first areas where we see wrinkles and puffiness, and they are notoriously difficult to smooth with fillers. That’s because of “the delicate anatomy and potential for inaccurate product placement,” says Rod J. Rohrich, MD, a board-certified plastic surgeon in Dallas.

When an undereye injectable goes wrong, the problem can be more than aesthetic: “There’s a risk of serious complications from vascular occlusion, [when blood cannot pass through a vessel] if performed incorrectly, and of late-onset edema after tear trough injections,” says Dr. Rohrich.

An injector who has a steady, precise hand is essential regardless of where you’re being treated, but the eye area requires even more care. “My concern about injecting anything around the eyes is that the skin there is super, super thin,” says Doris Day, MD, a board-certified dermatologist in New York City. “When you're doing injections around the eyes, or in the lips, even just the needle going under the skin can affect the lymphatic flow in those areas.”

"We don’t have anything like it in the US."

Those same caveats apply to MesoEye C71, an injectable doctors are using in the UK for a whole bunch of undereye concerns: bags, dark circles, sagging, and wrinkles, extending out to the crow’s feet. MesoEye C71 is unique in that it’s a non-cross-linked hyaluronic acid plus a proprietary peptide blend (Periorbital Peptide XP2 and Hexapeptide-17) that’s supposed to give skin care-like benefits. Says Dr. Rohrich, “The thought is to combine the volumizing and hydrating effects of hyaluronic acid with certain peptides that stimulate microcirculation and increase lymphatic drainage” as a way to address dark circles and puffiness.

We don’t have anything like it in the US, says Dr. Kim, who currently uses hyaluronic acid filler or blepharoplasty to treat the eyes. “A product such as this could be exciting if it is shown to increase vascularity [blood flow] and lymphatic drainage,” adds Dr. Rohrich.

Promoting healthy blood flow and boosting the lymphatic system could also head off the potential for lymphatic system blockages in this thin-skinned area, thereby “combatting complications [like edema] and that could have a real impact on the long-term outcomes of treating the eye area,” says Dr. Rohrich.

But the fact that the eye area is so delicate likely means that safety concerns could be a barrier to MesoEye C71 approval in the US, says Dr. Rohrich, adding that he thinks “it will be a while,” because doctors are just getting on-label approval to use fillers [like Restylane or Volbella] in the tear trough.

On-label use means the FDA has approved the product for a particular use, explains Dr. Shamban. Off-label use means there hasn’t been a clinical trial for that specific use, but there is often a consensus among experts that the product works in that area; a company may then spend the money to have it FDA approved for that indication.

MesoEye C71 may also have another hurdle to overcome, because it is a blend of hyaluronic acid and peptides and “the FDA does not like to approve combination injectables,” says Dr. Rohrich.

Belotero Revive for the Look of Glass Skin

Where you’ll find it: UK, Switzerland

If you’ve heard of Belotero, it’s because another injectable in the Belotero portfolio, Belotero Balance, is available in the United States, unlike the rest of the injectables on this list, which don’t have US cousins. Belotero Balance is a hyaluronic acid filler that has been FDA approved for wrinkles and nasolabial folds since 2011 and for the undereyes since 2023.

The entire Belotero portfolio, however, has not yet earned FDA approval. Doctors in the UK, Switzerland, and Asia have begun injecting Belotero Revive for a glassy effect. It’s a skin booster like Profhilo and Skinvive, but unlike those two, it’s a combination filler that blends hyaluronic acid with another hydrator, glycerol.

It is used in Asia where patients tend to favor glassy, dewy effects from injectables.

But without good data (from head-to-head studies, for example), it’s hard to say whether the addition of glycerol makes skin plumper or more moisturized than it is after treatment with Profhilo and Skinvive. But, Dr. Rohrich says, “the basic premise of Revive is similar to that of Skinvive and other skin-boosting hyaluronic products: Injections result in increased hydration of the skin, which translates to a dewy appearance.”

Belotero Revive is also used in Asia where patients tend to favor glassy, dewy effects from injectables, notes Dr. Kim: “There are different ways to get [the look of glass skin]: In Korea, there are over-the-counter ways—a lot of exfoliation, hydrafacials, creams for a slightly better glow—but honestly, the best way is a medical dermatology procedure.”

Polynucleotide Injectables—a Fancy Name for DNA Derived From Fish Semen

Where you’ll find it: Australia

This injectable is sourced from… fish semen? Stay with us here—your eyes are not playing tricks on you. Polynucleotides are derived from fish DNA. They’re not derived from just any fish DNA, though; it’s something called milt, which is actually fish semen, says Dr. Kim. (In this case, trout or salmon semen.)

Studies have shown polynucleotides to be beneficial for wound healing as it supports tissue regeneration and stimulates collagen production. For the skin, “early in vivo studies have shown improvement in skin tone, fine lines, skin elasticity, and hydration,” says Dr. Rohrich. (One study, published in the journal Dermatologic Therapy, found pore and skin thickness were improved in patients in their 30s, while skin tone, wrinkles, and sagging were improved for patients in their 40s.)

Polynucleotide injections go by different brand names, including Pluryal Silk and Nucleofill, and they come in different forms, says Dr. Kim. There’s a liquidy version that could be used as a skin booster, and another in which the polynucleotide is mixed with hyaluronic acid, which could be the most promising version. “The hyaluronic has an [almost] immediate effect, and then the polynucleotide does its magic underneath the skin to prompt regeneration over the course of the next couple of weeks,” Dr. Kim explains.

“I don't know when the FDA is going to ever approve [fish semen]-derived chemical compounds.”

Polynucleotides are a kind of biostimulator, which is a hot topic at the moment, says Dr. Rohrich: “Biostimulators seek to alter the physiologic composition of a patient’s skin and deep facial structures as it pertains to facial rejuvenation.” By stimulating new collagen and helping to regulate fibroblasts (connective tissue builders), “the idea is to obtain longer-lasting results that are facilitated by one’s own body.”

However, given the unconventional formulation, it could be a very long time—if ever—before the FDA approves something like this in the United States. “I don't know when the FDA is going to ever approve milt-derived chemical compounds for human use in Americans,” Dr. Kim says. And right now injectors in the US aren’t too eager anyway: “I would not consider using polynucleotides until I see more long-term safety and outcome data,” says Dr. Rohrich.

Multiple Injectables in One Syringe—Like Filler Plus Botox

Where you’ll find it: Brazil and Asia

What happens when you take two trends—skin boosters and skin Botox—and combine them into one treatment? You get a custom mix of hyaluronic acid and neuromodulator that “works great for delivering [the look of] dewy, glass skin” by reducing pore size and remoisturizing the skin, says Dr. Kim, adding that it’s a cocktail that doctors in Asia have started blending in their own practices. The combo may be injected using a medical device that delivers shallow injections across the face and neck.

In Brazil, hyaluronic acid and biostimulators (injectables that encourage collagen production) are mixed for an injectable hybrid blend. These concoctions are designed to give patients immediate wrinkle-filling results, with the longer-term benefit of stimulating the body’s collagen production for firmer skin.

In the United States, says Dr. Kim, it’s likely the FDA would never approve a prepackaged combo, such as a hyaluronic acid filler plus a neuromodulator. Botox has been FDA approved for cosmetic use for over 20 years, and Juvéderm for almost 20. “But the FDA doesn't care about that,” he continues. “They're not going to allow Allergan to mix them. They're not going to allow Dysport and Restylane to be mixed.” (Allergan makes both Botox and Juvéderm, while Galderma makes the FDA-approved neuromodulator Dysport and hyaluronic acid filler Restylane.)

Several doctors tell me that the margin for error can be very high when these products are mixed into one syringe. “I don't like it because I don’t think it’s possible to get an even mix of the Botox with the filler,” says Dr. Day. “Either there’s not enough Botox to do anything or there's too much Botox and it does what you don't want it to do—like creating a frozen look or uneven movement—so I don't think it's reliably effective.”

“Americans just love to jump in with two feet. The FDA is trying to protect us, desperately.”

Dr. Diamond agrees: “We don’t do that in one injection,” he says. “We use Botox on people, fillers on people, all in the same area, but not with one injection. I don’t know how you’d be precise with one injection. How do you adjust that for delicate, exquisite little areas?”

Dr. Rohrich is also skeptical, and curious: “Why combine them when you can layer them and/or use them separately?” He would want to see true comparative studies to determine whether there’s any advantage to these double-duty shots.

When it comes down to it, Dr. Day says, “I'm happy that we have this FDA-approval process that makes it harder for companies to bring products to market.” Though it can take months, if not years, for new products to show up on our shores, that can be a good thing. “Americans just love to jump in with two feet,” says Dr. Shamban. “[They think], A little is good, more is better. That’s kind of the American thing. We're willing to take a risk. The FDA is trying to protect us, desperately.”

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Originally Appeared on Allure