Bioremodulator Injections for Acne Scars

Bioremodulator - Biostimulator Injections; At A Glance

  • Best Results1-3 treatments
  • Treatment Recovery10 Hours
  • Procedure Time5-15 minutes
  • Skin SpecialistNurse, Davin Lim
  • Duration of ResultsLong-term
  • AnaestheticNot Required
  • Back to WorkImmediately
  • Cost$-$$

Bioremodulator Injections for Acne Scars

Biomodulators or biostimulator injectables have revolutionized acne scar treatment. Biostimulators comprise of unique compounds that include hyaluronic acid molecules, polynucleotides & collagen stimulating compounds. These are different from ‘dermal fillers’. Biostimulants refers to an increase in collagen production which results in reduction of atrophic acne scars. Unlike lasers, injectables provide fast results with little to no recovery time. Read more to understand the what types of acne scars respond to these injectable treatments. 

FactsFacts On Bioremodulator Injections for acne scars

  • These injectables stimulate collagen production to help remove acne scars
  • Unlike dermal fillers, biostimulators recruit collagen producing cells 
  • Biostimulators can be hyaluronic acid based; Profhilo
  • Biostimulators can also be DNA polynucleotide based; Rejuran
  • Other agents include PLLA, calcium hydroxyapatite & polycaprolactone
  • The ideal injectable depends on the degree & depth of atrophic acne scaring
  • Biostimulators can be used as a stand alone treatment for atrophic scars
  • Biostimulators can also be combined with lasers & peels for synergistic results 
  • Injectables are not associated with any downtime


How is this injectable different from dermal fillers?

Dermal fillers add volume via the injection of man-made hyaluronic acid, whist bio-remodelling or biostimulating injectables stimulate your own immune system to manufacture collagen, skin cells & adipose (fat) tissue.  Most atrophic acne scars will have an element of collagen & fat loss. 

In theory biostimulator injections provide a long-term solution to acne scars as it regenerates your own dermal matrix, providing your immune system can do it.

For acne scar revision, I employ both dermal fillers & biostimulatory injectables. This article explains the algorithm in greater detail.

This injectable stimulates your own body too produce collagen & connective tissue, improving atrophic scars.

How do injectable bioremodulators improve acne scarring?

In the context of acne scars, the aim is to stimulate your own immune system to repair atrophic scars by remodeling & regenerating collagen, fat & hyaluronic acid. Unlike normal hyaluronic acid dermal fillers, bioremodulators are aimed at providing long lasting results.

Secondly HA molecules provide an environment conducive to producing collagen. Thirdly, HA’s can act as a spacer, preventing re-attachment of acne scars post subcision.

bellafill acne scars
Injectables activate cells that produce collagen.



What is the advantage of biostimulators over lasers in the treatment of acne scars?

Biostimulators can give immediate results with little to no downtime as most work in two phases. The first phase is tissue swelling due to compounds mixed with the primary collagen stimulator. The second phase occurs 2-4 months after when your skin generates collagen. 

As these compounds are injected under the skin’s surface, the skin recovers very quickly. Lasers on the other hand treat from the top down, meaning that the upper layers of skin have collateral damage as the laser beam needs to penetrate these layers. 

Lasers work by collagen stimulation through thermal wounding, whilst biostimulators work by stimulating cells via receptors. 

Note: for scar signatures that are superficial, lasers will work better than injectables. Injectables work better than lasers for deep scar types.


When will I see the results?

Results are seen as early as two weeks, however, will be maximal at 8 to 12 weeks after your second session. Hence you will need to wait for your immune system to regenerate healthy skin & collagen. 

If you have a strict timeline & want faster results, consider HA dermal fillers (traditional. The advantage of HA fillers is a faster time of onset. The disadvantage? Not permanent.

acne scarring how to understand
Understanding your acne scar signature will determine the best treatment options. It takes time to regenerate your own collagen.

How many sessions will I need?

A minimum of two, a maximum of 4. It depends on the extent of acne scarring, the type of scars, volume of atrophy, location of scars, your immune system’s ability to regenerate tissue & most importantly, your expectations. 

scar acne treatments
Correction of scars are based around contour & colour changes. The number of sessions depends on the amount of atrophy, your skin type, age & expectations.

Remember, this treatment is only for select scar types, namely rolling scars. With skill & precision it can improve broad based boxcar scars & saucer scars. 

What are other factors that I consider in choosing the optimal biostimulator for my acne scars?

The algorithm is complex as many factors are considered for your injectable treatment. Factors include-

  • Depth of acne scars & scar signatures (as described above) 
  • Degree of non-scarring related atrophy of both fat & collagen (facial aging) 
  • Constitutional facial volume (genetic based) 
  • Patient’s age (mature patients require more powerful stimulation, & more sessions) 
  • Previous treatments
  • Time frame
  • Lifestyle choices – especially in superactive patients

davin lim acne scars

How would I know if biostimulators are suitable for my acne scar type?

Biostimulators are best for specific acne scar signatures. They are not a blanket treatment for all scar types. Here is a glimpse of the treatment algorithm based upon scar morphology

sydney acne scar treatment

acne scarring sydney

Will all my scars go with biostimulatory injectables?

Deeper scars respond better to biostimulation as compared to more superficial scarring in the context of injectables.

For superficial acne scars, the primary aim of injectables is to provide a universal objective improvement in acne scar severity. For ‘complete’ or near complete effacement of boxcar acne scars, lasers & or deep peels provide better outcomes. In the context of deeper rolling scars, we can expect a 50 to 95% improvement in scar severity after 2-4 treatment sessions. 

*This refers to an objective before & after photograph, it does not take into account your subjective assessment, as end points are subjectively measured.


Are the results of biostimulators predictable?

The results are predictable in over 80% of cases, but the results lie within a Gaussian curve. This means some individuals lie to the very right (highly effective, wow effect), conversely, others lie to the left (less effective, meh effect). 

Poor responders include-

  • Those with active acne (hence why absolute remission is encouraged)
  • Mature patients 
  • Poor lifestyle choices
  • Idiopathic (genetic reasons)

What is the longevity of biostimulators & will I require repeat treatments?

The longevity is not well studied however the general consensus is that if one stimulates dermal collagen (your own collagen as compared to HA dermal filler), then an age related reduction in collagen can be expected. This is called aging (both chronological ie. genetically predetermined, as well as exogenous aging, due to environmental factors). 

  • Longer lasting results can be expected with the following: CAH, PLLA, PDLLA, high & low molecular weight HA biostimulators, PCL. 
  • Shorter lasting results can be expected with: HA dermal fillers, skin boosters, non-cross linked hyaluronic acids, polynucleotide DNA. 

A recent study has shown that a collagen stimulating HA based injectable (Profhilo) has produced longer duration of improvement compared to traditional cross linked dermal fillers, namely Juvederm. Patients in the Profhilo group continue to improve after one year post injection. 

In summary, the degradation of collagen is controlled primarily by your body’s own aging process.

davin lim scar treatment
Once corrected, collagen levels are maintained by your skin & only decrease with the age of time itself.

Davin’s viewpoint on bioremodulator injectables

This product, namely a biomodulator injectable that consists of heat stable hyaluronic acid, has proven to be the most effective injectable for the treatment of acne scars. The two biggest papers with split face saline vs hybrid HA injectables came out in late 2021 & early 2022. They remain as landmark papers due to the size of the studies & importantly a control group. The only comment I would make is that in one paper the use of combined methodology was used, namely subcsion with a cannula. Ideally trials should be injectable only to the upper layers of skin, without mechanical assistance. The downside is that we still don’t have data on long term efficacy. Ideally scars should be followed up for 1, 3 & 5 years. (Once long-term data is obtained, there will be many other variables including fluctuations in weight, chronological aging & volume loss as well as other treatments during the follow ups that need to be factored in. The immense variable would make this complex, but one hell of a good study.)

Rolling scars do best with Profhilo. This product is not as effective as multilayer subcision followed by old school hyper diluted collagen stimulating fillers, however the price point makes this a very affordable & effective treatment option.

My take on longevity is that there will be net gains, even when Profhilo has ‘worn out’. This implies that biomodulation occurs despite the product having broken down, remembering that fat, skin cells & collagen levels are increased. The measurable net gain of these tissue is hard to measure as there are many variables including-

  • The use of other remodelling modalities post treatment as most acne scar patients have multiple scar signatures. 
  • Age related reduction in adipose tissue, HA, elastin & collagen (dermal matrix).
  • Ethnicity, suited skewed to ethnic patients, as we know collagen remodelling is brisker in darker skin types.
  • The site of injections; cheeks better at remodelling cf. temples & forehead.
  • Scar signatures: atrophic scars with very little bound down or anchored tissue will respond best. In other subcision will be required. Ice pick & boxcar scars generally will require different modalities (however I treat broad based boxcar scars with Profhilo to good effect). 

An important consideration is your age. This is by far the hardest message to convey to patients in their late 20s & beyond is that we are fighting both collagen loss in pre-existing scars & age-related volume loss. In your late 30s you are already behind by 25% as over time everyone’s collagen levels will deplete. Hence this age bracket, you will probably benefit from HA fillers (as volumetric replacement) & Profhilo to provide bioremodulation. Your other options include dermal grafts or fat replacement-transfer, with or without adipose stem cells.

HAs are naturally derived through fermentation & cross linking of sugar molecules derived from bacteria. It then undergoes heating for well over 100 degrees before packing it into a syringe. This is how dermal fillers like Restylane, Juvederm, & Teoxane are made. Profhilo is made the same way, but it is not cross linked.

Safety is paramount. The main risk is intravascular injection & occlusion of arteries. In acne scar patients the risk is EXPONENTIALLY higher than with normal dermal fillers. Here is why-

  1. Buffer zone depletion. With cystic acne, there usually is an element of fat atrophy due to collateral inflammation of deeper tissue. Additionally, the use of ILCS cortisone injections may also contribute. This means there may be less fat tissue to act as a buffer, exposing deeper vessels. 
  2. Change of anatomy. We know that scar tissue has aberrant vessels. In extreme cases fibrosis & inflammation not only depletes fat, but also may ‘pick up’ deeper arteries-arterioles, again increasing the risk of intramuscular injections & occlusion
  3. Scars disrespect vascular pathways. We all know the pathway of arteries, especially the facial artery. As injectors, we avoid these pathways, however acne scars can occur anywhere, meaning that in many cases we head to the danger zones & not avoid them. 

The chances of intravascular occlusion with this product is extremely low (1 case 2022 out of 4+ million treatments), possibly the rheology of this injectable follows so well that end aa occlusion is v v rare, however animal studies should come out in the next few years to determine if this is the case. Regardless, it is the law of probability that sooner or later arterial injections will occur. Hence the importance of having a specialist canter perform higher risk injections.

Profhilo has a very high tan delta, which reflects flow characteristics of the product. A tan delta of 0 is ice, 2 is water. It sits at 1.36, whilst normal fillers sit at 0.15 to 0.25. This tan delta means Profhilo flows well. It still follows flow dynamics of liquids, namely, to flow to the pathway of least resistance, however unlike normal fillers, Profhilo will flow around the tethers in rolling scars. What this means is that it provides excellent integration in tissue, whilst traditional fillers may exhibit over correction. The G Prime however is very low, this reflects the nature of this injectable.

So how does this bio-modulatory product fit in our clinic? Bioremodulatory injectable are ideal for patients who are looking for scar revision without the downtime of surgery, lasers, or deep peels. My colleagues & nurses also perform this procedure; hence it is readily available & importantly it is affordable. My nurses have had extensive experience in scar revision, including the use of soft tissue fillers, blunt cannula subcision & injecting bio-modulators for acne scars. 

Identify your scar type. Then match a treatment based upon your scar signature.

In my practice of treating objectively severe scars, I employ Profhilo at the end of the revision period as in most cases I subcise & excise early in the course of treatment. Alternatively, if you come to see me from overseas, to make the best of your time, my usual practice is to firstly subcise & laser, then in 5-10 days later, employ bio-modulators. For local patients, I do think that traditional treatments based upon scar signatures will give more predictable outcomes. Over the next decade we will have more hybrid injectables, namely those which give short term correction of volume & a long tail approach to neocollagenesis.

IDEALLY subcision should be done prior to treatment, however if you are on a budget, this injectable is super affordable at less than $460 per visit. *Note my nurses perform this treatment. My work focuses on surgical revision or exact placement of other collagen stimulating dermal fillers.

For deeper volume loss, namely large volume atrophic scars, I still employ older biostimulator injectables, namely PLLA & CAH. This group of collagen stimulating injectables have a safety record spanning two decades. 2-4 sessions are typically required, occasionally more for severe atrophic scarring in mature patients.

Conversely, if scarring is very superficial, another biostimulator that has been approved for use in Australia is called polynucleotide. This treatment uses DNA particles to stimulate collagen in the upper layers of skin. Unlike other injectables, the plane of injection is high up in the dermal layer of skin. Suitable scars include polymorphic, saucer & boxcar acne scars. The literature suggest 2-4 treatments over a period of 3 to 6 months. The recovery from Rejuran S injections is +36 hours as superficial blebs take longer to dissipate compared to HA hybrid molecules.

For those who are more inclined to ‘natural treatments’ short and long chain hyaluronic acid complexes can also increase the viability of fat transfer & ASC (Adipose stem cell transfer) as well as autologous grafting. This applies to treatment of hypopigmented acne scars. I currently mix a soup of micrografts & normal HA’s but will consider adding Profhilo to help with melanocyte activation. Additionally, HA’s can also speed up wound healing from micrografting as it provides an ideal environment for cell growth from the bone, all the way to the epidermal layer of skin. This is the power of hyaluronic acid. Don’t get high tech injectable HA’s confused with hyaluronic acid serums- it’s like comparing your iPhone 14 to your Motorola mobile from the 90s.

*Our practice in Sydney will offer biostimulators for both acne scarring in addition to Anti-aging. Our doctors employ the following biostimulators; polycaprolactone, poly-L-lactic acid, calcium hydroxyapatite, HA hybrid, polynucleotide, & upcoming PDLLA. E mail us for expression of interest.

Join the conversation

Join Dr Davin Lim on Instagram to stay up to date


Enquire now!

Get In Touch

Quick Contact

Dr Lim has unparalleled experience in dermatology. Fill in the form below and he will get back to you with your query