Should I Have Polynucleotides? When They’re Brilliant – and When I’d Choose Something Else

Polynucleotides have become one of the most talked-about injectable skin treatments over the last few years. Often described as a regenerative treatment, they are promoted for everything from dark circles and fine lines to rosacea, acne, hydration and general skin rejuvenation.

And I do really like polynucleotides.

But I don't think everybody needs them.

In fact, one of the most common things I hear from patients who have previously had polynucleotides elsewhere is: “I’m not sure they really did very much.” That doesn't necessarily mean the treatment didn't work. More often, I think it comes down to choosing the right treatment for the right problem — and having realistic expectations about what polynucleotides can actually change.

The emerging evidence is promising. Studies suggest improvements in wrinkles, skin texture, elasticity and hydration, but the research is still relatively small and variable, and we don't yet have the same depth of evidence that exists for some more established treatments. So, should you have polynucleotides?

It depends what you're trying to achieve.

What are polynucleotides good for?

One of the reasons I continue to use polynucleotides is that they can do certain things extremely well. Rather than thinking of them simply as another injectable for “better skin”, I tend to use them quite selectively.

1. Calming inflamed, reactive or compromised skin

This is probably one of my favourite uses for polynucleotides. I find their anti-inflammatory and skin-repairing effects particularly useful in patients whose skin is reactive, inflamed or struggling with conditions such as rosacea or acne.

There is increasing interest in polynucleotides for barrier repair and inflammatory skin conditions, including rosacea, although the clinical evidence is still developing.

For these patients, the aim isn't necessarily to produce a dramatic cosmetic transformation. It is to help create healthier, calmer, more resilient skin.

And when this is the problem we are trying to solve, I often find polynucleotides very worthwhile.

2. Targeting fixed lines

Another area where I really like polynucleotides is targeted treatment of specific lines.

For example:

• fixed forehead lines

• crow's feet and fine lines around the eyes

• crepey periocular skin

• certain fine lines on the face or neck

Rather than treating the entire face, we can concentrate the product where we actually want regenerative change. This fits very well with my general approach to treatment: don't inject something everywhere simply because we can. Identify the problem and use the treatment where it is most likely to make a meaningful difference.

For those who are looking to soften lines all over, we would consider how much is dehydration, in which case a hydrating skin booster like profhilo may be a good option, how much is skin texture in which case microneedling would be my suggestion and so on…it all depends on you individual needs!

What about polynucleotides for dark circles?

This is where expectations become particularly important.

Polynucleotides are frequently marketed as the treatment for dark circles or tired-looking eyes. But “dark circles” aren't actually one problem. The appearance of darkness underneath the eyes can come from pigmentation, visible blood vessels, thin translucent skin, dehydration, shadowing from a tear trough, loss of cheek support, fat-pad changes or simply your natural anatomy. Polynucleotides may improve skin quality, fine lines and crepiness around the eyes. Which means that as skin strengthens it becomes less translucent and you see underlying structures such as muscles and blood vessels less. But they cannot replace lost volume or fundamentally change the anatomy creating a shadow.

So if your “dark circle” is predominantly caused by a deep tear trough or loss of structural support, you may complete three sessions of polynucleotides and understandably feel underwhelmed. Equally if you have a lot of pigmentation in this area they may not be the best option.

The treatment will definately help improved your skin. But It just hasn't corrected the thing you were actually looking at. In those situations, we might instead consider treatments such as Sunekos, carefully selected dermal filler, structural cheek support or a combination approach, depending on what is creating the problem.

Why I don't automatically recommend polynucleotides for full-face rejuvenation

There is another practical consideration that isn't talked about enough. Polynucleotides can sting…a lot…but for some things it is absolutely worth it! Particularly sensitive areas are across the forehead, around the nose and mouth and where, large areas are needed to be targetted They also generally require a course of treatment. So when I'm recommending any injectable treatment, I think we have to ask:

Is the benefit we're expecting worth the treatment experience?

If I'm treating an inflammatory skin condition or directly targeting stubborn fixed forehead lines, my answer may well be yes.

If your main concern is simply:

“My whole face feels a bit dry, dull and tired and I want it to look fresher,”

then I may choose something else.

How does Teosyal Redensity 1 – Baby Glow –help skin?

For patients looking for more of a whole-face skin quality treatment, I often like Teosyal Redensity 1, which we call our Baby Glow treatment. Rather than concentrating primarily on one specific problem, this type of injectable skin treatment can work very nicely when the goal is: hydration + glow + fresher-looking skin + subtle improvement in overall skin quality.

It can therefore be a more practical choice for someone who wants a relatively straightforward full-face treatment rather than lots of individual polynucleotide injections.

This is an important distinction.

If your primary problem is inflamed, reactive skin, I may lean towards polynucleotides.

If your primary problem is a fixed forehead line, I may use polynucleotides directly within that area.

But if you tell me:

“I just want my skin to look really fresh and hydrated,”

Baby Glow may make considerably more sense.

And when might I choose Profhilo?

Profhilo is another treatment that can sometimes be a more practical option when the goal is more generalised hydration, elasticity and mild skin laxity, rather than targeting one particular line or inflammatory concern.

Its high concentration of hyaluronic acid is distributed from a relatively small number of injection points, making it a very different treatment experience from multiple small polynucleotide injections. Over time, and when encorporated into a regular regiment, this results in a firmed and lifted look.

This is why I don't think the question should be:

“Which skin booster is best?” It should be: “Which treatment is best for my skin and what I actually want to change?”

Can Polynucleotides help the neck?

Interestingly, the neck is an area where I find polynucleotides considerably easier for patients to tolerate. For crepey skin, fine lines and improving general skin quality, they can therefore be a useful option.

However, again, we need to work out what is actually causing the concern. If the main problem is skin laxity, rather than skin quality, an injectable alone may not be enough. Treatments such as RF microneedling, HIFU or collagen-stimulating treatments may need to form part of the plan.

Sometimes the best result comes from combining treatments that work at different depths rather than repeatedly injecting the superficial skin.

So, when would I choose polynucleotides?

I tend to particularly like them for:

• rosacea, redness and inflammatory skin

• acne-prone or compromised skin

• fixed forehead lines

• crow's feet and fine periocular lines

• thin or crepey skin around the eyes

• fine lines and skin quality on the neck

• targeted areas where we specifically want to encourage repair and regeneration

I am slightly less likely to reach for them as my first choice if your main goal is:

overall facial hydration → I may prefer Baby Glow / Redensity 1

generalised skin laxity and hydration → Profhilo may be more practical

significant sagging or jowling → we probably need to think deeper, with treatments such as RF microneedling, HIFU or a biostimulator such as Julaine

a deep tear trough or structural under-eye hollow → improving the skin alone may not adequately correct the shadow but Sunekos is a great softer alternative

general dullness and texture → skincare, medical facials, peels or microneedling may sometimes give you more noticeable results for your investment

Polynucleotides aren't overrated – but they can be over-prescribed

This is probably the most important point. I don't think polynucleotides are a miracle treatment. But I also don't think they're simply another aesthetic trend. Used for the right indication, I find them incredibly useful — particularly when I want their anti-inflammatory properties or when I want to target a very specific area of ageing skin.

The problem comes when every under-eye concern is treated with polynucleotides because someone has been told that polynucleotides “treat dark circles”, or when an entire face is repeatedly injected when the patient's real goal is simply hydration and glow.

Once we know what is causing your concern, and what your skin needs, we can choose the right option for you and choosing between polynucleotides, Sunekos, Baby Glow, Profhilo, microneedling, RF microneedling, HIFU, biostimulators or occasionally filler becomes much easier. Because ultimately, the best regenerative treatment isn't necessarily the newest or most talked-about one. It's the one that makes the most sense for your skin.