SkinVive: A Hyaluronic Acid Micro-Droplet Injectable

The first and only FDA-approved hyaluronic acid micro-droplet injectable in the US to improve skin smoothness of the cheeks, SKINVIVE^™ by JUVÉDERM^® is now available. SkinVive Glow is targeted toward a younger patient population of those in their 30s and 40s, and SkinVive Advanced, which is suggested for more mature patients.

To learn more about the product, we interviewed two clinicians who have extensive experience with the injectable: Shannon Humphrey, MD, a Vancouver dermatologist and clinical associate professor at the University of British Columbia, and Jose Raul Montes, MD, whose oculoplastic surgery and aesthetic private practice in San Juan, Puerto Rico, served as one of a number of sites performing clinical trials for SkinVive. Dr. Montes acted as a principal investigator and the treating physician on some of these trials.

Modern Aesthetics: In your view how does SkinVive differ from other injectables? 

 Shannon Humphrey, MD: While SkinVive is a hyaluronic acid, it’s intended for micro-droplet injection, intradermal, or immediate subdermal use to impact skin quality. As opposed to filler, which is for shaping, volumizing, and contouring, this product is strictly for skin quality improvement through a primary mechanism of hydration. When we increase hydration in the skin, three things happen: First, the skin looks better, so it has a glow or an improved radiance—it also looks smoother. The second is that it feels skin feels smoother, more supple, and more hydrated, as there are topographical changes. Finally, it behaves differently. This refers to biomechanics because when skin is hydrated, it becomes firmer and acts more like healthy, youthful skin. The primary mechanism of the SkinVive micro-droplet is through hydration that impacts the way skin looks, feels, and acts.

 Jose Raul Montes, MD: The product is a hyaluronic acid (HA). We have today a large menu of hyaluronic acid products on the market from several brands, each one with specific characteristics. We routinely explain to our patients that these injectable implants (HAs) are for filling creases, correcting volume deficit, and in some circumstances for “lifting” facial structures. SkinVive does none of that. This hyaluronic acid mostly brings to the skin the texture or the radiance that the skin usually has when we are younger. This is a skin injectable for a skin glow, you may say. 

MA: How do you introduce SkinVive to your patients?

SH: I’ve been using SkinVive for over five years. We have experience in my practice with over 2,000 treatments. We introduced it into our daily practice by discussing skin quality attributes with patients, and the way I describe this treatment is as a heavy-duty, long-lasting injectable moisturizer. We simply ask our patients, “Are you interested in discussing an injectable option to increase hydration within your skin?” What’s key about how we introduced it is that it was a complement to existing plans. While it can be a standalone treatment, it didn’t replace or cannibalize any other treatment in my practice--I think that’s one thing that makes it really unique. Also, it’s rare to have a treatment that is suitable for all patients, and any patient could benefit from increasing hydration. Patient selection is more about expectation management and patient budget.

JRM: I always start my consultation with patients trying to educate them on skin care and healthy life habits. My approach to looking good is looking healthy. Undoubtedly, I always say to them, “If you keep good skin through every decade of your life, you’re going to always look good and healthy irrespective of surgeries or injectables.” I’m very obsessed with skin quality and I’m always trying to convince patients that if they have the best skin possible under their specific circumstances, they will look well at any age. This product is basically for skin improvement, injected superficially within the skin (the injection area for the clinical trial comprised from the junction of the lower lid and the cheeks, down to the jawline). Patients are very happy because the results are quite remarkable immediately, and they get better two or three days after the treatment when the product settles within the skin. After all, smoother and glowing skin brings instant youthfulness.

MA: Who is the ideal patient for SkinVive? What results are you seeing in practice?

SH: All patients could benefit from improved skin quality. There are some archetypes that are perfect, like the positive aging patient, the patient who wants to look natural and healthy, and age gracefully. It’s also suitable for a younger-generation patient who’s really knowledgeable about skincare products but hasn’t really started to show many signs of aging. For them, a boost in hydration and glow is a great way to start their aesthetic treatments. Finally, for patients who are motivated and want lots of cosmetic treatment but really don’t need any more filler, this is a great option because it’s not a filler if we want to boost hydration and skin quality. I’ve been really happy with the results because they are predictable, natural-looking, and have high patient satisfaction. I think the high patient satisfaction is due to the results being not only visual but also tactile and biomechanical.

JRM: SkinVive is a product that could be indicated to everyone, irrespective of gender. In our clinical trial, we were the site that provided more men into the study. Our study actually had more than 50% male patient representation, so I can attest that the product results in high satisfaction after the treatment in both female and male patients. In terms of age, we treated young patients also; we were allowed to treat patients of over 22 years of age and up to and over 60 years of age. We noticed, especially in the middle-aged population, quite a remarkable improvement in the skin and how it looks in terms of fine lines and hydration. I think that Skinvive treatment has the greatest impact on the young and middle-aged patient.

MA: Is there a learning curve to injecting SkinVive?

SH: There’s a learning curve to the injection because it’s micro-droplets (a series of micro-droplet injections targeting the deep dermis). However, we believe in many cases likely placed in the immediate subdermal space but targeting the dermis, it’s a new injection technique for many injectors. We never used topical anesthesia during the trial; ice pads were the pre-procedure prep. Injection-related side effects include bruising, which may last for a week, and skin surface irregularities that usually disappear within two to three days. I would recommend one syringe per cheek to providers who are less experienced with this treatment, and a touch-up in two to four weeks, as needed.

For me, however, with five or 10 patients, it became second nature. I think the more unique learning curve is positioning. Each practice has a unique personality. Patients have unique expectations, so having the right language to discuss expectations is important. Similarly, the results are not immediate. Most patients will see and feel something within the first few weeks, so around one month is a great time to follow up and talk to patients about their experience, ask how their skin feels, and look at the before-and-after pictures. My advice to colleagues is really to view this as a new category of treatment: Micro-droplets for skin quality through hydration. This is not a filler.

JRM: This product is injected so differently compared to what we usually do. At the beginning, if you don’t have the experience, you may think that it takes you more time than what you expect with other procedures. However, once you understand the dynamic of product strategic placement within dermis and doing it sequentially in a specific area, it’s kind of a very fast, an easy to perform procedure, but it does have a learning curve to master efficiency with this procedure.

MA: How do you see the role of this product in your practice? 

SH: The product has had a great impact on my practice with improved patient outcomes, a real shift towards focus on skin quality, and growth to the business.

JRM: Hopefully this product will help me create a more consistent awareness among my patients about skin quality. We all know that one of the most underappreciated effects of neurotoxin treatments is skin texture improvement. I explain to my patients that we can combine their neurotoxin maintenance treatment with Skinvive and the results will be significantly amplified.

MA: Do you have a take-home message for practitioners who may be interested in offering this product to their patients?

SH: In terms of advantages: SkinVive has a solid scientific base and is predictable across patient types.

As for the challenges, it is a new category of treatment, and so we need to develop a new language to set expectations for our patients, and even as injectors, to understand that this is not a filler. I think if we position it as a filler, we’ll never get the benefit out of the treatment, which is improved skin quality through hydration. The other con is that because it is a series of micro-droplets, bruising is a side effect, and while not all patients bruise, some of them will. It’s important to manage those expectations.

JRM: We should always remember that one of the limiting factors for adopting a procedure is cost. As a provider, you should build your catalog of before-and-after pictures. You should also learn to use the product efficiently, so practice on your staff, family, and friends. Be reasonable in setting expectations, be conscious about introductory cost, and try to combine the procedure with your neurotoxin treatments when possible.

Disclosures
Dr. Montes is a speaker, trainer, investigator, and consultant to Allergan/AbbVie.
Dr. Humphrey is a speaker, consultant, and investigator for Allergan/AbbVie.