Polydeoxyribonucleotides in Plastic Surgery and Beyond

Every year in our ever-growing field of aesthetics, we seem to have hot products or emerging technologies that pique practitioners’ interest. After all, isn’t that the fun and exciting part about why we went into this specific field? It’s always evolving and, therefore, we evolve with it. Last December, I was fortunate enough to be a part of the truly outstanding faculty at the inaugural Genesis: Innovations in Aesthetic Regenerative Medicine meeting in New York that addressed the buzzing topics in aesthetics.

There are three things practitioners usually consider when we are presented with new products and new technologies:

1. Is there real science behind it?

2. Does it work?

3. Do we want to incorporate it into our everyday practice?

There are a couple things all of us, like it or not, must accept before we even begin discussing any of these three questions or polydeoxyribonucleotides (PDRN). First, regenerative medicine is here to stay—no ifs, ands, or buts. It’s what we ultimately want for ourselves and our patients, who are now demanding it. Second, yes, as a surgeon, I understand the regenerative space will probably not be as lucrative monetarily and may not have as dramatic and as immediate changes as operating, but please refer to my first point.

The bright side? We now have better and more effective ways of enhancing our results, offering less downtime to our patients, and maybe even truly turning back the clock on a cellular level. I had the privilege of discussing one of these emerging categories at Genesis.

WHAT ARE POLYDEOXYRIBONUCLEOTIDES (FOR EXAMPLE, PDRN, SALMON SPERM, AND SODIUM DNA)?

PDRN is a fragment of DNA derived from the sperm cells of salmon trout (Oncorhynchus mykiss) or chum salmon (Oncorhynchus keta) with molecular weights between 50 and 1500 kDa and a chain length ranging from 50 to 2000 bp. The chemical structure of PDRN consists of a low-molecular-weight DNA, composed of a linear polymer with phosphodiester bonds, which are represented by purine (adenine and guanine) and pyrimidine nucleotides (thymine and cytosine).

WHY SALMON SPERM AND NOT ANY OTHER SALMON CELL?

They are the most appropriate cells to provide highly purified DNA without the risk of impurities, such as additional peptides, proteins, and lipids that can remain in somatic cells.

HOW DID WE THINK OF USING PDRN IN AESTHETICS?

Just like most things in aesthetics, other specialties have used PDRN for years to treat medical problems. PDRN has been shown to enhance the growth rate of numerous cells in primary cultures at therapeutic concentrations, such as preadipocytes, osteoblasts, fibroblasts, and chondrocytes, and an abundant number of articles have discussed PDRN being used to treat diabetic foot ulcers in the regenerative as well as the wound-healing space.

HOW DOES PDRN WORK?

PDRN promotes wound healing primarily through the activation of the adenosine A2A receptor of the fibroblast cell, which enhances angiogenesis, increases fibroblast growth rates, and reduces inflammation. This receptor activation also leads to improved tissue oxygenation and blood flow, which are critical for effective wound healing and tissue regeneration.

It also works through the salvage pathway with its purine ring, enhancing DNA repair by catching free radicals (ie, reactive oxygen species; ROS)—that cause aging, tumors, cancer, decreased collagen production, etc.

HOW CAN WE USE PDRN AND HOW IS IT BEING USED IN PLASTIC SURGERY?

We can use it for wound healing and skin rejuvenation by increasing re-epithelization in skin grafts,¹ increasing granulation tissue thickness, accelerating healing times, and stimulating higher levels of VEGF-positive cells when used with fractional laser resurfacing,² restoring blood flow and improving tissue architecture by modulating HIF-1 alpha and VEGF expression in ischemic skin flaps.³ We also can use it for scar prevention, reducing hypertrophic scar formation and erythema when used with post-surgical wound injections,⁴ as well as to enhance outcomes in plastic surgery procedures, improving and reducing healing time after facelifting procedures when injected once a week for 4 weeks pre-operatively and post-operatively.⁵

CASE STUDIES

A case that was treated by Thiago Quiroz, MD, from Miami, Florida, involved a vascular occlusion caused by filler injection to the glabella that he promptly treated with multiple rounds of hyaluronidase (1500 units). He instructed the patient to chew baby aspirin and take oral steroids, and he applied nitro paste, massaged the area, applied warm compresses, and then microneedled PDRN 3% (there are several different types of PDRN of different percentages, from different sources, and from various areas of the world based on the company providing it) to the area.

Figures 1 and 2 are before and after photos following 4 weeks of performing four treatments of microneedling with 3% PDRN.

Another case, treated by me, used PDRN 3% for cosmetic improvement for texture, skin tone, hyperpigmentation, and all-over improved radiance. Figure 3 is before microneedling with PDRN 3%. Figure 4 is after three treatments of microneedling with 3% PDRN and Figure 5 was taken in the evening on the day of microneedling treatment.

Fig 1: A patient’s skin problem prior to four treatments of microneedling PDRN 3%.(Image courtesy of Thiago Quiroz, MD, from Miami, Florida)

Fig 2: The patient’s skin 4 weeks after undergoing four treatments of microneedling PDRN 3%.
(Image courtesy of Thiago Quiroz, MD, from Miami, Florida)

Fig 3: A patient’s face before microneedling PDRN 3%.

Fig 4: A photo was taken in the evening on the day of microneedling treatment.

Fig 5: The patient’s face after three treatments of microneedling with 3% PDRN.

The third case was treated by Shino Bay Aguilera, DO. Figure 6 shows visible melasma prior to treatment and Figure 7 shows the results after four sessions of microneedling, with each treatment 3 weeks apart, utilizing Lumicen (Toskani), Radiance Intimate Cream (Toskani), and WCPR (Toskani).

Fig 6: A patient’s pre-treatment photo, in which melasma is visible.
(Image courtesy of Shino Bay Aguilera, DO)

Fig 7: Results after four sessions of microneedling, each 3 weeks apart, utlizing Lumicen (Toskani), Radiance Intimate Cream (Toskani), and WCPR (Toskani).
(Image courtesy of Shino Bay Aguilera, DO)

IN SUMMARY

I look forward to seeing what else we see with PDRN because if it can help heal diabetic foot ulcers, ischemic skin flaps, and vascular occlusions with solid science behind it—I’m in.

1. Urso Pitassi LH, Pearson K, Antônio de Assis L, et al. Polynucleotides in Skin Regeneration: Targeting the Adenosine A2A Receptor and Salvage Pathway. Dermatol Surg. 2024;50(11S):S131-S134. doi:10.1097/DSS.0000000000004438.

2. Rubegni P, De Aloe G, Mazzatenta C, Cattarini L, Fimiani M. Clinical evaluation of the trophic effect of polydeoxyribonucleotide (PDRN) in patients undergoing skin explants. A Pilot Study. Curr Med Res Opin. 2001;17(2):128-131.

3. Yu M, Lee JY. Polydeoxyribonucleotide improves wound healing of fractional laser resurfacing in rat model. J Cosmet Laser Ther. 2017;19(1):43-48. doi:10.1080/14764172.2016.1247966.

4. Polito F, Bitto A, Galeano M, et al. Polydeoxyribonucleotide restores blood flow in an experimental model of ischemic skin flaps. J Vasc Surg. 2012;55(2):479-488. doi:10.1016/j.jvs.2011.07.083.

5. Kim BR, Kwon SH, Kim JW, et al. Early Postoperative Injections of Polydeoxyribonucleotide Prevent Hypertrophic Scarring After Thyroidectomy: A Randomized Controlled Trial. Adv Wound Care (New Rochelle). 2023;12(7):361-370. doi:10.1089/wound.2022.0025.

6. Cavallini M. Bio revitalization and cosmetic surgery of the face: Synergies of action. Journal of Applied Cosmetology. 2004;22(3):125-132.

Disclosure: Dr. Barbarino is a paid speaker for Toskani.