Following my previous post on the development of facial plastic surgery in South Korea, this blog post includes a list of cosmetic treatments for the face that are available in South Korea but not the United States (US). It is important to note that not all of the treatments listed below have been evaluated, much less approved, by the Food and Drug Administration (FDA). That is, to the best of my knowledge, why the medications and devices are not yet widely available in the US. I will do my best to update this list as I identify additional treatments as well as any additional publications that weigh in on the actual safety and effectiveness of these treatments. It is important to seek not only a fellowship-trained but also a double board-certified facial plastic surgeon if you have aesthetic concerns about your face and/or neck.
What Cosmetic Treatments for the Face are Currently Available in South Korea but Not Widely Available the United States?
Dr. Jeffrey Harmon
Rejuran® (PRM-001 Polynucleotide Product [Pharmaresearch Products, Inc., Seoul, South Korea])
I first learned about this product while reading Flawless: Lessons in Looks and Culture from the K-Beauty Capital by the National Public Radio (NPR) reporter Elise Hu. She mentioned the use of a product derived from salmon gonads (seriously) that South Koreans inject in their face at cosmetic clinics, ostensibly for the purposes of improving the appearance of the skin. Additional research revealed that this product, called Rejuran®, is available not only in South Korea but also now in Europe and Australia. It is an injectable like hyaluronic acid fillers but rather than using cross-linked hyaluronic acid to add volume to the face, fish gonadal polynucleotides are injected to increase the production of collagen and elastin in the skin, both of which are important to maintain the smooth and supple qualities of youthful skin.
Polynucleotides are simply a string of signaling molecules which DNA and RNA is composed of. I am skeptical that a chain of these molecules from fish can somehow induce signaling in another species (i.e., humans) to achieve cosmetic results. Interestingly, the only study I found in the literature on this product was a phase III trial of Rejuran® conducted in South Korea in 2014 that was retracted from the medical literature two years after its publication (1). That, to me, is a red flag regarding its actual safety and effectiveness. Additional studies should help determine whether this product is worth evaluation by the FDA.
Local Dynamic Micro-ultrasound (LDM) or Micro-Massage or Dual Frequency Ultrasound
Termed Local Dynamic Micro-Ultrasound, Local Dynamic Micro-Massage (LDM), or Dual-Frequency Ultrasound, this treatment consists of an ultrasound device (probe) that alternates between two very high frequencies when applied to the surface of the skin. The device is being promoted as a technique to improve skin surface quality, with mechanisms of action which are unclear but may include changes in the inflammatory cascade that affect skin surface quality. My review of the literature identified studies that found improvements in bruising and swelling after rhinoplasty and improvements in redness in patients with rosacea and acne with the use of LDM (2, 3). However, as is common with facial plastic surgery studies, the methodology included largely subjective physical assessments by surgeons and patient satisfaction scores to determine their results. Moreover, papers I found that published on the effects of dual frequency ultrasound on wound healing had no comparison group from which to determine whether this treatment accelerated the healing process. This somewhat limits the value of the research itself. Moreover, while I was able to identify the above studies reporting the effects of the device on bruising, swelling, redness, and wound healing, I found no patient studies evaluating the aesthetic qualities of the skin as would be used in a cosmetic practice.
Skin Botox©
Skin Botox is exactly as it sounds. The technique involves the use of botulinum toxin injections with products including, but not limited to, Botox© more superficially in the skin. It is argued that, when injected superficially to the facial muscle, botulinum toxin decreases pore size without affecting the muscle. This is considered an FDA off-label use of the medication in the United States, which is sometimes mixed with diluted hyaluronic acid filler and injected in the superficial surface of the skin. I would imagine it to be extremely challenging to place Botox© or other similar products precisely in the skin such that it is unlikely to diffuse to the underlying musculature which, if affected, could adversely affect facial movements including, but not limited to, smiling. Certainly, an appropriate dilution of the medication(s) and a needle that controls the depth of injection may make such a treatment consistently safe. Otherwise, it would seem a challenging thing to perform safely consistently, regardless of considerations of effectiveness. In my opinion, additional research is required.
Ionophoresis/Sonophoresis Devices
One of the more difficult problems with administering medications trans-dermally, or through the skin, is that it is difficult to get many products to actually be absorbed through the skin barrier. Instead, many products simply sit on the surface of the skin. The ability to move medications across this barrier precisely, efficiently, and safely would have potentially profound implications. And, if a device was found to be clinically safe and effective, the question then becomes whether the products administered are clinically safe and effective.
The concepts of ionophoresis and sonophoresis have been around for many years. Iontophoresis involves the use of an electrical current through the skin to facilitate the transfer of products (4). Sonophoresis involves the use of sound waves through the skin to accomplish this (5). Both iontophoresis and sonophoresis techniques are intended to temporarily increased the permeability of skin in the specific area treated.
The Environ Ionzyme® DF Machine is the device I found to be most commonly associated with the use of iontophoresis and sonophoresis to facilitate the transfer of medications and other products through the skin to achieve a clinical and/or aesthetic goal. My review of available information suggests the advertised products used with this device are often vitamins, including Vitamin A.
I could not find definitive information as to whether the Environ Ionzyme® DF Machine specifically is FDA approved. Moreover, it does not appear to be widely available in the United States (US). I will be following the development and availability of ionophoresis/sonophoresis devices in the US.
Air Dissection Filler Technique
The air dissection filler technique utilizes pressurized air delivered into the skin using a special needle and device for the purposes of delivering products such as hyaluronic acid filler.
One argument made for this technique is that hyaluronic acid filler can be delivered more evenly in the same tissue plane because the resistance to injecting into the specific tissue plane in which air is placed is reduced. Most of the before and after photos I have seen have demonstrated improvements in severely depressed scars.
It is also argued that this technique can reduce the rare complications associated with intra-vascular injection of hyaluronic acid filler. However, I have found no study demonstrating this.
I find the air dissection technique intriguing, especially for severely depressed acne scarring. I am looking forward to the opportunity to evaluate a device if and when it becomes FDA approved and available in the US.
Trust Your Face to a Double Board-Certified Facial Plastic Surgeon
It is important to seek a fellowship-trained, double board-certified specialist in plastic surgery of the face and neck when you have concerns about your face or neck.
Why Choose Dr. Harmon
- The mission of Harmon Facial Plastic Surgery is to help people along their journey towards self-confidence, to feel good about feeling good.
- Dr. Harmon is a double board-certified facial plastic surgeon
- Dr. Harmon values making patients feel welcomed, listened to, and respected.
- Dr. Harmon graduated with honors from Cornell University with a Bachelor of Science degree in molecular biology.
- Dr. Harmon earned his medical degree from the University of Cincinnati.
- Dr. Harmon underwent five years of extensive training in head at neck surgery at the prestigious residency program at the University of Cincinnati.
- Dr. Harmon then underwent focused fellowship training in cosmetic facial plastic surgery through the American Academy of Facial Plastic and Reconstructive Surgery (AAFPRS) with the world-renowned surgeon, Dr. Andrew Jacono, on Park Avenue in New York City.
Request a Consultation
Request a consultation with Dr. Harmon at Harmon Facial Plastic Surgery in Cincinnati. Visit our clinic. You will learn more about Dr. Harmon’s credentials, style, and approach. Build a relationship with our dedicated team. Do not stop searching “plastic surgery near me.” Get in touch with us to learn more.
References
- Notice of Retraction: Pak CS, et al. A Phase III, Randomized, Double-Blind, Matched-Pairs, Active-Controlled Clinical Trial and Preclinical Animal Study to Compare the Durability, Efficacy and Safety between Polynucleotide Filler and Hyaluronic Acid Filler in the Correction of Crow's Feet: A New Concept of Regenerative Filler. J Korean Med Sci 2014; 29(Suppl 3): S201-S209. J Korean Med Sci. 2016 Feb;31(2):330.
- Ahn TH, Lee JS, Kim SY, Lee SB, Kim W, Kruglik I, Yi KH. Application of dual-frequency ultrasound for reduction of perilesional edema and ecchymosis after rhinoseptoplasty. J Cosmet Dermatol. 2024 Mar;23(3):830-838.
- Kim YJ, Moon IJ, Lee HW, Won CH, Chang SE, Lee MW, Choi JH, Lee WJ. The Efficacy and Safety of Dual-Frequency Ultrasound for Improving Skin Hydration and Erythema in Patients with Rosacea and Acne. J Clin Med. 2021 Feb 18;10(4):834.
- Roustit M, Blaise S, Cracowski JL. Trials and tribulations of skin iontophoresis in therapeutics. Br J Clin Pharmacol. 2014 Jan;77(1):63-71.
- Rao R, Nanda S. Sonophoresis: recent advancements and future trends. J Pharm Pharmacol. 2009 Jun;61(6):689-705.
This blog post is for educational purposes only and does not constitute direct medical advice. It is essential that you have a consultation with a qualified medical provider prior to considering any treatment. This will allow you the opportunity to discuss any potential benefits, risks, and alternatives to the treatment.