Eminent experts share tips on aesthetic treatment using collagen

Collagen is a versatile dermal filler that has been used since the 1980s in aesthetic treatments around the world. While newer fillers such as hyaluronic acid have gained popularity, collagen is still important in selected procedures, including in Asia’s expanding aesthetic medicine sector. Four aesthetic experts outlined various treatments using collagen at the recent Aesthetic Medicine and Surgery Conference and Exhibition (AMSC) 2025 in Kuala Lumpur.

Atelocollagen for periorbital rejuvenation
Dr Yu-Tsung Chen, MD, Ph.D
Director, VIGOR Aesthetic Clinic, Taiwan

Periorbital ageing involves loss of structural bone support in mid-face and collagen; weakening of the superficial musculoaponeurotic system (SMAS) layer, increased ligament laxity, hypertrophy of superficial fat pads, and reduction of deep fat pads. [https://www.researchgate.net/publication/303512351_The_Aging_Face, Plast Aesthet Res 2021;8:2] These changes cause issues such as droopy upper eyelids, eye bags, tear trough deformity, crow’s feet, midcheek groove, hollow cheeks, and deeper nasolabial groove. [Aesthet Surg J 2021;41:1107-1119]

Collagen injections are able to build out the anterior projection contour and support for the mid-face, addressing 80 percent of the tear trough deformity. Atelocollagen, a purified extract from specific pathogen-free porcine skin and similar to human dermal collagen, has no risk of bovine spongiform encephalopathy and shown lower incidents of immunogenicity. The key benefits of atelocollagen injections in periorbital rejuvenation are shown in Table 1.

Atelocollagen can be injected into the deep fat layer under the orbicularis muscle or the superficial fat layer after dilution with normal saline. Over time, atelocollagen breaks down into peptides and amino acids, which inhibit tyrosinase and lighten dark circles. After 2 months, treatment effects on periorbital depressions and dark circles can be seen.

Heterologous type I collagen in skin regeneration
Dr Joyce Lim
Dermatologist, Singapore

Heterologous type I collagen is extracted from equine tendons and purified for use in skin regeneration as it stimulates fibroblast formation, type III collagen production and angiogenesis. It also has anti-inflammatory and immuno-modulatory properties. The collagen powder, micronised for uniform particle size and to preserve biological activity, is reconstituted just prior to treatment with a solution of normal saline, anaesthetic, and sodium bicarbonate.

Upon reconstitution, the collagen is completely hydrolysed into amino acids and tripeptides, which stimulate dermal growth factor and inhibit matrix metalloproteinases (MMPs), thus enhancing collagen production. It is safe, non-allergenic, and more than 500,000 vials have been used in treatments without adverse events. However, mild erythema may occur if injected above the ideal concentration of 100 mg.

Applications include aesthetic indications like anti-ageing, medical conditions such as melasma and acne scars, and post-surgical treatments. The protocol involves intradermal or subdermal injections using small gauge needles and one vial every 2 weeks for four sessions, followed by maintenance every 2 months. Clinical results show improvements in fine lines, pore size, hyperpigmentation, and skin quality as well as improvements in melasma and jawline definition.

The collagen is also used to treat cutaneous atrophy after steroid treatment, with improvements in skin texture and elasticity. [Dermatol Surg 2024;50:298-299] It is also effective for vitiligo, with significant improvements observed after six sessions. [J Clin Aesthet Dermatol 2021;14:31-34] The collagen has also shown hair growth in case studies of patients with alopecia areata.

Injectables in collagen regeneration
Dr Tingsong Lim
Aesthetic Doctor, Malaysia

Collagen is important in maintaining tissue structure and tactile senses, especially in the extracellular matrix (ECM). Collagen production begins in the embryonic state, with the fascia playing a crucial role in organising muscles, bones, and other structures. Fibroblasts are identified as the primary builders of collagen and are more abundant in fat and fascia. [https://www.researchgate.net/publication/285192058_Fascia_is_alive]

The structure of collagen in the body can be described as a spider web, enhancing tensile force and wrapping around tissues allowing them to return to their original shape. Although humans are born with more type III collagen, ageing leads to a shift towards more type I collagen and the  formation of fibrosis. [Afr J Biotechnol 2011;10:2524-2529] Thus, the need to stimulate collagen production in the fascia rather than just the skin, to maintain physiological function. [BMB Rep 2021;54:329-334, J Burn Care Res 2024;45:1269-1273]

Unlike the olden days of using collagen as fillers where large amounts of collagen can cause adverse reactions, the aim is to use collagen to improve skin health and reverse the ageing process. [Clin Cosmet Investig Dermatol 2021;14:643-654] The suitable type and amount of collagen has the potential to remodel the ECM, reduce fibrosis, and enhance lymphatic drainage and circulation.

Recombinant humanised type III collagen in precise regeneration
Dr Allan Yong
Aesthetic Doctor, Malaysia

Using the right type of collagen for skin regeneration can prevent complications such as granuloma formation due to inflammation. Now, the focus has shifted to rethinking regeneration and putting the patient at the forefront. Overall, aesthetic treatment aims to achieve youthful healing and resilience. Thus, type III collagen is preferred for its role in building softness, flexibility, and repair, over the stronger type I collagen that forms scar-like tissue. [Adv Wound Care (New Rochelle) 2015;4:119-136]

A genetically engineered, recombinant type III collagen is a superior alternative due to its safety and efficacy in clinical use. It promotes skin repair, reduces inflammation, and enhances elasticity, leading to visible and lasting aesthetic improvements. More than 2 million vials have been used in the past 3 years with no reported cases of allergy or anaphylaxis. In comparison, animal-sourced collagen has pathogen risk, immunogenicity, and poor water solubility while human-derived collagen from foreskin is limited in supply, expensive, and difficult to scale.

The recombinant collagen is described as humanised, purified, and precisely sequenced; it self-assembles into the networks and integrates with the ECM. [Biochem Biophys Res Commun 2019;508:1018-1023] It suppresses inflammation, repairs elastin, promotes collagen synthesis, and activates fibroblasts, among other benefits. [Bioact Mater 2021;11:154-165, J Investig Dermatol Symp Proc 2009;14:36-43, Trends Mol Med 2008;14:20-27] Clinical results of periorbital treatment show enhanced elasticity, barrier function, and skin tightness when using recombinant type III collagen with a 4-week interval dosage. Within 3 weeks, there is collagen integration, improved hydration, and texture smoothing. By 8 weeks, there is visible lifting and strengthening of the ECM.