Consensus Guidelines on Combined Aesthetic Skin Treatment with Collagen Therapy and Energy Based Procedures
DOI: 10.32364/2587-6821-2026-10-6-8
Consensus Guidelines on Combined Aesthetic Skin Treatment with Collagen Therapy and Energy Based Procedures
O.B. Borzykh1, I.Yu. Bragina2, S.V. Danilova3, M.M. Petrova4, N.A. Schnayder4,5, A.S. Romashkina6, A.I. Priluchnaya7, S.A. Antipina8, K.A. Filippova9, T.O. Polyaeva10, E.M. Borzykh11
1 Dr. Albrecht Clinic of Plastic Surgery and Cosmetology, Voronezh, Russian Federation
2 SportMedImport Group of Companies, Moscow, Russian Federation
3 Galaktika Clinic, Moscow, Russian Federation
4 Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Krasnoyarsk, Russian Federation
5 V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology, St. Petersburg, Russian Federation
6 Chistotel Clinic, Moscow, Russian Federation
7 Angiopharm Clinic LLC, Moscow, Russian Federation
8 Ural State Medical University, Yekaterinburg, Russian Federation
9 Cosmetology Clinic on Raushskaya Embakment LLC, Moscow, Russian Federation
10TerraSomnia Plastic Surgery Clinic, Saratov, Russian Federation
11N.N. Burdenko Voronezh State Medical University, Moscow, Russian Federation
Background: a combined approach should be used to manage involutional skin changes. However, there is a lack of available data on a combination of collagen therapy and energy based procedures.
Aim: to develop guidelines on combined use of native collagen type I products and energy based procedures.
Materials and Methods: these Consensus Guidelines are based on the authors' (Coordinating Council's) experience of using a product based on native (bovine) collagen type I and opinions of experts in collagen therapy (27 cosmetologists aged from 28 to 51 years [40.7±6.07 years] whose experience in cosmetology is 5–25 years [16.3±5.34 years] and experience in collagen therapy is 2–20 years [11.1±5.15 years]). In addition, literature data on histological changes in tissues exposed to native collagen and energy based treatment were evaluated.
Results and Discussion: a combination of collagen therapy and energy based procedures increases efficacy of therapy for involutional skin changes. It may be implemented as a part of a course of procedures or performed simultaneously with them. For example, non-ablative and ablative lasers, needle radiofrequency (RF) lifting, monopolar RF lifting and HIFU (high-frequency ultrasound) should be carried out before administration of native collagen type I. Moreover, intense pulsed light (IPL) should not be used simultaneously with native collagen type I. Within the framework of the same course, collagen therapy can be performed both before and after a energy based procedure. If collagen therapy precedes the energy based procedures, non-ablative lasers (low- and medium-intensity erbium lasers), needle RF lifting, monopolar RF lifting, and HIFU should be used in 3–4 weeks after it. As for non-ablative (high-intensity neodymium and erbium lasers) and ablative lasers, the gap time is 6 weeks, and IPL should be used in 2–3 weeks after collagen therapy. If the therapy succeeds the energy based procedures, it should be conducted in 2 weeks after non-ablative lasers and HIFU, in 2–4 weeks after ablative lasers, in 1–3 weeks after needle RF lifting, in 2–3 weeks after monopolar RF lifting, and in 1–2 weeks after IPL.
Conclusion: a combined approach including several techniques in a specific sequence should be implemented for safe and efficient treatment of patients with involutional skin changes. The consensus has determined the best possible time gaps between administration of native collagen type I and implementation of the energy based procedures, as well as a choice of optimal native collagen type I products, depending on the indications.
Keywords: native collagen type I, energy based procedures, cosmetology, involutional skin changes, guidelines, histological changes.
For citation: Borzykh O.B., Bragina I.Yu., Danilova S.V., Petrova M.M., Schnayder N.A., Romashkina A.S., Priluchnaya A.I., Antipina S.A., Filippova K.A., Polyaeva T.O., Borzykh E.M. Consensus Guidelines on Combined Aesthetic Skin Treatment with Collagen Therapy and Energy Based Procedures. Russian Medical Inquiry. 2026;10(6):447–453 (in Russ.). DOI: 10.32364/2587-6821-2026-10-6-8
Background
Combined treatment may be necessary to manage involutional and cicatrical skin changes. A heart of the matter is when and how to combine various aesthetic interventions safely and efficiently [1].
Some authors believe that laser therapy following filler administration can significantly reduce an effect of injectable preparations and/or lead to their rapid degradation [2]. Other studies have shown that laser, radiofrequency (RF), and intense pulsed light (IPL) interventions can be performed safely without a decrease in overall clinical effect immediately after the injection [3, 4].
One of the studies demonstrated high safety and increased efficiency of simultaneous use of a 675-nm laser and reticulated hyaluronic acid (HA) [5]. Another study has shown safety and efficiency of combined treatment (reticulated HA + subsequent high-intensity high-frequency parallel ultrasound, picosecond alexandrite laser or sequential monopolar-bipolar pulsed radiofrequency exposure in 1 month) [6].
Simultaneous use of a laser device and an injectable facial rejuvenation product on the same day is an efficient safe strategy that improves clinical outcomes and increases patients' satisfaction [1]. A Russian comparative study has demonstrated greater clinical efficiency of a combination of biorevitalization and erbium laser than those of erbium laser monotherapy and biorevitalization alone [7].
There is good reason to believe that collagen will no longer be considered as just a cosmetic ingredient, and it will become a cornerstone of regenerative medicine and a personalized approach to patient management by 2030 [8]. A combination of collagen therapy and energy based procedures is justified by age-related deficiency of collagen synthesis and impaired collagen metabolism in the skin [9]. Mature skin demonstrates lower density of collagen which becomes increasingly cross-linked and fragmented [10]. Age-related changes (i. e., decreased collagen deposition and increased non-enzymatic crosslinking) affect mechanical environment of the skin and predispose to impaired wound healing [11, 12]. In regenerative medicine, collagen use is based on its maintenance, improvement or restoration of functionality of the extracellular matrix) [13]. However, there is a limited number of available studies on combined use of native collagen products and energy based procedures. Thus, an aim is to develop clinical guidelines for combined use of native collagen type I products and energy based procedures.
Materials and Methods
The Consensus Guidelines are based on the authors' (Coordinating Council's) experience of using a native (bovine) collagen type I product (Collost, BioPHARMAHOLDING, Russian Federation) and opinions of experts in collagen therapy. In addition, literature data on histological changes in tissues exposed to native collagen and energy based procedures were evaluated. 27 cosmetologists experienced in dealing with the native collagen type I product and the energy based procedures were invited as experts in collagen therapy. The responders' age was 28 - 51 years (40.7±6.07 years), as well as work experience in cosmetology and collagen therapy was 5 - 25 years (16.3±5.34 years) and 2 - 20 years (11.1±5.15 years), respectively.
Before the survey, the authors prepared a questionnaire that included several questions on combined use of native collagen type I products with ablative and non-ablative lasers, needle and monopolar radio frequency (RF) lifting, intense pulsed light (IPL), and high-intensity high-frequency ultrasound (HIFU). The experts expressed their opinions on time gaps between the interventions, possibility of simultaneous use (on the same day), and top-priority agents for patients with involutional and cicatrical skin changes. The Coordinating Council analyzed data of histological changes and the results of a survey of experts in collagen therapy, and then final guidelines were approved.
Statistical processing was performed by Jamovi application software 2.3 (Australia). To represent quantitative indicators, depending on distribution nature, the mean and standard deviation (M±SD), as well as median, the first and the third quartiles (Me [Q1; Q3]) were used. Absolute and relative (%) values were used to represent qualitative indicators. Significance of the differences between qualitative indicators was determined using Pearson's chi-square test.
Results and discussion
See the questionnaire processing results in Tables 1-4.
![Table 1. Application of native collagen type I products before and after energy based procedures, Me [Q1; Q3])](/upload/medialibrary/846/gqgo45ays1x9r2t94we32x74asqd2smp/2e-1.png "Table 1. Application of native collagen type I products before and after energy based procedures, Me [Q1; Q3])")
The analysis results indicate development of consistent approaches to combined use of the native collagen type I products and the energy based procedures. In case of most techniques (including non-ablative and ablative lasers, needle and monopolar RF lifting, as well as HIFU therapy), the product should be administered after the interventions (69-81% of cases). The exception is provided by IPL where refusal from collagen therapy is more common (up to 80%) and its use after this intervention is reported substantially more rarely. A dosage form and concentration of the product are inextricably linked with severity of clinical changes. For example, less concentrated dosage forms (e. g., 3-5% micronized collagen gel and 7% gel) are common choice to deal with moderate age-related changes, whereas more pronounced changes and atrophic manifestations require higher strength (6-15% micronized collagen and 15% gel) (32-56% of cases). In general, the data reflect feasibility of differentiated selection of a dosage form and concentration of collagen considering severity of changes and a specific energy based procedure.
A literature data analysis showed histological changes in tissues after intradermal administration of 7% native collagen type I. Mild inflammatory response is an initial phase of the changes (Day 2 - Day 4). Then, fibroblast proliferation, thin newly formed collagen fibers, and a significant glycosaminoglycan level in granulation tissue are reported between Days 7 to 14. On Day 21, dermis thickens due to formation of thickened mature collagen bundles in the regeneration zones. On Day 37, free unsubstituted collagen fibers of the injected product were not detected in the injection site. The skin demonstrated specific structure [14]. Thus, the native collagen type I product degrades completely within 5-6 weeks. Granulation tissue remodeling is reported between Weeks 3 to 4.
Based on histological change data after administration of native collagen type I and considering the survey data, the Coordinating Council decided to coordinate time gaps between administration of native collagen type I and needle/monopolar RF lifting, IPL, and HIFU. As for laser therapy, the authors clarify that a time gap between application of non-ablative erbium laser (low and medium intensity) and collagen therapy should comply with the survey data; a high intensity non-ablative neodymium laser and an ablative laser should be used after complete degradation of collagen (i. e., 6 weeks).
To make a decision on a time gap between implementation of the energy based procedures and subsequent administration of the native collagen-based product, histological changes in tissues were evaluated. The analysis was dedicated to a search for temporal features of an inflammatory response, epithelialization, neocollagenesis, and remodeling (replacement of newly formed collagen fibers with mature ones). See the search results in Table 5.
![Table 5. Main phases of histological changes after application of the energy based procedures [15–22]](/upload/medialibrary/dfd/v84m6ond9q8pc8rpq7do8vqxcpfpm9ob/2e-5.png "Table 5. Main phases of histological changes after application of the energy based procedures [15–22]")
After administration of 7% native collagen type I, histological changes in tissues are similar to those reported after most energy based procedures [23]. Therefore, combined use of the methods on the same day will contribute to synergy of a clinical outcome.
The native collagen type I product administered after the energy based procedures is the most appropriate choice at neocollagenesis and remodeling stages. According to data on histological changes after application of the energy based procedures and considering the survey data, the Coordinating Council decided to coordinate time gaps between implementation of the energy based procedures and administration of the native type I collagen products.
The native collagen type I products should be combined with the energy based procedures considering time gaps and severity of clinical changes. The energy based procedures should be implemented in 3-6 weeks after or 1-3 weeks before collagen therapy. As for most techniques, the products can be used on the same day as the energy based procedures (apart from IPL where simultaneous use is not recommended). A dosage form and concentration of collagen should depend on severity of the changes. In particular, less concentrated forms (3-5% micronized collagen and 7% gel) are preferable to manage moderate age-related changes, whereas more concentrated products (6-15% micronized collagen and 15% gel) should deal with pronounced changes and atrophic scars. When the products are combined with monopolar RF lifting, IPL and HIFU, their strength should be selected similarly, while the methods should be limited in patients with atrophic scars taking into account their lower feasibility in this clinical situation.
Conclusion
Many studies suggest a need for a combination of different techniques to manage involutional skin changes. Such combinations can increase clinical efficacy and safety, as well as reduce total rehabilitation time for a patient. However, a number of large-scale papers is limited at this date.
According to a general opinion of the experts, a combined approach including a specific sequence of several techniques should be implemented for safe and efficient treatment of patients with involutional skin changes.
The consensus has determined the best possible time gaps between administration of native collagen type I and implementation of the energy based procedures, as well as a choice of optimal native collagen type I products, depending on the indications.
As a limitation of this consensus, it should be noted that all the discussions and guidelines concerned Collost native collagen type I products (BioPHARMAHOLDING, Russian Federation).
About the authors:
Olga B. Borzykh — D. Sc. (Med.), Dermatologist, Cosmeto-logist, Dr. Albrecht Clinic of Plastic Surgery and Cosmetology (Artis LLC); 87, Proletarskaya str., Voronezh, 394030, Russian Federation; ORCID iD 0000-0002-3651-4703
Irina Yu. Bragina — C. Sc. (Med.), Physiotherapist, Cosmetologist, Physiotherapist, Cosmetologist, Gerontologist, Rehabilitologist, Expert Instructor at the European Laser Academy of Health (LA&HA), Brand Doctor at Fotona Russia, Scientific Coordinator of the Laser Direction at SportMedImport Group of Companies; 8 bldg. 1, Nezhinskaya str., 119501, Moscow, Russian Federation.
Svetlana V. Danilova — C. Sc. (Med.), Dermatologist, Cosmetologist, Physiotherapist, Galaktika Clinic (Parallelepiped LLC); 6, Yakimanskyi lane, Moscow, 119049, Russian Federation; ORCID iD 0009-0001-4549-7749
Marina M. Petrova — Dr. Sc. (Med.), Professor, Head of the Department of Polyclinic Therapy and Family Medicine with a Professional Education Course, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University; 1, Partizan Zheleznyak str., Krasnoyarsk, 660022, Russian Federation; ORCID iD 0000-0002-8493-0058
Natalia A. Schnayder — Dr. Sc. (Med.), Professor, Chief Scientific Officer, Deputy Head of the Institute of Personalized Psychiatry and Neurology, V.M. Bekhterev National Research Medical Center for Psychiatry and Neurology; 3, Bekhterev str., St. Petersburg, 192019, Russian Federation; Leading Scientific Officer at the Molecular and Cellular Technologies Center for Collective Use, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University; 1, Partizan Zheleznyak str., Krasnoyarsk, 660022, Russian Federation; ORCID iD 0000-0002-2840-837X
Anastasia S. Romashkina — C. Sc. (Med.), Dermatovenero-logist, Cosmetologist, and Physiotherapist, Chistotel Clinic (Zeus LLC); room 1, 24, Partizanskaya str., Moscow, 121351, Russian Federation; ORCID iD 0000-0002-6775-9797
Anna I. Priluchnaya — C. Sc. (Med.), Dermatovenerologist, Cosmetologist, and Ultrasound Diagnostics Doctor, Angiopharm Clinic LLC; 1 bldg. 2, Novovladykinskyi ave., Moscow, 127106, Russian Federation; ORCID iD 0000-0001-9686-7677
Snezhana A. Antipina — Dermatovenerologist, Cosmetologist, Expert of the Accreditation Board for Cosmetology, Ural State Medical University; 3, Repin str., Yekaterinburg, 620028, Russian Federation; ORCID iD 0009-0004-0746-2598
Kira A. Filippova — Dermatologist, Cosmetologist, and Plastic Surgeon, Cosmetology Clinic on Raushskaya Embankment LLC; 4/5, bldg. 1, Raushskaya emb., Moscow, 115035, Russian Federation; ORCID iD 0009-0000-6584-0068
Tatyana O. Polyaeva — Dermatologist, Cosmetologist, and Trichologist at the TerraSomnia Plastic Surgery Clinic; 72, 2nd Sadovaya str., Saratov, 410004, Russian Federation; ORCID iD 0009-0006-9068-4208
Ekaterina M. Borzykh — 5th Year Student at the Institute of Dentistry, N.N. Burdenko Voronezh State Medical University; 10, Studencheskaya str., Voronezh, 394036, Russian Federation; ORCID iD 0009-0001-1858-0512
Contact information: Olga B. Borzykh, e-mail: kurumchina@mail.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 13.04.2026.
Revised 07.05.2026.
Accepted 29.05.2026.
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