Value and Benefits of the Polynucleotides HPT™ Dermal Priming Paradigm A Consensus on Practice Guidance for Aesthetic Medicine Practitioners and Future Research

Background: Polynucleotides High Purification Technology (PN HPT™), a highly biocompatible functional ingredient without protein contaminants and no pharmacological or allergic potential, demonstrated a reconditioning effect on the dermal environment. Might dermal cells react with improved responses to other skin revitalisation strategies after, or concomitantly with, a PN HPT™ priming treatment that makes them more metabolically reactive? A digital survey of dermatologists, plastic surgeons, and aesthetic physicians investigated the rationale of such a "PN HPT™ dermal priming paradigm". A meeting by distinguished experts to discuss the survey outcomes led to this consensus paper, which provides a rationale for the confirmatory studies currently planned and launched and a set of practical recommendations for the proposed priming paradigm. Methods of consensus development: Three years after their first 2020 consensus meeting on PN HPT™ in aesthetic medicine as the only ingredient of medical devices for intradermal injection or combined with hyaluronic acid, the PN HPT™ Priming Board of eight distinguished experts in cosmetic medicine and plastic surgery convened once again. The purpose of the 2023 Board meeting was to produce a guidance document on the PN HPT™ benefits on skin quality in sequential or combined treatment protocols with other skin revitalisation strategies and the framework for a clinical research program to support the concept. The paper originated from the Board's digital and face-to-face discussions on the outcomes of the digital survey (16 questions), designed by the Board's experts and filled out by 51 surveyed specialists. Results: The Board reached a "Recommendation" (consensus of more than 80%) about the value and scope of the PN HPT™ dermal priming paradigm before or concomitantly to all secondary treatments-skin resurfacing and stretch mark treatment with ablative CO2 and Er:YAG lasers, volume-enhancement with fillers in perioral, cheeks, lips and other areas, carboxytherapy, chemical peels, needling, Intense Focused Ultrasound and radiofrequency, and LED treatment of the scalp area. The Board's orientation was for a "Consensus statement" (agreement level, 71%) only for carboxytherapy. The Board's suggestions included details of doses and volumes to inject and the ideal number of priming sessions. Conclusions: The Consensus document illustrates the rationale behind the PN HPT™ dermal priming paradigm and provides practical guidance for its application in different skin areas. It also lays the foundations for the ongoing clinical research program, conceived to provide new evidence supporting the PN HPT™ dermal priming paradigm.