Interest in treatments that focus on skin quality has grown alongside a better understanding of the biology of the dermis and its extracellular matrix.  Research into combinations of hyaluronic acid and selected amino acids suggests they may influence fibroblast activity and pathways involving collagen, elastin and fibronectin, although the strength of the evidence varies considerably between laboratory studies and clinical research.  This article looks at what has actually been demonstrated so far, where the evidence remains limited, and how these findings may fit into a more considered approach to skin ageing.

Microneedling is often described as a treatment that stimulates collagen and rejuvenates the skin. Those statements are broadly true, but they only tell part of the story. After reviewing the published evidence, I explore what mechanical microneedling can realistically achieve, which patients are most likely to benefit, and why understanding the underlying skin concern matters more than choosing a device.