Expert Consensus on the Clinical Use of Skin Boosters: A Delphi-Based Recommendation Framework

Skin boosters have become an increasingly popular modality in aesthetic dermatology due to their ability to enhance skin hydration, elasticity, texture, and overall dermal quality through minimally invasive intradermal injections. Despite their rapid integration into clinical practice, current approaches to skin booster therapy remain highly variable. Differences exist in product selection, injection depth, dosing regimens, treatment intervals, technique, indications, and safety monitoring. Moreover, the evidence base is still evolving, and most available data come from fragmented clinical studies or manufacturer-driven guidelines. As a result, there is a significant need for unified, expert-driven recommendations that can standardize practice, optimize patient outcomes, and minimize complications.

This research project aims to develop comprehensive, evidence-informed consensus guidelines for the use of skin boosters in aesthetic practice. The study will use a structured Delphi methodology to gather and synthesize the perspectives of leading dermatologists and aesthetic medicine specialists. Through multiple iterative rounds, experts will evaluate and rate a series of statements addressing key clinical domains including: appropriate indications; patient selection criteria; anatomical considerations; recommended injection depths and techniques; dosing strategies; frequency and number of treatment sessions; choice of products (e.g., HA-based, polynucleotides, bio-remodeling agents); combination therapies; expected outcomes; management of adverse events; and contraindications.

The consensus-building process ensures anonymity, reduces bias, and encourages equal participation among experts. Quantitative analyses (e.g., percentage agreement thresholds, median and interquartile range scoring) will be used to determine which statements achieve consensus. Statements not reaching agreement will be revised and re-evaluated in subsequent rounds until final consensus is achieved.

By the end of the project, the expert panel will produce clear, standardized, and clinically actionable recommendations that can be used globally or regionally to harmonize the use of skin boosters. These guidelines will support clinicians by improving the consistency and quality of care, informing training programs, guiding patient counseling, and reducing complication rates. Ultimately, the project aims to fill a critical gap in aesthetic dermatology literature by establishing a scientifically grounded, consensus-driven framework for safe and effective skin booster therapy

Inclusion criteria

• Inclusion Criteria

Experts will be eligible to participate if they meet all of the following:

Board-certified dermatologist or aesthetic physician

With recognized qualification in dermatology, aesthetic medicine, plastic surgery, or related fields.

Minimum clinical experience

At least 5 years of experience performing aesthetic injectable procedures.

OR at least 3 years of consistent use of skin boosters in clinical practice.

Demonstrated expertise in skin booster therapy

Must have performed ≥100 skin booster procedures overall,

OR ≥20 sessions per year over the past 2 years.

Active clinical practice

Currently practicing in an aesthetic or dermatology clinic, medical center, or hospital.

Authorship or contribution to aesthetic/dermatology education (desirable but not mandatory)

Publications, lectures, workshop instruction, or conference involvement in aesthetics.

Ability to participate in Delphi rounds

Must agree to complete all survey rounds within the specified timeframe.

Must be fluent in the language used for the study (e.g., English or Arabic).

Willingness to provide informed consent

Voluntary participation with confidentiality maintained.

Exclusion criteria

• Less than the required experience

<5 years of aesthetic practice

OR insufficient hands-on experience with skin booster injections.

Limited familiarity with skin booster products or techniques

No regular use in the last 2 years.

Has not performed the minimum number of required procedures.

Industry conflict of interest

Direct employment by a company manufacturing skin booster products.

Significant financial relationship with a single product manufacturer that may bias responses.

Inability to commit to multiple Delphi rounds

Anticipated non-compliance or non-response in iterative rounds.

Non-clinical or administrative professionals

Those not actively practicing (e.g., retired, research-only positions, students, trainees).

Participation in a competing guideline project

Experts currently serving on another skin booster consensus panel to avoid duplication or bias.

Failure to provide informed consent

Declines participation or withdraws consent at any time.