Stepwise Rejuvenation Strategies Focus on Controlled Injury and Regenerative Support
A structured, biologically driven approach to skin rejuvenation may improve clinical outcomes by aligning procedural injury with targeted support of wound healing and dermal remodeling, according to Ava Shamban, MD, during her Music City SCALE 2026 presentation, “How to Win at the Aging Game.”
The session outlined a stepwise framework centered on 3 phases: controlled dermal injury, optimization of wound healing, and long-term support of tissue remodeling. This approach reflects growing emphasis on regenerative dermatology rather than isolated procedural intervention.
Microneedling was highlighted as a foundational technique for “controlled dermal injury.” The procedure induces microchannel formation, platelet activation, and release of growth factors such as TGF-β and PDGF, initiating fibroblast recruitment. These events activate downstream signaling pathways, including PI3K/Akt and MAPK, which support cell survival, proliferation, and migration.
Adjunctive therapies aim to enhance this response. Topical insulin was presented as a method to amplify cellular signaling, promoting tissue repair and protein synthesis. The result includes downregulation of inflammatory mediators such as IL-6 and TNF-α, shortened erythema duration, and improved barrier recovery.
Oxygen delivery was identified as a critical factor in wound healing. Dr Shamban emphasized that “fibroblast migration, collagen synthesis, and angiogenesis are oxygen-dependent processes.” Transdermal carbon dioxide therapy was proposed as a method to improve oxygenation through the Bohr effect, increasing local oxygen release and enhancing microvascular perfusion.
Clinical and histologic data support this approach. Use of a topical CO₂-emitting facial mask following laser resurfacing was associated with faster resolution of erythema and reduced downtime. Histologic analysis demonstrated a greater than twofold increase in epidermal thickness and increased elastin deposition compared with placebo-treated skin.
Importantly, microbiome analysis showed no adverse shifts with CO₂ therapy, supporting its safety profile.
The presentation also explored emerging regenerative strategies, including fibroblast-derived secretome products. These formulations leverage cytokines and growth factors to support extracellular matrix repair and collagen production. Experimental approaches using telomerase activation were also discussed as potential tools to enhance cellular longevity and regenerative capacity.
Dr Shamban summarized the approach as an “optimized treatment cascade,” combining microneedling, topical insulin, CO₂-mediated oxygenation, and fibroblast-based skincare to support tissue repair.
For more meeting coverage, visit the Music City SCALE newsroom.
Reference
Shamban A. How to win at the aging game. Presented at: Music City SCALE Symposium; May 13–17, 2026; Nashville, TN.
