We can all remember what got us into collagen. Maybe it was the edible gummies or liquid gold drinks marketed to us on social media, or perhaps the topical serums that promised rejuvenation from the outside in. Injectable-wise, biostimulators developed in recent years – including Sculptra and Radiesse – are said to restore our collagen levels over time in a more comprehensive way, too. But it seems we’re never quite satisfied, always looking for the next best thing to restore our levels for youth and bounce.
Case in point: human tissue-derived treatments (known as human Acellular Dermal Matrix, or hADM), which are reportedly growing rapidly in South Korea. These use a collagen-rich 'extracellular matrix' derived from human skin, which is then formulated into an injectable for areas of the face, such as under the eyes.
But whose skin is the collagen used in these treatments coming from? Is it safe? And above that, is it ethical? There are plenty of unknowns when it comes to this controversial new procedure, not least what it says about our relationship with regenerative aesthetics and where it's headed in future.
Here's what you need to know, including whether this is set to appear in the UK any time soon.
What are 'human collagen treatments', and how do they work?
"Collagen is the main structural protein in our skin. It is what keeps it firm and bouncy, and it is the thing that naturally drops off as we age, which is why we start to see fine lines, crepiness, sagging and a loss of volume," explains Dr Christine Hall, Aesthetic Doctor at Taktouk Clinic and K-beauty expert. The aim of most collagen-based injectables, therefore, is to restore collagen levels for youth, longevity and overall skin health.
Treatments such as Elravie RE2O are reportedly set to be the next generation of regenerative collagen-stimulating procedures—notably because they use a collagen-rich 'extracellular matrix' derived from real human skin rather than from animals or synthetic, lab-grown alternatives. Usually the process goes something like this: skin is donated (usually from screened deceased donors), living cells are removed, DNA, blood vessels and other cellular material are removed, and what's left becomes an 'extracellular matrix' (ECM) that, once sterilised and ground into smaller particles, can be injected. The ECM is made up of collagen, elastin, proteins, and proteoglycans.
Lee Joon, MD, PhD, Medical Director at DOD Dermatology Clinic performs the treatment at his clinic in Seoul. He notes that for this procedure, "the mechanism is biostimulation, not volumising—it recruits host fibroblasts and induces neocollagenesis rather than merely filling space." This means results are focused on skin health and longevity rather than creating volume as filler does. While he makes clear that this kind of treatment isn't exactly 'replacing' filler (they do different things, after all), there's been a clear uptake in interest: "At our own clinic, usage has been climbing sharply relative to other skin boosters—for improving skin texture, fine lines, and pore refinement, and for softening dark circles."
Are these actually safe (or ethical)?
Here's where things get blurred, both in terms of safety and ethical implications.
To begin, it's important to note that human tissue-derived ECM treatments, such as Elravie RE2O, are very new to the market and not yet approved in many countries (primarily due to regulatory reasons). There have been very few human studies conducted so far on the safety and efficacy of the approach, with this paper being the most notable. Often referred to as the 'split-face' study, this study had 20 participants receive an injectable human collagen treatment on one side of their face and hyaluronic acid (HA) on the other. Results showed that the collagen-treated side improved skin across several metrics, including elasticity, hydration, and barrier function, compared with the HA-treated side.
That said, this experiment involved a very small cohort, and it only followed participants for 20 weeks following their procedures, meaning we don't yet have long-term data to support the narrative that this could be some 'game-changer' in injectables. And, one of the study's authors served as an advisor on the development of Elravie Re2O at the parent company, L&C Bio Co., Ltd.
There are also ethical considerations regarding these kinds of treatments. Korean classification rules mean products derived from donated human tissue often sit in something of a regulatory grey area. Dr Lee Joon says: "In Korea, these products are classified as 'human tissue,' not medical devices. Human tissue can be supplied to clinics without per-product approval from the Ministry of Food and Drug Safety (MFDS), whereas a medical device requires product-specific approval for its intended use and indications. This classification gap explains both the rapid spread and the current controversy."
For donors, too, there is the question of whether they knew (or fully understood) that their future skin donation could include cosmetic use—although L&C Bio’s chairman has previously said that Elravie RE20 uses only overseas donated human tissue for which consent for cosmetic use has been obtained.
However, as more ECM products enter the market, there have been issues with clarity and communication in some clinics. "There is a duty to disclose the raw-material origin, yet some clinics use euphemisms ('premium collagen')," says Dr Lee Joon, which can understandably feel confusing, unclear, and not fully truthful.
Why are they becoming so popular in South Korea?
The rise in popularity of collagen treatments is generally linked to the way aesthetics is heading as a whole: there's a focus on regeneration and skin health, rather than on obvious filling or volume. But now, new technologies and innovations are advancing alongside this desire for more effective regenerative treatments.
In Korea, demand for collagen regeneration has, in many cases, overtaken that for more 'traditional' injectable treatments such as hyaluronic acid fillers. Dr Lee Joon adds that "fatigue with filler complications" plus a sense of “human-derived = natural” has resulted in a "K-beauty premium narrative" for these newer treatments.
Could these treatments be coming to the UK?
As mentioned, this is still an area of cosmetic aesthetics that is massively in its infancy, even over in South Korea, where it's being used. It's also been a rather controversial point of contention for the medical world, so there are plenty of barriers for these kinds of treatments to overcome before they can become available in the UK (or if they ever will).
"This is a complex area, especially concerning the regulatory pathway for treatments involving donated human tissue/skin products for injectables in the UK, as they would need to go through rigorous assessment with the MHRA [Medicines and Healthcare products Regulatory Agency] as they'll be classified as medicines," comments Kam Kaur from The Cosmetic Regulator. "I don't see the MHRA approving human tissue/skin products for use in the UK, though, so any clinic offering this is likely to be non-compliant."
"The UK faces a much higher bar under the HTA (Human Tissue Authority) and MHRA for cadaver-derived tissue used in cosmetic injection," agrees Dr Lee Joon. "Expect rhCollagen, PLLA, PDRN, and exosome biostimulators to lead in the UK/EU instead."
As the doctor notes, there are plenty of other commonly used (and potentially less controversial) collagen-stimulating treatments you can have here. These include biostimulators such as polynucleotides, Sculptra, and Radiesse, as well as radiofrequency approaches such as Morpheus8. Also evolving is recombinant collagen, which is produced in a lab using genetically engineered cells rather than extracted from human or animal tissue. For many, this may feel like a safer, more ethical injectable alternative for the future.
You should always choose a qualified practitioner who is recommended and has expertise and experience in the chosen treatment.
This content is for informational and educational purposes only and does not constitute medical advice - always consult with a qualified healthcare professional before treatment decisions.
