Persistent Loss of Skin Turgor After PRX-T33 Combined With Microneedling

Patient description

Female

50s

Case description

Background. Patient in her 50s underwent PRX-T33 with microneedling in the same session, reportedly following the manufacturer’s recommendations. PRX-T33 is marketed as a “no-peel” biorevitalization; in this case, peeling did occur post-procedure. She had 2 sesions, one month apart.

Chief complaint. Since the session, the patient reports marked loss of collagen and skin turgor, with a subjective sense of retraction around the orbits and even gingival tissue changes. She explicitly denies post-inflammatory hyperpigmentation at any point.

Course. Peeling developed early after treatment; the perceived soft-tissue deflation/turgor loss has persisted for months. No prior history of similar reactions. She only had used Indiba and Radiesse in the past.

Exam & data available. Clinically she look a lost of volume (she said that was lipolitics what was used by  the doctor, but is not true is PRX), she said reduced turgor/elasticity but she only came with personal photos. (Microneedling device type Dr Pen, needle depth 0,5 36 needle, number of passes , and exact PRX-T33 volumes are not yet documented; we are attempting to retrieve full records from the treating center.)

Working hypotheses (to stress-test with the community).

• Augmented penetration of TCA via needling channels → deeper chemical injury than intended.
• Cumulative barrier disruption/inflammation leading to transient or prolonged dermal matrix depletion.
• Less likely but worth excluding: systemic contributors to facial deflation (weight loss, endocrinopathies, medications, connective-tissue disease, nutritional factors), she was in very stressfull personal situation but insist that is not the cause and dont suffer any pathologyes

Í ask to colleagues (IMCAS community).

1. Have you seen sustained loss of turgor/dermal atrophy after PRX-T33 combined with microneedling (done per manufacturer guidance)?
2. If yes, what time course did you observe and did turgor recover spontaneously or require intervention?
3. What work-up do you recommend to objectify/monitor change (e.g., cutometry/elasticity measures, ultrasound elastography, standardized photography)?
4. What management has helped in your hands for similar presentations?
   • Barrier repair + anti-inflammatory skincare protocols?
   • Biostimulatory approaches (e.g., dilute CaHA, PLLA), PRP/PRF, polynucleotides, HA skinboosters?
   • Device-based options (timing/parameters) vs. avoidance of further trauma?
5. Any protocol safeguards you apply when combining PRX-T33 + microneedling (sequence, depths, interval between procedures) to mitigate risk?