Is There an Injection for Pigmentation? How Hyaluronic and Succinic Acid Work Together
Patients who have been treating pigmentation for years arrive with a specific frustration. They have used the creams. They have had the lasers. The pigment fades and then, after a hot month or a holiday or a stressful quarter, it comes back. Somewhere in that cycle they read that there is an injectable for pigmentation and they want to know whether it is real, or whether it is a hydration treatment being marketed at a different problem.
It is real, and it is narrower than the marketing suggests. There is an injectable preparation that combines non-cross-linked hyaluronic acid with succinic acid, and it is proposed to influence melanogenesis via several mechanisms. That is a genuine pigmentation mechanism rather than a hydration treatment with a pigmentation claim attached. It is also not a replacement for laser, not a replacement for topical treatment, and not a cure for melasma, which remains a condition that is managed rather than solved.
What follows sets out what is in the preparation, how succinic acid acts on melanin production, what the published evidence actually shows, which pigmentation problems it suits and which it does not, how it sits alongside laser and topical treatment, and what the treatment course involves.
Is there an injectable treatment for pigmentation?
Yes. There is an injectable that combines non-cross-linked hyaluronic acid with succinic acid, injected intradermally. The combination is proposed to influence tyrosinase activity and melanin synthesis, while hyaluronic acid also contributes hydration and extracellular-matrix support.. It is used for hyperpigmentation including melasma, post-inflammatory pigmentation and sun-induced spots. It complements laser and topical treatment rather than replacing either.
The distinction worth holding onto is that this is not a skin booster that happens to be used on pigmented skin. The two components have overlapping but distinct proposed roles: HA primarily supports hydration and tissue quality, while succinate is proposed to contribute antioxidant and pigment-modulating effects. That is why it is not interchangeable with the hydration and repair injectables, and why describing it as a variant of one of them misrepresents what it does.
What is actually in it?
Two distinct molecules, not one molecule with a modification. High molecular weight hyaluronic acid, non-cross-linked, and succinic acid in the form of sodium succinate. In the 1.8 per cent preparation, the manufacturer’s formulation is 18 mg/ml of hyaluronic acid and 16 mg/ml of succinic acid. Three concentrations are available: 1.1 per cent, 1.8 per cent and 2.2 per cent.
The concentration is selected by indication and by the presenting pattern of the face rather than by patient preference. The manufacturer’s protocol distinguishes between a tired-looking face, a face where tissue has descended, a face where fine wrinkling dominates, and a face where muscular activity dominates, and matches concentration accordingly.
Three things it is not, all of which appear in circulation and all of which are wrong. It is not salmon-derived. It is not a polynucleotide, so it is not in the same molecular family as the repair injectables. It should not be thought of simply as a conventional hydration skin booster, because the formulation is also intended to have pigment-modulating and antioxidant effects.
The manufacturer uses the term ‘redermalization’ to describe the combined effects of HA and succinate on hydration, tissue quality and cellular metabolism.
How might HA and succinate influence pigmentation?
Melanin production depends on tyrosinase, and tyrosinase depends on copper at its active site. The manufacturer proposes an interaction with the copper-containing active site of tyrosinase, which interferes with the enzyme’s function and reduces melanin synthesis. It also acidifies the local environment and acts as an antioxidant, both of which further suppress the pathway. Meanwhile products of HA metabolism, including N-acetylglucosamine, may interfere with tyrosinase glycosylation, a process required for normal enzyme maturation and activity.
This mechanism is worth understanding because it explains both the appeal and the limits. Most topical brightening agents also work by interfering with tyrosinase, so the mechanism is a familiar one. The difference is delivery: a cream has to cross the stratum corneum and reach the melanocytes at the base of the epidermis, and how much of it arrives is variable. Intradermal injection bypasses the stratum-corneum barrier and changes tissue exposure, although this does not automatically mean that more active compound reaches epidermal melanocytes.
The limit follows from the same logic. Interfering with melanin synthesis reduces new pigment production. It does not remove pigment that has already been deposited, particularly pigment that has dropped into the dermis. Existing pigment, particularly dermal pigment, may require additional strategies such as pigment-targeting lasers or other energy-based treatments. A patient with established dermal pigment who treats only the synthesis pathway will see less new pigment and the same old pigment.
What does the evidence show?
The manufacturer cites a 2016 Prime Journal article by Maurizio Ceccarelli on treating hyperpigmentation with a combination of hyaluronic and succinic acids. Beyond that, the manufacturer has published a post-marketing observation on periorbital treatment, and that observation is the most specific data available on the dark-circle indication.
That observation followed 30 female patients aged 30 to 60 across 2017 and 2018. Average periorbital melanin readings moved from 85.3 before treatment to 79 at two weeks and 70.4 at five weeks. Average hydration readings moved from 29.5 to 58.4 at two weeks and 61.6 at five weeks.
Two honest observations about that data. The direction is consistent and the hydration change is large. But 30 patients in a manufacturer post-marketing observation is a modest evidence base, there is no control group, and it is not equivalent to a randomised trial. This is the level of evidence that supports trying a treatment in a considered plan; it is not the level that supports presenting it as a settled answer. Any clinic that describes this as proven is overstating what exists.
Which pigmentation problems does it suit?
It is used at Dr Cindy’s Medical Aesthetics as a first-line injectable where pigment is the primary concern. The manufacturer lists conditions including PIH, melasma, solar lentigines and ephelides; however, the quality of clinical evidence varies considerably between indications. Our guide to identifying which type of pigmentation you have covers that classification, and the guide to brightening and whitening treatments covers what is safe and what to avoid.
The distinction that decides how much it will help is pigment depth, and it is why assessment matters more than the product choice.
Epidermal pigment sits in the upper layer. It has sharper borders, and may show greater contrast under Wood’s lamp examination, although this is not completely reliable, particularly in darker skin types and mixed melasma.
Dermal pigment sits deeper. It looks greyer or bluer rather than brown, the borders are less defined, and it does not enhance under Wood’s lamp. It often responds less well to synthesis-directed treatment and may require additional pigment-targeted treatment.
Mixed epidermal and dermal pigmentation is frequently seen in melasma, and it means both approaches are doing necessary work.
This is why Wood’s lamp assessment is part of the pigmentation examination at the clinic, alongside visual examination, clinical history and Fitzpatrick typing. It is one tool among several, and it is most informative for the epidermal-versus-dermal question rather than being definitive on its own.
Can it treat dark circles under the eyes?
It is used in the periorbital zone for dark circles where the cause is pigmentation, and the manufacturer protocol is three sessions at two-week intervals, 0.5 cc per side, using the 1.8 per cent concentration, placed as intradermal papules 5 mm apart. It does not correct dark circles caused by hollowing or by visible vessels, which are structural and vascular problems.
Dark circles are usually multifactorial, with pigmentary, vascular and structural contributors often overlapping. Pigmented circles are brown and respond to pigment-directed work. Vascular circles are blue or purple, are visible vessels or thin skin showing what is underneath, and need a vascular approach. Structural circles are shadow cast by a tear-trough hollow and need volume. Hollow circles are volume loss in the area. Most patients have at least two of the four.
Our guides to identifying which type of dark circles you have and to matching treatments to each type set out that classification in full, and they are the better starting point if you are not sure which you have.
How does it fit with laser and topical treatment?
It sits alongside both rather than in place of either, and in an established melasma protocol all three layers are load-bearing.
The daily topical regimen does the continuous work. For pigment cases at the clinic that means cysteamine as Cyspera Original+, which replaces hydroquinone in the protocol, applied as a rinse-off cream with a five-minute to fifteen-minute exposure ramp, then daily through a sixteen-week intensive phase and twice weekly thereafter. Alongside it, a retinol derivative rather than tretinoin, niacinamide, tranexamic acid, and daily tinted SPF 50 paired with oral sun-protection tablets such as Crystal Tomato and Heliocare from the start of the cycle rather than held back for maintenance.
Laser reaches deposited pigment, including the dermal component that topicals and synthesis-directed injectables cannot address effectively. Laser may be useful in selected patients, particularly when there is a dermal or vascular component. Patients often ask whether they can skip laser and treat topically. For established melasma with a dermal component, the answer is that they will get a partial result, because the layers are not substitutes for one another.
RF Microneedling addresses something neither of the others does. In melasma the basement membrane between epidermis and dermis is frequently disrupted, which is what allows melanin to drop into the deeper dermal layer where it becomes much harder to clear and much harder to prevent. RF Microneedling delivers radiofrequency energy at controlled dermal depths and may improve basement-membrane integrity and dermal remodelling, which is why it earns a place in melasma protocols rather than being an optional extra.
The injectable is intended to reduce new synthesis and hydrates the dermis, which is the layer the other three do least well.
Our melasma treatment guide sets out how the full protocol is sequenced, and the guide to why melasma recurs covers the trigger inventory that determines whether any of it holds.
Why this matters more in Singapore
Singapore experiences high to very high UV exposure throughout the year, with periods reaching the extreme range. Ultraviolet exposure is the primary driver of melanin synthesis, so a treatment that suppresses synthesis is working against a continuous stimulus rather than an intermittent one. That is the clinical reason photoprotection is not adjacent advice in this city, it is the foundation the rest of the protocol sits on.
Heat may exacerbate melasma independently of direct UV exposure and is frequently overlooked. Melasma flares with heat exposure independent of sun, which in practice means cooking over a hot stove, hot showers, outdoor exercise in the middle of the day, and steam rooms. Patients who protect diligently against sun and never consider heat often cannot work out why their pigment fluctuates.
Many patients in Singapore have intermediate-to-higher Fitzpatrick phototypes, which matters twice. Higher constitutive melanin means more reactive pigment production in response to any inflammatory insult, and it means a higher risk of post-inflammatory hyperpigmentation from aggressive treatment. That combination is why protocols here favour a sequence of well-tolerated interventions over a small number of aggressive ones, and it is part of the case for a low-inflammation layer in a pigmentation plan.
What the treatment involves and what to expect
For the periorbital indication the manufacturer protocol is three sessions at two-week intervals. For facial pigmentation the course is planned at consultation according to the pattern and depth of pigment. Treatment areas include the face, neck, décolletage and hands, as well as the periorbital zone.
Placement is intradermal, as small papules spaced 5 mm apart across the treatment area. The papules are visible immediately afterwards and settle over several hours to a day. Bruising is possible, and the periorbital area bruises more readily than elsewhere, so allow a week before anything is photographed.
In the manufacturer’s observation, hydration measurements had improved by the two-week follow-up. The pigment change is slower and accumulates across the course, and the observational data above showed continued improvement between the two-week and five-week measurements. The result should be judged at the end of the course rather than after the first session.
Realistic expectations, stated plainly. Pigment improves and it does not clear completely. Melasma in particular is managed rather than cured, and it recurs when triggers return regardless of which treatments were used. Dermal pigment may require additional treatment beyond melanogenesis suppression, such as lasers. And no part of this works if photoprotection is not maintained, because the treatment is suppressing a pathway that ultraviolet exposure is continuously stimulating.
What the consultation involves
A pigmentation consultation should establish the type of pigmentation, its depth, and its triggers before any treatment is named. That means clinical history covering onset, hormonal factors, medications, prior treatments and heat as well as sun exposure; visual examination; Wood’s lamp assessment for the epidermal-versus-dermal question; and Fitzpatrick typing, because it changes what is safe.
You should leave knowing what type of pigmentation you have and at what depth, which layers your protocol needs and why each one is there, what the topical regimen is and how to ramp it, how many sessions of any in-clinic treatment are proposed, what realistic improvement looks like, and which of your own triggers you need to change. A consultation that names a product without establishing pigment depth has skipped the step that determines whether the product will help you.
Frequently asked questions
Is there an injection for pigmentation?
Yes. An injectable combining non-cross-linked hyaluronic acid with succinic acid is used for hyperpigmentation. The manufacturer proposes that the HA–succinate combination may reduce melanogenic activity through effects involving tyrosinase and oxidative stress, while HA also improves hydration. It works alongside laser and topical treatment rather than replacing them.
What is in it?
Two distinct molecules: high molecular weight non-cross-linked hyaluronic acid, and succinic acid as sodium succinate. In the 1.8 per cent preparation that is 18 mg/ml of hyaluronic acid and 16 mg/ml of succinic acid. Three concentrations exist, 1.1, 1.8 and 2.2 per cent, chosen by indication and by the presenting pattern of the face.
How does succinic acid help pigmentation?
Tyrosinase, the enzyme that controls melanin production, requires copper at its active site. Succinic acid is proposed to bind to that copper, which interferes with the enzyme and reduces melanin synthesis. It also acidifies the local environment and acts as an antioxidant, both of which suppress the same pathway further.
Is it better than lasers for pigmentation?
They do different things and neither replaces the other. This suppresses new melanin synthesis. Laser breaks up pigment that has already been deposited, including the dermal component that synthesis-directed treatment cannot reach. For established melasma with a dermal component, laser is essential to the protocol, and treating synthesis alone produces a partial result.
Can it treat dark circles?
Where the cause is pigmentation, yes, and the protocol is three sessions at two-week intervals, 0.5 cc per side, at 1.8 per cent, placed as intradermal papules 5 mm apart. It does not treat dark circles caused by hollowing or by visible vessels. Since most patients have more than one cause, establishing which type you have comes first.
How many sessions will I need?
Three sessions at two-week intervals for the periorbital indication, per the manufacturer protocol. For facial pigmentation the course is planned at consultation according to the pattern and depth of pigment, since epidermal and mixed pigmentation do not need the same plan.
Is it safe for darker skin types?
The mechanism suppresses melanin synthesis rather than delivering energy into the skin; because it does not rely on thermal or light energy, it avoids some of the mechanisms by which energy-based procedures can provoke post-inflammatory hyperpigmentation. Injection-related inflammation can still occur, so suitability should be assessed individually. That is part of why a low-inflammation layer is useful in pigmentation protocols here. Suitability still depends on individual assessment and history.
What are the side effects?
Visible papules at each injection point that settle within hours to a day, bruising, particularly around the eyes, and transient redness and tenderness.
Will my pigmentation come back?
Melasma recurs when triggers return, even after successful treatment. That is a property of the condition rather than a failure of the treatment. Sustained photoprotection, heat avoidance and a maintained topical regimen are what determine whether a result holds, which is why the trigger conversation is part of the consultation rather than an afterthought.
References
Ceccarelli M, “Treating hyperpigmentation using a combination of hyaluronic and succinic acids”, Prime Journal, Vol 6 Issue 4, July/August 2016
Vashi NA, Kundu RV, “Facial hyperpigmentation: causes and treatment”, British Journal of Dermatology, 2013 (https://onlinelibrary.wiley.com/doi/10.1111/bjd.12536)
National Environment Agency Singapore, UV index measurement and health advisory, 2026 (https://www.nea.gov.sg/weather/ultraviolet-index)
Pigmentation protocols at Dr Cindy’s Medical Aesthetics are built after establishing the type and depth of pigment, because that assessment is what decides which layers your plan needs. Dr Cindy has practised aesthetic medicine for 20 years, with a particular focus on pigmentation in Southeast Asian skin.
