Two strings, one sound – on harmony in life and biostimulation ahead of its time
AUTHOR:
Elżbieta Anna Zielińska, MD
Ophthalmologist, oculoplastic surgeon and aesthetic medicine physician
Needle-Free Injection Effect – Why Is There a Need for It?
The skin is a barrier to most active substances. That is why aesthetic medicine largely relies on injection-based methods or those that temporarily disrupt the epidermal barrier. In the clinic, limitations include pain, haematomas, bruising, variability in manual administration and patients’ concerns related to needles. For some people, the mere acceptance of a needle insertion is a problem, regardless of the technique or anaesthesia used.
The periocular area raises the bar even further. The skin here is thinner, more highly vascularised and innervated, and more prone to swelling. This reduces tolerance to mechanical trauma and increases the importance of dose control. In this area, the margin for error is smaller than in areas with thicker skin.
What is Mirajet?
Mirajet is a needle-free system for delivering products into the skin, powered by Er:YAG laser energy (2940 nm). It is not a conventional resurfacing-type laser procedure. The laser acts as an energy source in a system that generates a very short pressure pulse. The pulse accelerates the product and forms a microjet that penetrates the epidermis and deposits the substance directly into the dermis.
In practice, this means administration without a conventional needle and delivery of the dose in a series of micropulses. This facilitates uniform treatment of the area and reduces the dependence of the outcome on differences in manual injection technique.
Er:YAG drive mechanism – brief but technical
Er:YAG energy is absorbed by water in a sealed container. A water vapour bubble is formed and then rapidly collapses. This phenomenon generates a shock wave that transfers energy to a membrane. The movement of the membrane is converted into a pressure pulse acting on the product. The product exits through the nozzle, forming a high-velocity microjet.
Parameters that translate into clinical practice
Technical descriptions indicate typical values: a nozzle of approximately 250 µm, a volume of <1 µl per pulse, a deposition depth of approximately 100–1500 µm depending on laser settings and tissue conditions, a frequency of 10–40 Hz, and particle velocity of approximately 150–800 m/s (around 350 m/s on average).
For the physician, this means the ability to build the treatment effect through a series of micro-deliveries. In typical clinical practice, the repeatability of the microdose and uniformity of “coverage” of the treatment area are more important than individual, larger deposits.
The eye area – a zone requiring precision
The periocular skin is thin, sensitive and often more reactive in vascular terms. It also tends to be more prone to swelling. In this area, dose control within a small treatment field, predictability of the post-treatment response and minimising trauma resulting from repeated needle insertions are particularly important.
Mirajet enables treatment of delicate skin around the orbital area, including the eyelids, with precise deposition of small volumes in a series of micropulses. This translates into more uniform treatment of the skin and less dependence on the angle of needle insertion and manual variability of the injection technique. However, it requires careful parameter selection, as the eye area does not tolerate excessive aggressiveness.
Crow’s feet – neuromodulation and skin quality improvement
Wrinkles around the lateral canthus (“crow’s feet”) have a significant dynamic component. The standard approach is botulinum toxin type A, aimed at reducing excessive activity of the orbicularis oculi muscle and weakening the mimetic component.
In some cases, neuromodulation is complemented by treatment aimed at improving skin quality. For this purpose, biostimulating products are used, including those based on poly-D,L-lactic acid (PDLLA). Botulinum toxin and biostimulators have different mechanisms of action. By combining them, we can achieve improved skin quality and reduce wrinkles and shadows around the eyelids.
There is an option to combine botulinum toxin in the form of “baby Botox” with poly-D,L-lactic acid and administer it using a needle-free technique with the MiraJet system. This can deliver spectacular results without pain or a long recovery period.
After blepharoplasty – working with postoperative tissue and scars
In oculoplastic surgery, assessing healing and tissue quality is fundamental to patient management. Following eyelid surgery, temporary thickening within the scar, tissue irregularity, local skin stiffness and a subjective feeling of tightness may occur during the remodelling phase. In some patients, the problem is not the visibility of the scar itself, but how it behaves within the tissue: lack of elasticity and discomfort during facial expression.
Mirajet can be used as part of supportive therapy when working with postoperative tissue following blepharoplasty, including in the area of scars. With the needle-free system, we can also administer steroid preparations, such as triamcinolone, even within keloid scars, inhibiting their overgrowth. We can increase skin elasticity in the scar area, improve the quality of the skin around the incision and reduce tissue discomfort during the remodelling process.
Patient selection and contraindications – no shortcuts
Patient selection for the procedure should take into account the condition of the skin in the treatment area, the presence of infections and active dermatoses, susceptibility to post-inflammatory hyperpigmentation, a history of healing disorders and a tendency to form keloids, anticoagulant treatment and the patient’s expectations regarding the post-treatment response.
Contraindications remain similar to those for other procedures that disrupt the skin barrier: active infection, uncontrolled inflammation and inability to maintain aseptic conditions. In the eye area, additional importance should be given to ophthalmic factors, including active blepharitis and inflammatory reactions within the conjunctival sac.
What does the patient notice after the treatment: discomfort and “downtime”?
The most common questions concern sensations during the procedure and the appearance of the skin afterwards. Typical reactions include mild erythema and temporary swelling. Their severity depends on the treatment area, parameters, skin sensitivity and the type of product used. The periocular area is more prone to swelling, so the patient should be clearly informed about what to expect and how to manage the skin after treatment.
“Social downtime” – the period during which the reaction remains visible – is also important. Protocol planning should minimise the risk of excessive symptoms, particularly in patients with vascular reactivity and a tendency to swelling. Appropriate post-treatment skincare and strict photoprotection are also essential, as post-inflammatory reactions and hyperpigmentation depend not only on the procedure itself but also on post-treatment management.
Needle-free penetration: what do studies confirm, and what cannot honestly be promised yet?
The aim of transdermal delivery systems is to overcome the epidermal barrier in a controlled manner. Publications concerning Er:YAG-powered microjets have described the possibility of deposition within the dermis, as well as histological observations suggesting penetration within the range typical of the upper layers of the dermis. The results naturally depend on device settings, tissue conditions, the substance used and the assessment method.
Scientific data do not replace clinical assessment, particularly in the eye area and in postoperative treatments. In these situations, safety, predictability of healing and the appropriate timing of intervention are the priorities. In practice, it should also be understood that the effect may result both from substance deposition and from mechanical channelling and tissue stimulation by the micropulses. The proportions of these components depend on the energy and frequency of the laser, the product used and the characteristics of the skin.
Conclusions from clinical practice
Mirajet is a highly useful tool wherever dose control, uniform delivery and treatment of thin and sensitive skin are key. An important aspect is its use in patients who are highly sensitive to pain or even have a phobia of “needles” and injections. Following anaesthesia, the treatment is virtually painless. The recovery period is relatively short. Post-treatment erythema lasts for several hours, while the risk of bruising is minimised, which is of great importance in the modern world. After the treatment, patients can return to their professional activities the following day.
