NAD+ Injections Before and After: What to Expect and Clinical Insight

NAD⁺ (Nicotinamide Adenine Dinucleotide) is a vital coenzyme found in every cell of the human body, responsible for fueling metabolic reactions, DNA repair, and mitochondrial function. As we age, NAD⁺ levels decline, impacting energy production, cellular regeneration, and skin vitality.

In aesthetic medicine, NAD injections support systemic energy, optimize cellular communication, and create an internal environment where skin healing and vibrancy are naturally enhanced. Understanding the full scope of NAD⁺ injections before and after allows medical professionals to integrate this therapy into daily practice with precision and confidence.

Delivery Methods Explained: IM, SC, or IV?

NAD⁺ can be administered via intravenous (IV), intramuscular (IM), or subcutaneous (SC) injection. While IV is common in wellness clinics for systemic delivery, it requires longer appointments and clinical supervision.

IM and SC routes are increasingly favored due to ease of administration, shorter procedure time, and patient tolerance. IM injections offer rapid absorption and are often used when quick energy restoration is desired. SC injections, by contrast, allow for a slower, sustained release of NAD⁺, ideal for ongoing skin health and maintenance.

Who Should Consider NAD⁺ Injections?

Ideal candidates for NAD⁺ therapy in aesthetic medicine include patients struggling with fatigue, burnout, poor post-procedure healing, and signs of “tired skin.” It’s particularly beneficial for those recovering from illness, high-stress lifestyles, or experiencing an age-related slowdown in skin recovery and collagen synthesis.

Patients with dull, dehydrated, or inflamed skin, especially after procedures like laser or RF, may notice faster recovery and a return to glow. Injectable NAD results are most appreciated in patients who show delayed healing, loss of firmness, or chronic skin stress.

What to Know Before Starting NAD⁺ Therapy?

Before administering NAD⁺, ensure patients are hydrated and have provided a full medical history, especially regarding autoimmune disease, cancer history, or pregnancy. 

Protocols typically include 4 to 8 weekly sessions, depending on clinical goals. Combination therapies are common, pairing NAD⁺ injections with exosomes, radiofrequency (RF) devices, or biostimulatory fillers to enhance skin regeneration.

In advanced longevity and integrative clinics, baseline evaluations may also include biological markers such as the NAD⁺/NADH ratio, oxidative stress panels, and assessments of mitochondrial function. While not required for every patient, these indicators can provide valuable insights for personalizing treatment plans and monitoring metabolic impact.

What Happens Right After the Injection?

Within 24 to 48 hours of NAD⁺ administration, patients often report systemic effects such as:

• Increased mental clarity and focus.
• Elevated energy levels.
• Improved sleep quality.

These early effects signal mitochondrial activation and nervous system recalibration. However, skin-based changes are not immediately visible. Emphasize to patients that the NAD⁺ skin glow treatment develops gradually.

Visible Skin Improvements: The First Few Weeks

Over the next 2 to 4 weeks, patients begin to notice improved hydration, tone, and radiance. Post-procedure healing accelerates, especially after microneedling, fractional lasers, or RF treatments.

Skin may appear brighter, more even, and less inflamed. This phase marks the shift from internal metabolic repair to visible external improvements. NAD⁺ contributes to the skin’s ability to retain moisture, fight oxidative stress, and bounce back from trauma.

Long-Term Changes to Skin and Stress Response

After 6 to 8 weeks, cumulative effects become more evident. Patients often experience:

• Increased stress resilience (fewer inflammatory flares).
• Greater collagen production.
• Enhanced response to other treatments.

NAD⁺ also helps skin resist daily environmental stressors - a key factor in longevity-focused aesthetic care. It is especially useful in patients with high cortisol levels or chronic inflammation. Long-term NAD⁺ protocols have also been linked to improvements in transepidermal water loss (TEWL), reduced sensitivity to chemical and mechanical stress, and a more balanced skin microbiome. 

Moreover, repeat NAD⁺ sessions appear to prime dermal tissue for biostimulatory agents, potentially enhancing fibroblast activity and extending the duration of results from energy-based devices. For aging patients or those experiencing oxidative overload, this approach offers a strategic tool for maintaining long-term skin vitality.

Before and After Results in Aesthetic Practice

Before-and-after results may include a more even tone, faster wound healing, and revived texture. Practitioners have observed enhanced skin density, improved dermal hydration, and better elasticity following a complete NAD⁺ protocol. These changes are particularly evident in patients with previously compromised skin or those undergoing energy-based interventions.

Unlike hyaluronic acid fillers that restore volume or neuromodulators that act on muscle dynamics, NAD⁺ injections before and after comparisons reveal improvements in overall skin quality. These include better color uniformity, smoother surface texture, and reduced appearance of fatigue or dullness. In photographic documentation, patients often appear fresher, more rested, and subtly rejuvenated.

Ideal case examples include:

• Faster healing post-microneedling or PRP.
• Restored glow in perimenopausal or post-viral fatigue patients.
• Reduced downtime after laser resurfacing.
• Improved skin resilience in patients with high cortisol levels or chronic inflammation.
• Enhanced tone and hydration in patients with photoaged or glycation-affected skin.

How Clinicians Use NAD⁺ in Daily Practice

Practitioners often use NAD⁺ as a prep or recovery agent:

• Before threads to optimize tissue response.
• After RF or microneedling to speed re-epithelialization.

It's frequently combined with exosomes, peptides, and regenerative injectables. Also, it is one of the therapies covered in the Regenerative Medicine Course, designed to educate clinicians on advanced cellular strategies in aesthetic practice. Patient types include executives, athletes, individuals with long COVID, and clients seeking full-body skin rejuvenation.

Is It Safe? Dosing, Tolerance, and What to Tell Patients

Common dosages range from 100 mg to 300 mg per session, depending on delivery route and clinical indication. While most patients tolerate NAD⁺ well, mild side effects may occur, and they include:

• Warmth or flushing.
• Nausea (rare).
• Injection site tenderness.
• Mild headache or lightheadedness following the first session.
• Temporary fatigue as the body adjusts to cellular-level changes.
• Transient mood shifts or increased emotional sensitivity, particularly in patients with underlying stress-related conditions.

Patient education is key. Explain that results are not instant and that this is a restorative therapy. Clear, honest communication builds trust and reduces unrealistic expectations.

When NAD⁺ Is Not Recommended

Although most individuals tolerate NAD⁺ injections without complications, the therapy is not universally appropriate and should be administered with patient selection. Careful screening is crucial to minimize risk and ensure optimal outcomes. This therapy should be avoided in individuals with the following conditions:

• Pregnancy or breastfeeding.
• Active autoimmune conditions.
• Ongoing cancer treatment or history of malignancy.
• Severe liver or kidney dysfunction.
• Known hypersensitivity to NAD⁺ or any component of the formulation.
• Uncontrolled hypertension or cardiac arrhythmias.
• History of seizure disorders or epilepsy.
• Current psychiatric instability or untreated anxiety disorders.
• Recent cerebrovascular events, such as stroke or TIA.
• Use of MAO inhibitors or stimulant-based medications without physician oversight.

The Bottom Line

NAD⁺ injections are becoming a cornerstone of regenerative aesthetics, supporting energy metabolism, skin healing, and improved stress response. While they do not replace structural treatments, their synergistic value with lasers, threads, and RF is profound.

Clinicians who aim to broaden their offerings in cellular rejuvenation and longevity aesthetics will find that NAD⁺ protocols are a worthwhile addition. Explore more strategies and education in HubMed Ed medical aesthetic courses to elevate your NAD⁺ practice and stay at the forefront of regenerative protocols. Educate patients thoroughly, manage expectations, and consider combination strategies for optimal results.

FAQs

Does NAD get rid of saggy skin?

Not directly. NAD⁺ improves skin function and collagen health, which may slightly tighten skin over time, but it doesn’t replace lifting procedures.

Is NAD like Ozempic?

No. Ozempic is a GLP-1 receptor agonist for blood sugar and weight loss, while NAD⁺ is a cellular coenzyme used for energy metabolism and repair.

What food has the most NAD⁺?

Foods rich in niacin (like tuna, liver, and mushrooms) support NAD⁺ production, but they don’t provide NAD⁺ directly in injectable form.

Are NAD injections better than pills?

Injections bypass the gut and deliver NAD⁺ directly into the bloodstream or tissue, resulting in faster and more bioavailable effects.

What not to mix with NAD?

Avoid concurrent use with immunosuppressants, certain cancer therapies, or high-dose corticosteroids unless under medical supervision.

How do you feel after injecting NAD⁺?

Many report clearer thinking, better sleep, and more energy within 24-48 hours. Skin improvements emerge more gradually over weeks.

References:

1. Radenkovic D, Reason S, Verdin E. Clinical evidence for targeting NAD therapeutically. Pharmaceuticals (Basel). 2020;13(9):247. doi:10.3390/ph13090247. PMID: 32942582; PMCID: PMC7558103. https://pmc.ncbi.nlm.nih.gov/articles/PMC7558103/
2. Iqbal T, Nakagawa T. The therapeutic perspective of NAD⁺ precursors in age-related diseases. Biochem Biophys Res Commun. 2024;702:149590. doi:10.1016/j.bbrc.2024.149590. https://www.sciencedirect.com/science/article/pii/S0006291X24001256
3. Gindri IM, Ferrari G, Pinto LPS, Bicca J, et al. Evaluation of safety and effectiveness of NAD in different clinical conditions: a systematic review. Am J Physiol Endocrinol Metab. 2024;326(4):E425–E437. doi:10.1152/ajpendo.00242.2023. https://journals.physiology.org/doi/full/10.1152/ajpendo.00242.2023

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