Role of Biostimulators in Facial Rejuvenaton

As aesthetic practitioners seek more natural and long-lasting solutions for patients, the use of biostimulators injections has risen substantially. Rather than providing immediate volumization like traditional fillers, biostimulators prompt neocollagenesis, leading to gradual improvements in skin firmness, elasticity, and contour.

Biostimulators rely on materials that the body recognizes and processes over time. These materials—such as poly-L-lactic acid (PLLA), calcium hydroxylapatite (CaHA), or polycaprolactone—stimulate the fibroblasts to produce new collagen and elastin. This process helps restore the extracellular matrix, resulting in more resilient skin and enhanced structural support.

Key Takeaways

• Biostimulators are gaining traction for providing subtle, long-lasting results by inducing collagen and elastin production.
• Various biostimulators face treatments, including collagen biostimulators and next-generation formulas, target multiple areas from the midface to the jawline.
• Compared to traditional dermal fillers, biostimulators offer a unique mechanism of action focused on tissue remodeling rather than only volumizing.
• Careful technique, product selection, and knowledge of proper injection planes are essential for optimal outcomes and minimal biostimulators side effects.
• Products such as Sculptra®, Radiesse®, Ellansé®, and HarmonyCa® represent key biostimulators brands that have shown favorable results in clinical practice.

Mechanisms of Collagen Induction and Tissue Remodeling

Collagen biostimulators injection introduces molecules that serve as scaffolds for collagen deposition. The body metabolizes these materials over several weeks to months, leaving behind newly formed collagen fibers that improve skin quality. This gradual, organic effect contrasts with traditional fillers, which add volume directly.

Key physiologic mechanisms include:

• Fibroblast Activation: Biostimulators activate fibroblasts, which synthesize collagen types I and III, leading to thicker, firmer skin.
• Vascularization: Improved microcirculation supports nutrient delivery, promoting healthier skin over time.
• Elasticity Improvements: Enhanced collagen and elastin networks restore elasticity, reducing skin laxity and improving facial contours.

Biostimulators vs Fillers: Understanding the Difference

While injectable fillers—particularly hyaluronic acid (HA)—remain mainstays in aesthetic medicine, biostimulators represent a nuanced approach. Both offer solutions for facial volume loss and contour refinement, but their mechanisms and longevity differ:

• Immediate vs. Gradual Results: HA fillers provide immediate volumization. In contrast, Biostimulators rejuvenation yields progressive improvements as collagen develops over time.
• Longevity: HA fillers typically last 6–18 months, depending on the product and treatment area. Biostimulators may offer results that extend beyond 2 years due to ongoing collagen stimulation.
• Tissue Quality Improvement: HA restores lost volume, but does not inherently improve tissue quality once it’s resorbed. Biostimulators enhance tissue structure, leaving skin more elastic and robust long after the product is metabolized.

Applications in Facial Rejuvenation

Biostimulators for jowls and midface contouring are popular applications, as collagen induction can help restore a more defined jawline and lifted appearance. By gradually improving skin structure, practitioners can address subtle sagging and volume depletion. 

Additional areas include:

• Midface and Cheeks: Biostimulators enhance cheek volume and contour while simultaneously improving skin thickness.
• Jawline and Jowls: Targeted injections can improve lower-face definition, mitigating the appearance of jowls.
• Biostimulators under eyes: Careful application can improve tear troughs by thickening the dermis and reducing the visibility of underlying structures over time.
• Neck and Décolletage: While often associated with facial rejuvenation, biostimulators can also be used off-face for a more comprehensive aesthetic approach.

How to Choose the Right Biostimulators

A range of biostimulator products are available, each with unique properties and clinical considerations. Notable options include:

• Sculptra® (PLLA): One of the earliest FDA-approved biostimulators, Sculptra® is a proven option for stimulating collagen over months, gradually improving facial volume and texture.
• Radiesse (CaHA): Radiesse® provides immediate structural support before it’s metabolized, encouraging robust collagen growth. It is versatile and well-studied for midface and lower-face treatments.
• Ellanse (PCL): Ellansé® offers tunable longevity and a controlled collagen induction profile, allowing practitioners to customize outcomes based on patient needs.
• HarmonyCa®: HarmonyCa®, an innovative hybrid filler, uses CaHA combined with HA to deliver immediate volumization while stimulating long-term collagen production, bridging the gap between filler and biostimulator strategies.

Injection Techniques and Considerations

Proper technique is critical to maximize patient outcomes and minimize biostimulators side effects. Key steps include:

1. Patient Assessment: Evaluate facial symmetry, skeletal support, skin quality, and volume deficits. Identify treatment objectives, from subtle contouring to more pronounced lifting.
2. Anatomical Mastery: Knowledge of facial anatomy is paramount. Deep understanding of the fat pads, retaining ligaments, and vasculature ensures safe, effective injections. Consider a layered approach—deep injections for structural support, and more superficial placement to improve skin quality.
3. Dilution and Reconstitution (for PLLA Products): Sculptra®, for instance, requires proper reconstitution and hydration time to ensure even distribution and minimal lumps.
4. Cannula vs. Needle: A blunt cannula may reduce bruising risk and improve control depending on the product and treatment area. Needles provide precision but may require multiple entry points.
5. Massage Post-Injection (When Indicated): Certain biostimulators, particularly PLLA-based products, benefit from post-treatment massage to ensure even dispersion and mitigate nodule formation.

Comparing Modalities: Biostimulators vs Hyaluronic Acid in Detail

Biostimulators and hyaluronic acid (HA) fillers are both popular injectable treatments in aesthetic medicine, but they work differently and are suited for distinct purposes.

Hyaluronic Acid Fillers

• Mechanism: HA fillers provide immediate volume by attracting water to the injected area. They are commonly used for volumizing lips, cheeks, and smoothing fine lines.
• Duration: Depending on the product and area treated, the effects typically last 6 months to 2 years.
• Reversibility: HA fillers are reversible using hyaluronidase, making them a safer option for those new to facial injectables.
• Best For: Immediate results and areas requiring hydration and subtle enhancement.

Biostimulators

• Mechanism: These fillers, such as Radiesse (calcium hydroxyapatite) and Sculptra (poly-L-lactic acid), stimulate the body’s natural collagen production. Results appear gradually but can last longer as they improve skin quality and structure over time.
• Duration: Depending on the specific product and individual metabolism, effects can last 1–2 years or more.
• Reversibility: Unlike HA fillers, biostimulators are not reversible, requiring a more thoughtful approach to treatment.
• Best For: Long-term volume restoration, improving skin elasticity, and enhancing areas like the jawline or cheeks.

Combination Treatments

To achieve the best results, many are turning to a combination of HA fillers and biostimulators. This approach provides immediate volume while promoting long-term collagen production, making it an increasingly popular choice. This approach can provide both instant gratification and lasting improvements in skin quality and structure.

While HA fillers are versatile and often preferred for subtle, reversible enhancements, biostimulators cater to those seeking more durable and comprehensive rejuvenation. It’s essential to consult a qualified professional to tailor the treatment to your specific goals and facial anatomy.

Safety Profiles and Biostimulators Side Effects

Biostimulators, such as Poly-L-lactic acid (PLLA) and Calcium Hydroxylapatite (CaHA), are known for their favorable safety profiles. These substances are biocompatible, meaning they are well-tolerated by the body.

For instance, PLLA has been used for over 50 years in medical applications, including dissolving sutures and implants, and has been utilized in cosmetic procedures since 2008. Similarly, CaHA is one of the most studied dermal fillers, recognized for its high elasticity and ability to induce long-term collagen formation.

When administered by qualified practitioners—such as registered nurses or medical doctors—biostimulators demonstrate a high level of patient satisfaction with minimal adverse effects reported. Most studies indicate that any side effects tend to be mild and transient, commonly limited to temporary swelling, redness, or bruising at the injection site.

Potential Side Effects

While biostimulators are generally safe, there are some potential side effects and risks associated with their use:

• Injection Site Reactions: Common side effects include swelling, redness, bruising, and tenderness at the injection site. These reactions usually resolve within a few days.
• Nodule Formation: In rare cases, patients may experience the formation of nodules or lumps under the skin. This can occur if the product is not injected properly or has an inflammatory response.
• Infection: As with any injectable procedure, there is a risk of infection. Proper hygiene and technique during administration can mitigate this risk.
• Vascular Occlusion: Although rare, there have been instances where biostimulator injections have led to vascular occlusion, where the injected product blocks a blood vessel. This can result in serious complications requiring immediate medical attention.

Mitigating Risks

To minimize the risks associated with biostimulator treatments:

• Choose Qualified Practitioners: It is essential to have these procedures performed by experienced professionals who understand facial anatomy and injection techniques.
• Follow Pre- and Post-Treatment Guidelines: Adhering to pre-treatment instructions (like avoiding blood thinners) and post-treatment care (such as avoiding strenuous activities) can help reduce complications.
• Discuss Medical History: Patients should provide a thorough medical history to their practitioners to identify any potential contraindications.

Selecting reputable biostimulators brands, adhering to recommended protocols, and maintaining proper aseptic technique are critical for minimizing adverse events.

Frequently Asked Questions (FAQ)

How long do results from Biostimulators rejuvenation last?

Results typically last 1–2 years or longer, depending on the product and individual patient factors. Unlike traditional fillers, which provide immediate volume, biostimulators like Sculptra and Radiesse continue to enhance skin structure over time, offering sustained benefits as collagen remodeling occurs.

Can Biostimulators for face be combined with other treatments?

Yes, biostimulators are often combined with hyaluronic acid (HA) fillers, neuromodulators such as Botox, and energy-based devices like laser treatments for comprehensive facial rejuvenation. This synergy enhances overall outcomes, addressing multiple signs of aging simultaneously and providing a more holistic approach to aesthetic enhancement.

Are there any contraindications for collagen biostimulators?

Yes, contraindications may include active infections, severe allergies, or autoimmune conditions that affect the injection area. A thorough patient evaluation and screening process are critical to ensure safety and efficacy.

How do I minimize biostimulators side effects?

To minimize side effects associated with biostimulators, it is essential to employ proper injection techniques, select the appropriate product for the patient’s needs, and adhere strictly to manufacturer guidelines. Additionally, educating patients on post-injection care, including potential massage of the area (when indicated), can help reduce complications and enhance recovery.

What makes Radiesse and Ellanse different from each other?

Radiesse® (calcium hydroxylapatite) provides both immediate volume and long-term collagen stimulation, making it effective for contouring and enhancing facial features. In contrast, Ellansé® (polycaprolactone) allows practitioners to customize the duration of results—ranging from one to four years—while also promoting incremental collagen production.

Final Thoughts

In conclusion, biostimulators are valuable tools in aesthetic medicine for achieving natural-looking and long-lasting results. They offer a versatile and innovative approach to enhancing facial features by stimulating the body’s natural collagen production.

However, proper patient selection, injection techniques, and adherence to manufacturer guidelines are crucial for maximizing safety and efficacy. As with any cosmetic procedure, thorough consultations with patients and continuous education on post-injection care are essential to ensure optimal outcomes.

References

1. Bernardo, R., Oliveira, R., Freitas, K. M., Barbosa, J. R. D., & Barbosa, C. (2024). Effect of poly‐L‐lactic acid and polydioxanone biostimulators on type I and III collagen biosynthesis. Skin Research and Technology, 30, e13681.
2. Ianhez, M., de Goés E Silva Freire, G., Sigrist, R. M. S., Colpas, P. T., de Faria, I. A., Parada, M. O. A. B., & Miot, H. A. (2024). Complications of collagen biostimulators in Brazil: Description of products, treatments, and evolution of 55 cases. Journal of Cosmetic Dermatology, 23(9), 2829–2835.
3. Mashiko, T., Mori, H., Kato, H., Doi, K., Kuno, S., Kinoshita, K., Kunimatsu, A., Ohtomo, K., & Yoshimura, K. (2013). Semipermanent volumization by an absorbable filler: Onlay injection technique to the bone. Plastic and Reconstructive Surgery Global Open, 1(1), e4–e14.
4. Rho, N. K., Kim, H. S., Kim, S. Y., & Lee, W. (2024). Injectable “Skin Boosters” in aging skin rejuvenation: A current overview. Archives of Plastic Surgery, 51(6), 528–541.
5. Wollina, U. (2016). Facial rejuvenation starts in the midface: Three-dimensional volumetric facial rejuvenation has beneficial effects on nontreated neighboring esthetic units. Journal of Cosmetic Dermatology, 15(1), 82–88. 
6. Yag-Howard, C., & DeNigris, J. (2021). Novel filler technique: Hyaluronic acid and calcium hydroxylapatite mixture resulting in favorable esthetic and longevity outcomes. International Journal of Women’s Dermatology, 7(5 Pt B), 817–819.