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"Biostimulation is redefining aesthetic medicine’s philosophy: from filling to regenerating, from masking aging to restoring skin vitality."
In recent years, biostimulation has become one of the fastest-growing sectors in aesthetic medicine, promising natural regeneration and long-lasting results. Rather than filling or replacing lost volume, biostimulation aims to regenerate the skin from within—stimulating fibroblasts to produce collagen and elastin, restoring structure, elasticity, and radiance. But as with any fast-moving field, rapid innovation brings both excitement and controversy.
The aesthetic industry has shifted from the era of “volume restoration” to one focused on skin quality— tone, texture, firmness, and glow. Patients increasingly seek a refreshed and authentic appearance rather than dramatic transformations. As the global population ages—by 2050, 1.5 billion people will be over 65—the demand for regenerative, collagen stimulating treatments continues to surge.
Data from 2023 estimated the global market for injectable biostimulators at USD 1.2 billion, with projections to double by 2032. Regenerative injectables such as calcium hydroxylapatite (CaHA), poly-L-lactic acid (PLLA), and hybrid fillers represent a major driver of growth in aesthetic medicine.
Collagen production begins to decline as early as the mid-20s, with an annual reduction of 1%. By the age of 50, women can experience up to 30% collagen loss, accelerated by estrogen decline during menopause. This loss manifests as reduced elasticity, thinning dermis, and dullness—hallmarks of aging skin.
Biostimulation seeks to counter this through controlled induction of neocollagenesis. CaHA microspheres, for instance, activate fibroblasts through direct contact, prompting the synthesis of new collagen (particularly type III). Studies demonstrate that more diluted CaHA formulations disperse wider and deeper within the dermis, increasing the number of fibroblasts in contact with the particles and thus enhancing collagen formation.
The introduction of hybrid fillers, combining CaHA with cross-linked hyaluronic acid (HA), has opened new possibilities. This synergy offers the structure and collagen induction of CaHA with the hydration and softness of HA, producing immediate and longterm benefits. Clinical evaluations show histological improvements in dermal architecture and skin density, supporting the hybrid concept as both safe and effective.
Despite these advances, biostimulation remains a topic of debate among practitioners and scientists alike. MUDr. Kavková highlights several key controversies shaping current discussion.
While clinical enthusiasm is high, long-term evidence remains limited. Much of the market’s momentum is driven by marketing narratives rather than robust comparative data. Patients’ expectations— often shaped by social media—may exceed what biostimulators can realistically achieve.
Although rare, complications such as nodules or granulomas can occur, particularly when off-label dilutions or unstandardized protocols are used. Proper training, product knowledge, and complication management are crucial to minimize risk.
The “more-is-better” mentality that once plagued filler treatments risks repeating itself in biostimulation. Excessive stimulation or poorly planned combination therapies may lead to irregularities or fibrosis. The focus must remain on moderation, individualized assessment, and quality over quantity
Not every patient benefits equally. Advanced laxity, metabolic disorders, or unrealistic expectations can compromise results. As MUDr. Kavková emphasizes, careful assessment and education are essential to achieving satisfaction and avoiding misuse.
Threads, toxins, devices, and fillers are often combined, but the ideal sequencing and timing are still under debate. Overstimulation can be as counterproductive as undertreatment. Evidence-based protocols and a holistic understanding of tissue physiology are key to achieving synergistic outcomes.
Patients frequently believe biostimulation will provide permanent rejuvenation. In reality, product longevity and collagen remodeling vary widely between individuals. Honest communication about duration, maintenance, and follow-up is a professional necessity.
Perhaps the most critical issue is ethical responsibility. Aggressive marketing of “miracle” biostimulators and widespread off-label practices risks undermining the credibility of the field. MUDr. Kavková calls for international guidelines and stresses that professional duty must always outweigh commercial pressure.
With the face remaining the most frequently treated area“ in her own clinical practice, MUDr. Kavková uses CaHA and hybrid formulations across multiple anatomical zones—neck, décolleté, hands, elbows, knees, and even for post-surgical or post-liposuction defects—with visible improvements in skin firmness and texture over three months.
Biostimulation is redefining aesthetic medicine’s philosophy: from filling to regenerating, from masking aging to restoring skin vitality. The evidence, though still evolving, points toward a future where personalized regenerative protocols replace traditional volumizing approaches.
As MUDr. Kavková concludes: “Biostimulation is not just correction—it is true rejuvenation from within.”
Goldie K, Kerscher M, Fabi SG, Hirano C, Landau M, Lim TS, Woolery-Lloyd H, Mariwalla K, Park JY, Yutskovskaya Y. Skin Quality - A Holistic 360° View: Consensus Results. Clin Cosmet Investig Dermatol. 2021 Jun 14;14:643-654. doi: 10.2147/CCID.S309374. PMID: 34163203; PMCID: PMC8214518. Skin Tightening With Hyperdilute CaHA: Dilution Practices and Practical Guidance for Clinical Practice Z. Lorenc, J. M. Black, Jessie S Cheung, A. Chiu, Roberta Del Campo, A. Durkin, M. Graivier, Jeremy B Green, Gideon P Kwok, Keith Marcus, C. Rammos, W.Werschler. Aesthetic surgery journal 30 June 2021 Nowag B, Casabona G, Kippenberger S, Zöller N, Hengl T. Calcium hydroxylapatite microspheres activate fibroblasts through direct contact to stimulate neocollagenesis. J Cosmet Dermatol. 2023 Feb;22(2):426-432. doi: 10.1111/ jocd.15521. Epub 2022 Dec 27. PMID: 36575882. Combining Calcium Hydroxylapatite and Hyaluronic Acid Fillers for Aesthetic Indications: Efficacy of an Innovative Hybrid Filler. Fakih-Gomez N, Kadouch J. Aesthetic Plast Surg. 2022 Feb;. Clinical and Histopathological Evaluation of Skin Changes Following Intradermal Injection of Hybrid Products Combining Calcium Hydroxyapatite with Various Density Hyaluronic Acid Ya. A. Yutskovskaya1*, Е.А. Kogan2, A. Yu. Koroleva3 ISSN: 2639-0353 Madridge.Journal of Dermatology & Research
