The Evolving Field of Regenerative Aesthetics: A Review and Case Series

Dermal fillers such as calcium hydroxyapatite-carboxymethylcellulose (CaHA-CMC), polycaprolactone (PCL), and poly-l-lactic acid (PLLA) are increasingly used as 'biostimulators' to stimulate native collagen production for longer-lasting aesthetic improvement. Volume replacement should, ideally, renew local tissue architectures and functions, but the replaced volume may not align structurally or functionally with the original tissue. The ability to achieve this regenerative, biostimulatory aesthetic rejuvenation requires a thorough understanding of the principles and mechanisms of tissue regeneration and its proper application. We reviewed the concepts of regenerative medicine, regenerative aesthetics, and biostimulation in the context of PLLA and CaHA and discussed the effects on immunological pathways and neocollagenesis when these materials are used as biostimulators in clinical aesthetics. Additionally, to understand how the concept of regenerative aesthetics is applied in the real world, we present cases demonstrating best practices and outcomes when using CaHA-CMC in a group of 11 Asian patients. Asian physicians' practices with CaHA-CMC have evolved beyond its volumizing and contouring benefits to its ability to induce regeneration in aging tissues. This has been achieved through the use of CaHA-CMC as monotherapy or in combination with other modalities. Moreover, CaHA-CMC allows physicians to offer a single, minimally invasive product to patients seeking treatment for skin laxity, wrinkles, crepiness, and volume loss while achieving multiple visible aesthetic improvements. Unlike conventional dermal fillers, the ability to leverage the regenerative qualities of CaHA-CMC effectively resolves age-related aesthetic issues in a durable manner using their body's own systems, allowing patients to emphasize their own unique features.