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. 2024 May:92:118-129.
doi: 10.1016/j.bjps.2024.02.069. Epub 2024 Mar 6.

The emerging role of biostimulators as an adjunct in facial rejuvenation: A systematic review

Sean M Fisher  1 , Zachary Borab  1 , David Weir  1 , Rod J Rohrich  2
Affiliations

The emerging role of biostimulators as an adjunct in facial rejuvenation: A systematic review

Sean M Fisher et al. J Plast Reconstr Aesthet Surg. 2024 May.

Abstract

Introduction: Facial aging has long been an area of focus in esthetic surgery. It is the consequence of physiologic and environmental factors, with a trend toward non-surgical modalities. Although volume augmentation has long been a focus of non-surgical facial rejuvenation, there is emerging interest in the use of biostimulators to induce physiologic changes in the skin. This article aimed to provide an overview of this class of therapies.

Methods: A systematic review regarding the clinical use of biostimulatory agents including platelet-rich plasma (PRP), platelet-rich fibrin (PRF), poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHA) in facial rejuvenation was performed using PubMed databases. The protocol was developed following the preferred reporting for items for systematic reviews-protocols guidelines. Included studies matched predetermined criteria according to the employed intervention and outcomes.

Results: The systematic review was performed in September 2023, with the primary search yielding 464 articles. Abstract review resulted in 73 articles of potential relevance. Comprehensive review of the articles and manual reference checks were performed, independently, by 2 authors. This yielded a total of 45 articles that met the inclusion criteria.

Conclusions: There is an increasing role for non-surgical modalities in facial rejuvenation. Biostimulatory agents may be used as an alternative, or act as an adjunct, to other non-surgical modalities. These agents induce physiologic changes that mitigate facial aging. There is limited, quantifiable data, which fully illustrate the effect in these products. Although these agents are known to illicit inflammatory changes, more controlled studies are needed to better elucidate the biostimulatory capacity of such non-surgical treatments.

Keywords: Biostimulators; Calcium hydroxylapatite; Facial rejuvenation; Injectables; Platelet-rich fibrin; Platelet-rich plasma; Poly-l-lactic acid.

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Conflict of interest statement

Declaration of Competing Interest Financial Disclosure Statement: Dr. Zachary Borab: No disclosures. Dr. Sean Fisher: No disclosures. David Weir, NP-C: No disclosures. Dr. Rod J. Rohrich Disclosures: Allergan/AbVie: Research support and Consultant. Musculoskeletal Transplant Foundation (MTF): Research support and Consultant. Galderma: Research support and Consultant. InMode: Research support, Consultant, Speakers Bureau. Evolus: Consultant. Merz: Research support. Cytrellis: Research support. Rion: Research support. Teoxane: Research. Thieme Publishers: Book royalties. Eriem Surgical (Micrins): Instrument royalties. Medical Seminars of Texas: Owner.

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