Injectable Aesthetic Treatments for Immediate and Regenerative Results

Injectable treatments remain central to aesthetic medicine because they can deliver immediate improvement while also stimulating regenerative changes that enhance long-term outcomes. The following overview highlights several key agents and combinations currently used to balance short-term correction with enduring collagen remodeling.

Neuromodulators Combined with Hyaluronic Acid Fillers

Aesthetic concerns are often multifactorial and require an astute understanding of the aging process. It is important to try to address as many factors as possible to provide an ideal aesthetic outcome. The combined use of neuromodulators along with hyaluronic acid (HA) fillers is a well-known strategy to address aging. HA filler does have biostimulatory effects on the skin when injected intradermally, albeit less than other modalities discussed in this article. Injecting HA fillers intradermally in close proximity to neurotoxin-treated hyperdynamic muscles may improve aesthetic outcomes. By reducing mechanical stress on the skin in highly active areas and supporting the skin with dermal HA filler, this strategy enhances wrinkle reduction and promotes longer-term correction. Reports support this strategy for dynamic lines and furrows in the periorbital and perioral regions with favorable safety outcomes. This strategy can also be used to improve the appearance of acne scars and other perceived imperfections on the skin, such as prominent pores.

Poly-L-lactic Acid (PLLA)

Poly-L-lactic acid (PLLA) is a proven treatment for sustained benefits in the improvement of facial lipoatrophy and dermal rejuvenation. PLLA is limited in providing immediate results, as initial volume correction is only transient. Its primary value is in stimulating fibroblast activity and new collagen and elastin production, leading to gradual improvement in skin thickness and volume. For patients seeking immediate correction, the author commonly combines the use of high–G′ HA fillers with PLLA, either as combination treatment or in sequential visits. Using high–G′ prime HA fillers supraperiosteally in strategic areas such as the pyriform space, inferior aspect of temporal crest, malar eminence, and chin allows for immediate correction, while utilizing PLLA in subcutaneous planes allows for improvement of shadowing in the submalar region, temples, marionette region, and midface.

PLLA Reconstituted with Platelet-Rich Plasma (PRP)

Reconstituting PLLA with platelet-rich plasma (PRP) adds concentrated autologous growth factors to the volumizing effects of PLLA. Growth factors exert their effect on local cells, including fibroblasts, leading to tissue regeneration and remodeling. This blend has been reported to improve wrinkle severity and overall skin quality, offering both structural and biologic benefits. While evidence is limited, early clinical experiences suggest a synergistic effect.

Platelet-Rich Fibrin Matrix (PRFM) Gel

Platelet-rich fibrin matrix (PRFM) gel is a natural gel derived from autologous blood. PRFM solution is warmed to create a gel substance that is injected similarly to HA filler, yet it releases growth factors gradually over time. The gel provides immediate correction, yet the sustained release of growth factors creates a supportive microenvironment to promote tissue rejuvenation via collagen synthesis. Though PRFM gel can be injected in areas commonly treated with HA gel, its most impactful utility may be in areas that need immediate volume correction and improvement of skin quality. These include areas where static lines overlie volume loss, such as the nasolabial folds, infraorbital hollows, radial smile lines of the cheeks, and décolletage. PRFM represents an accessible regenerative tool that complements existing filler strategies, although more clinical research is needed.

Calcium Hydroxylapatite (CaHA)

Calcium hydroxylapatite (CaHA) is another traditional treatment option for immediate and long-term correction. CaHA functions as both an immediate volumizing filler and a biostimulator. It provides an immediate volumizing effect while initiating a regenerative healing response that leads to collagen and elastin deposition over several months. Histologic studies show increased collagen and elastin deposition, contributing to sustained improvement in skin quality. CaHA is often reconstituted with bacteriostatic normal saline and/or plain lidocaine at varying ratios and injected into facial and body areas, harnessing the regenerative effects while minimizing the volumizing effect.

CaHA Reconstituted with HA Gel

To enhance and sustain the immediate results, CaHA can be reconstituted with HA filler. When CaHA is mixed with HA, the combination delivers the immediate volumizing effect of HA along with the regenerative properties of CaHA. This approach stabilizes volume and enhances patient satisfaction.

Autologous Fat Grafting

Fat grafting provides natural volume replacement and enhances tissue regeneration by delivering adipose-derived stem cells (ADSCs). Nanofat preparations remove the volumizing effects of adipose tissue and isolate the stromal vascular fraction (SVF), emphasizing the regenerative component and offering improvements in skin texture and elasticity. ADSCs may increase local HA, creating an immediate improvement in skin appearance. Larger-caliber fat transfers provide significant volumizing effects while regenerating the surrounding tissues with ADSCs. This regenerative effect may improve all layers of soft tissue, including the skin, subcutaneous tissues, and the superficial musculoaponeurotic system (SMAS).

Clinical Perspective

Multiple injectable tools are available that balance immediate results with regenerative potential. An adequate patient assessment paired with aligning patient and clinician outcomes is essential in deciding which approach will provide ideal results. PLLA and CaHA provide collagen stimulation. PRP, PRFM, and fat grafting add biologic cues for enhanced healing. HA ensures instant correction while providing notable collagen stimulation. Neuromodulators improve durability in dynamic areas and can provide a swift change in the appearance of the skin. The beauty of these tools is that many can be combined into a single session or implemented sequentially to reach a desired goal. Strategic use of these options lets clinicians tailor treatment plans for both short-term aesthetic enhancement and long-term tissue health.