Today’s aesthetic patients want to recapture their youth with treatments that restore vitality. This has led to a change in the landscape of regenerative medicine. Those working in the 
aesthetic field are responding with treatments that harness the body’s natural regenerative capabilities to restore structure and function of tissues and cells, while addressing the cellular damages of aging. And the results are nothing short of spectacular.
“The role of social media has grown to the level that people are well aware of the regenerative armamentarium in the field of aesthetics. Most of my clients directly demand regenerative therapies and treatments,” reported plastic surgeon Afzaal Bashir, MD (Lahore, Pakistan).
Because the majority of his patients’ concerns involve pigmentary issues, hair loss, scarring, rhytids and skin laxity, Dr. Bashir utilizes a variety of regenerative treatments. “I use plateletderived growth factors (PDGF), a super derivative of platelet-rich plasma (PRP) to address hair loss,” he shared. “Facial volumization and contour defects are managed by fat grafting enriched with ex vivo expanded mesenchymal stem cells (MSCs). I often treat wrinkles with microneedling with supercharged PRP. In addition, hyaluronic acid (HA) filler is my choice after homogenized fat, which I inject both intradermally and subdermally to give a filling effect.”
Dr. Bashir added that 12 projects on the regenerative aspects of stem cell therapy are currently in progress under his supervision. “Stem cell therapy – 
uncultured as well as cultured – is the regenerative aesthetic technique of my choice,” he expressed. “Due to commendable regenerative potential, I find its utility not only in managing skin issues but also in regional volumization. I feel stem cell therapy to be the real future solution for many issues in the aesthetic world.”
Nanofat Grafting in Aesthetics
Adipose tissue has been widely used in aesthetic medicine thanks to its accessibility and harvesting potential. Today, nanofat grafting is emerging as a novel aesthetic treatment to achieve lipomodelling that may last for several years, leading to the development of technologies that make it easier for providers to fill the demand for longer-lasting regenerative treatments.
“One notable approval is the Lipocube device from Lipocube. It has received 510(k) approval from the FDA, which highlights the 
continued advancement and acceptance of regenerative medicine technologies,” reported Aris Sterodimas, MD, MSc, who is head of the plastic surgery department at Metropolitan General Hospital (Athens, Greece) and also a pioneer in stem cell applications in plastic and reconstructive surgery. Dr. Sterodimas invented the Stromal Enriched Lipograft™ (SEL™), performing the first worldwide study that was published in the official journal of the American Society for Aesthetic Plastic Surgery (ASAPS).
Combining traditional facelift principles with the regenerative potential of stem cell-enriched fat transfer via the Lipocube device, SEL is a regenerative aesthetic technique aimed at restoring a natural and youthful appearance to the face. “By meticulously transplanting fat drop by drop, we ensure optimal blood supply for the survival of stem cell-enriched fat cells, resulting in longlasting and harmonious facial rejuvenation,” Dr. Sterodimas explained. “Our procedure involves tightening deeper facial tissues while carefully contouring and restoring volume, all with minimal scarring and reduced recovery time.”
“The Lipocube device represents a significant advancement in re
generative medicine, offering a fast, practical and user-friendly solution for isolating stem cells from fat tissue,” Dr. Sterodimas continued. “Stem cells play a crucial role in regenerative therapies due to their remarkable ability to differentiate into various cell types and promote tissue repair and regeneration. With new technology available to us, the process of isolating stem cells becomes streamlined and accessible, enabling healthcare professionals to harness the regenerative potential of these cells more efficiently.”
Regenerative Aesthetic Mainstays
Saami Khalifian, MD, is a board-certified dermatologist at SOM Aesthetics (Encinitas, Calif.) who specializes in regenerative treatments. “I leverage a variety of modalities simultaneously to get a synergistic effect, not just an additive effect,” Dr. Khalifian explained. “One tool that I reach for more than anythi
ng else is our Sylfirm X from BENEV (Mission Viejo, Calif.), which I feel is a superior technology for radiofrequency (RF) microneedling. For overall facial rejuvenation, I resuspend tissue by strategically replacing filler in the lateral face and then use RF microneedling to tighten the skin, then biostimulators (often blended with PRP) to further improve skin laxity.”
Dr. Khalifian shared that he is always looking at new technologies to meet patient demand for longer-lasting treatments. Fiber optic treatments to improve the submental area are on his radar, as well as innovative injectables. “There are a host of quality products coming down the pipeline. HArmonyCa® (Allergan) is a revolutionary new hybrid stimulator that restores volume loss and stimulates collagen production. It combines cross-linked HA with calcium hydroxyapatite microspheres.”
While the term “filler fatigue” has become common, these products and treatments remain popular, but with a more toned-down approach. “I think you can create wonderful outcomes with dermal fillers, but you have to be very strategic as it requires the most artistry,” Dr. Khalifian clarified. “Working from the inferior medial face up and out often requires more product and leads to overfilling. My technique is to go in superior to inferior, lateral to medial in the face to lift and resuspend tissue, strategically placing filler while being careful to avoid overfilling.”
Patients continue to request biostimulators and skin boosters to maintain healthy, youthful skin for as long as possible. “I use regenerative or biostimulant agents mostly for skin thickening and rejuvenation,” mentioned oculoplastic surgeon José Raúl Montes, MD (San Juan, Puerto Rico). “This translates into wrinkle reduction and texture improvement. The goal of my treatments with biostimulant agents is to increase the soft tissue health as well as skin revitalization.”
Dr. Montes shared that the regenerative aesthetic procedures he performs mainly include poly-L-lactic acid (PLLA) and calcium hydroxylapatite (Radiesse; Merz Aesthetics) in different constitution or dilution levels. “I use PLLA to improve the transition between the lower eyelid and the midface and I plan to expand the use of my biostimulant agents in different dilutions for different body areas, such as the décolleté, neck, arms and knees, among others.”
Product Watchlist – Technologies That Exemplify the Spirit of Regenerative Aesthetics
PRX Derm Perfexion by WiQo® US (Woburn, Mass.) is a patented trichloroacetic acid (TCA) plus hydrogen peroxide treatment, and a recent innovation in biostimulators. According to the company, PRX Derm Perfexion is a chemical collagen Stimulator™ (CCS) that has been scientifically validated to visibly improve the appearance of aging skin, texture, laxity, wrinkles and dullness. “We use a variety of regenerative technologies,” shared plastic surgeon M. Bradley Calobrace, MD, of CaloSpa® Rejuvenation in Louisville, Ky. “PRX Derm Perfexion has no downtime, is safe for all skin types, and can be combined with our favorite treatments. Our patients leave happy with a ‘PRX Glow’ and always return for more.”
Stemming from years of scientific research, ( plated )™ HAIR Serum from Rion Aesthetics (Rochester, Minn.) delivers a combination of platelet derived Renewosome™ technology 
fortified with antioxidants, a growth factor complex, and a proprietary blend of nurturing ingredients. The ( plated ) HAIR Serum features a high concentration of platelet-derived exosomes that fortifies the hair from the root for benefits that include less shedding and breakage, improved appearance in hair density, volume and thickness. Renewosome technology has the potential to upregulate the extracellular signalregulated kinase (ERK) pathway, a crucial signal for hair proliferation. With the ability to deliver powerful nutrients to the scalp and increase the appearance of density, thickness, and fullness, ( plated ) HAIR Serum is meticulously crafted for improved scalp and hair health.
AGF Mesenchymal Dermal by LIVECELLS USA (South Jordan, Utah) is a cutting-edge skincare product that leverages the combination of exosomes and protein extracts for biostimulation and cell regeneration after dermabrasive or minimally invasive aesthetic treatments. This innovative formula is based on growth factors secreted by MSC cultures and exosomes. The combination favors cell metabolism, triggering the activation of natural collagen and elastin production. Biological effects include 
regeneration, remodeling and repair of tissues. LIVECELL’s AGF Mesenchymal Capillary is a product designed to counteract hair loss and stimulate the growth of new hair by increasing the oxygenation of cells to nourish and strengthen hair follicles.
Renuva by MTF Biologics (Edison, N.J.) is an allograft adipose matrix, derived from human tissue, which goes through strict screening and processing to preserve the collagens and proteins inherent to adipose tissue. “Renuva stimulates the body’s own fat production through the presence of growth factors and cytokines in its formulation, reported Lisa Goodman, PA, founder of GoodSkin Clinics & RMÉD by GoodSkin in New York, N.Y. and Los Angeles, Calif. “These bioactive molecules act as signals to trigger adipogenesis. This product can be diluted for use in different areas 
of the body, such as the neck, which is prone to aging drastically with loose crepey skin. For this concern, we dilute Renuva to what we call a ‘wash’ to help hide the neck bands and improve crepey skin without giving them a ‘fatty’ neck. We also treat the hands with Renuva to increase volume and look more youthful.”
Refine USA (Jacksonville Beach, Fla.) is introducing innovation in microneedling tips with a device that has four times the treatment surface area and double the diameter of other microneedling tips. Created specifically for the Rejuvapen NXT®, the EXCEL Microneedling Tip helps providers achieve maximum results while reducing treatment time. The tips include scalloped edges to eliminate suction and clogging with a 24 stainless steel needle array and an exclusive 6.5 cm circumference microneedling tip. H. William Song, MD, founder and medical director of Omni Aesthetics (Oakland, N.J.), explained that the larger surface area allows him to perform a microneedling treatment in half the time. “The powerful motor on the Rejuvapen handles this new tip beautifully without compromising on the results. This is going to be the new gold standard for our Vampire Facial procedures,” he added.
VIOLA Threads from AMA Meditime (Brea, Calif.) offers a range of fully biodegradable threads for medical aesthetic practitioners, available in diverse shapes, sizes and materials. 
Their polydioxanone (PDO) threads are designed for soft tissue approximation, particularly when the use of absorbable sutures is suitable, and have received U.S. FDA 510(k) clearance (#K190264) for barbed sutures. According to plastic and reconstructive surgeon Arthur Yu, MD, PhD (Arcadia, Calif.), treatment with VIOLA PDO threads stimulates new collagen production for long-lasting results that can be applied to the face and body. “I use VIOLA Threads for various applications including thread-based facelifts, PDO thread-assisted facial and neck contouring with liposuction, nipple/areola complex elevation for gynecomastia after liposuction, and liposuction assisted abdominoplasty without any skin excision,” Dr. Yu reported. “The last three aim to achieve permanent results and drastically reduce the need for a formal surgical facelift, mastectomy or abdominoplasty.”
The ELEVAI E-Series products, empower and efinity, from ELEVAI Labs (Newport Beach, Calif.) are created with their powerhouse ingredient ELEVAI Exosome™ through a process called PREx Technology™ using age zero Wharton’s Jelly derived stem cells. According to dermatologist Tess Mauricio, MD (Beverly Hills, Calif.), “ELEVAI exosomes are ethically sourced, so these products have the greatest potential to rejuvenate the skin versus exosomes from older sources. We currently use ELEVAI empower post-procedure serum after our laser, RF, microneedling and plasma resurfacing treatments. The use of exosomes is an essential part of our protocol with its anti-inflammatory effects, especially for patients with skin of color as they are more prone to complications such as postinflammatory hyperpigmentation and scarring.”
AnteAGE MD Hair Solution from AnteAGE MD (Irvine, Calif.) combines the influence of bone marrow MSC cultures in addition to twelve bio-identical growth factors and cytokines. 
Hair Solution is the first product of its type to specifically treat signaling towards the Wnt-1a pathway for follicle regeneration and growth. Board-certified facial plastic and reconstructive surgeon Adrian House, MD (San Francisco, Calif.), shared that AnteAGE MD Hair Solution has become a cornerstone treatment for hair rejuvenation in his practice. “It uses the power of stem cell signaling combined with a unique blend of growth factors and cytokines, specifically targeted to stimulate hair growth and scalp health,” Dr. House emphasized. “This allows AnteAGE to create a hair solution with twelve bio-identical growth factors and cytokines, each with proven efficacy in hair follicle stimulation. It is backed by science that I trust and, as a result, use on myself.”
