Resumen

Objectives: The objectives of this presentation: 1. Describe the histological evidence of skin aging and the loss of collagen 2. Discuss the evidence behind 4 main groups of biostimulators - hyaluronic acid, Ca-hydroxyapatite, Poly-L-Lactic acid, and Polycaprolactone. 3. Explore the published literature about the combination of energy based devices with biostimulators. Introduction: Biostimulators have major role in aesthetic medicine. They can be suggested to most of our patients. However, a common problem of physician is to decide which product to choose, what to expect from its injection, and how to combine it with other therapeutic modalities, including energy based device. Materials / method: Review of the literature discussing skin aging, biostimulators, and combination of biostimulators with energy based devices. It included free search in Pubmed, and articles sent by the leading marketing companies in Israel. Results: Biostimulators result in great change in the quality of the skin, and it can be injected to almost every patient. From all the biostimulators, PLLA proved to have the longest effect (up to 25 months) with the highest amount of new collagen in the tissue (up to 66.5%). Calcium hydroxyapatite and polycaprolactone act as scaffolder, hence, although result in less new collagen, they have dual affect of biostimulation and volumizing the tissue. Regarding combination with energy based device, the combination is not yet proved in vitro, nevertheless, many clinical study shows excellent results. Conclusion: Skin aging is a complex process, resulting in the net loss of collagen. Biostimulators have a major role in skin rejuvenation, and should be used in combination with other modalities and chosen according to their strength.