Objectives: To analyse the immunological foundations underlying biostimulators' mechanisms of action and their consequent relevance to aesthetic medicine in clinical settings.
Introduction: A key focus of regenerative aesthetics is the ability to manipulate wound healing processes towards regeneration by creating new tissue with the normal structure and function of the original tissue. Injectors achieve this through biostimulators that function through regenerative wound healing mechanisms. These mechanisms require the involvement of the extracellular matrix (ECM), which plays a crucial part by influencing cell behaviours.
Materials / method: An comprehensive review of the literature was undertaken to investigate the various immune responses elicited by frequently utilised biostimulators, such as poly-L-lactic acid (PLLA), polycaprolactone (PCL), and calcium hydroxylapatite (CaHA). The study placed particular emphasis on examining these substances' physicochemical characteristics and their effects in clinical settings
Results: . Calcium hydroxyapatite (CaHA) and poly-L-lactic acid (PLLA) have been found to elicit different responses by macrophages, leading to different immunological wound healing pathways. CaHA initiates a regenerative healing response, stimulating production of all the ECM elements: collagen, elastin, and ground matrix. PLLA polymer induces a different macrophage response initiating a predominantly replacement pathway with collagen. Cytokine expression profiles reflected the different macrophage responses to CaHA and PLLA in an in vitro study. It is not only the particles’ physicochemical attribute
Conclusion: The physicochemical properties, size and shape of biostimulant particles will influence whether the response pathway is going to be driven more towards regeneration or towards replacement. Other factors, such as injection technique and contamination, can influence the immunological response. These findings underscore the need for tailored treatment plans based on each biostimulator’s unique properties.
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