02 May Dr. Sandra Abi Akl El Asmar

Reviving Skin Naturally: A Deep Dive into Biostimulators

In today’s world of aesthetics, the shift from artificial volume to natural rejuvenation is more prominent than ever. Biostimulators have taken center stage as patients seek glowing, firm skin without the “overfilled” look. To shed light on this exciting trend, we spoke with Dr. Sandra Abi Akl El Asmar, American Board-certified in Aesthetic and Anti-Aging Medicine, who practices between Lebanon and Kuwait.

In this insightful conversation, Dr. El Asmar breaks down everything you need to know about biostimulators—from how they work to why they’re redefining the future of regenerative aesthetics.

What exactly are biostimulators, and how do they differ from traditional dermal fillers?

Biostimulators and fillers serve different purposes. Fillers are gel-like substances made of hyaluronic acid, used mainly to restore lost volume. Biostimulators, on the other hand, are formulated with specific molecules like PLLA or calcium hydroxyapatite that stimulate the body’s fibroblasts to naturally produce collagen and elastin. Instead of simply filling, they improve the quality, firmness, and glow of the skin over time.

Which skin concerns or signs of aging respond best to biostimulators?

Biostimulators are excellent for early signs of skin laxity, dullness, and a loss of elasticity or firmness. I often recommend them from the age of 30 onwards, as they work preventively by boosting collagen before the skin becomes too lax. They’re especially effective for those who want skin tightening and rejuvenation without adding volume.

How do biostimulators work beneath the skin to deliver results, and who is the ideal candidate?

They activate fibroblasts—the skin cells responsible for collagen and elastin production. Over time, this stimulation improves skin density, tone, and texture. It’s not an instant volumizing effect like fillers; rather, the skin becomes firmer and more radiant from within over a few weeks to months.

The ideal candidates are individuals in their 30s to 60s who are experiencing early to moderate signs of aging or skin laxity. However, I would avoid them in cases of autoimmune diseases, active infections, pregnancy, or breastfeeding.

How long does it take to see results, and how long do they last?

Results begin to appear within 1 to 2 weeks but continue to improve for up to 3 months as collagen builds. Radiesse and PLLA offer results that can last up to two years, depending on the number of sessions and the patient’s age. Polynucleotides and exosomes typically require 3 sessions per year and have gentler but still visible results.

Collagen stimulation is a buzzword in aesthetics. What role do biostimulators play in this process?

They are among the most effective tools we have for collagen stimulation. By encouraging your own skin to regenerate, they create long-lasting improvements in firmness, elasticity, and radiance without overfilling.

How do PLLA, calcium hydroxyapatite, and other biostimulators compare in terms of results and longevity?

PLLA-based treatments offer long-lasting results but carry a slightly higher risk of side effects like granulomas if the product isn’t correctly handled. Calcium hydroxyapatite, on the other hand, provides visible skin tightening and is ideal for areas like the face, neck, and hands. Polynucleotides and exosomes are gentler options, offering more subtle improvements and often used in more delicate areas. The right choice depends on the patient’s skin quality and goals.

Are biostimulators safe? What should patients expect post-treatment?

Generally, they are very safe when administered by a trained professional. Minor side effects can include swelling or bruising. Proper dilution and massage techniques are critical to avoid nodules, especially with PLLA. With correct technique, risks are minimal, and results are beautiful.

Can biostimulators be combined with other treatments for enhanced results?

Absolutely. Combining treatments is the future of aesthetic medicine. I often pair biostimulators with microneedling, peels, or even fillers—depending on the goal. For instance, fillers may be used to restore volume, while biostimulators improve skin texture. Botox can also complement by targeting dynamic wrinkles.

What’s the best treatment for the under-eye area using biostimulation techniques?

The under-eye area often shows signs of aging earlier than the rest of the face. For this delicate zone, I recommend PDRN (polydeoxyribonucleotide), polynucleotides, or salmon DNA-based treatments. These options are ideal because they’re gentle, regenerative, and improve skin thickness, brightness, and hydration without adding unnecessary volume.

What’s a common myth about biostimulators you often hear?

Many patients think biostimulators give instant volume like fillers, which isn’t true. Others believe they’re unsafe due to complications like nodules. The truth is, when done correctly—with proper dilution and technique—they are very safe and produce natural, long-lasting improvements.

Some practitioners remain cautious about using certain biostimulators like PLLA. Why is that, and how do you address those concerns?

That caution is understandable. Biostimulators based on PLLA can sometimes result in granulomas and are not reversible, unlike many dermal fillers. This is why training, technique, and proper patient assessment are vital. In my practice, I prefer using biostimulators that are safer, more predictable, and better suited to the individual’s needs. Each case is unique, and careful planning ensures the best results with minimal risk.

Regenerative aesthetics is a hot topic. How do biostimulators fit into this trend?

Biostimulators are at the heart of regenerative aesthetics. Instead of just treating the surface, they stimulate the body’s own healing processes. Treatments like exosomes are now even used for hair restoration with excellent results—strengthening follicles, reducing hair loss, and encouraging new growth.

What advice would you give someone considering biostimulators for the first time?

Start early—don’t wait until the skin has significant laxity. Biostimulators are best used as a preventive and regenerative tool. Also, trust your doctor to choose the right product and technique for your skin type. There’s no one-size-fits-all approach.

About Dr. Sandra Abi Akl El Asmar

Dr. Sandra Abi Akl El Asmar is a renowned expert in Aesthetic and Anti-Aging Medicine, certified by the American Board. She studied medicine at Saint Joseph University in Beirut and completed her residency at Hôtel-Dieu de France in Beirut. With her clinical practice based in Lebanon and Kuwait, she is at the forefront of regenerative aesthetics, offering a patient-centered approach that combines scientific innovation with natural beauty. Her expertise in biostimulators and combination treatments makes her a trusted voice in the field.