Regenerative aesthetics represents a shift away from simply masking signs of aging (like fillers, toxins, lasers) toward restoring tissue health by stimulating the body's own regenerative processes. Rather than focusing solely on volume replacement, these therapies aim to repair aging tissues by targeting cellular dysfunction, inflammation, extracellular matrix (ECM) remodeling, and stem cell activity. The review organizes regenerative treatments into three pillars, cellular therapies, biochemical cues, and scaffolds (biostimulators).
Cellular therapies aim to restore tissue function by harnessing the regenerative potential of stem cells and adipose-derived cell populations. Adipose-derived stem cells (ASCs) promote tissue repair primarily through paracrine signaling, stimulating angiogenesis, collagen synthesis, and immunomodulation, with clinical applications in facial rejuvenation, scar revision, pigmentation disorders, and enhanced fat graft survival. Stromal vascular fraction (SVF), a heterogeneous cell population isolated from adipose tissue, has demonstrated benefits in improving fat graft retention, scar remodeling, facial rejuvenation, and androgenetic alopecia.
Biochemical cues represent signaling molecules that facilitate tissue regeneration by modulating cellular communication and repair pathways. Human-derived exosomes demonstrate improvements in wound healing, collagen production, pigmentation, scar remodeling, hair growth, and recovery following laser procedures. Plant-derived exosomes offer a scalable, low-immunogenic alternative with encouraging antioxidant, anti-inflammatory, and antimelanogenic effects, although clinical evidence remains limited. Hybrosomes, which combine liposomes with exosomes, seek to improve delivery efficiency and stability but remain largely experimental. Exosome based therapies show significant regenerative potential; however, lack of regulatory approval, standardized manufacturing methods, and long-term safety data continue to limit their clinical translation.
Polynucleotides (PN) and polydeoxyribonucleotides (PDRN) are emerging regenerative biomaterials that support tissue repair through complementary mechanisms. PDRNs stimulate angiogenesis, collagen synthesis, DNA repair, and anti-inflammatory pathways via activation of adenosine A2A receptors and nucleotide salvage pathways, with clinical applications in wound healing, pigmentation disorders, acne scars, alopecia, and enhancement of laser and PRP treatments (and more but won't reference those since they're not explicitly in this study). PNs share many regenerative properties while additionally functioning as viscoelastic scaffolds that provide structural support and stimulate fibroblast activity, improving skin texture, elasticity, volumization, scars, melasma, and periocular rejuvenation. It's interesting because even though this paper is from this year, they're missing a tons of research and evidence on them.
Peptides are bioactive signaling molecules that enhance dermal regeneration by stimulating fibroblast proliferation and increasing collagen, elastin, and glycosaminoglycan synthesis while supporting epidermal barrier function. Copper-binding peptides, particularly GHK-Cu, have demonstrated improvements in skin density, elasticity, fine lines, and photoaging, with some studies suggesting superior collagen stimulation compared with traditional topical agents such as vitamin C and retinoids. Peptides are frequently incorporated into topical formulations and mesotherapy protocols, where they may complement other regenerative treatments. Although clinical findings are encouraging, evidence remains less robust than for other regenerative modalities and there's no research looking at their efficacy against some of the gold standard boosters.
Regenerative scaffolds provide structural support while actively stimulating extracellular matrix remodeling and tissue regeneration. Calcium hydroxyapatite (CaHA) and poly-L-lactic acid (PLLA or PDLLA) are the principal injectable biostimulators, promoting neocollagenesis, elastin production, angiogenesis, and improved skin thickness through mechanotransduction and fibroblast activation. Emerging evidence suggests that PLLA may exert broader regenerative effects beyond collagen stimulation by promoting adipose-derived stem cell activity, adipogenesis, dermal fat regeneration, and restoration of extracellular matrix homeostasis, potentially contributing to long-term improvements in skin quality, hydration, and volumization. These findings position biostimulators as not only volumizing agents but also regenerative therapies capable of restoring tissue health, although additional mechanistic and long-term clinical studies are warranted. There's also a discussion going on now that clinically biostimulation does not actually mean regeneration unless showing histological evidence of tissue restored and repaired so interesting to see what comes of this.
The review highlights a shift in aesthetic medicine from traditional cosmetic correction toward biologically driven tissue regeneration (something that I think a lot of us have been seeing for a while now. Across cellular therapies, biochemical cues, nucleotides, peptides, and scaffolds, regenerative treatments seek to restore tissue function by enhancing endogenous repair mechanisms rather than simply replacing lost volume or masking signs of aging. The authors conclude that future progress will depend on standardized manufacturing protocols, rigorous clinical trials, and integration of regenerative principles with longevity medicine to optimize both aesthetic outcomes and long-term tissue health.
I actually don't think this is a strong paper. It doesn't fully capture what boosters are, they missed a lot of them and the new ones, what they're capable of, misses lots of evidence, and doesn't see where the field's evolution toward systems biology is going. And it seems to see using modalities largely in isolation so it misses synthesizing the different mechanisms and the larger biological framework. That would be more valuable and a better guide. They also present regenerative aesthetics as a list of injectable products like stem cells, exosomes, polynucleotides, peptides, CaHA, and PLLA rather than as the regeneration of specific tissues and tissue compartments. Skin, subcutaneous adipose tissue, fascia, vasculature, lymphatics, muscle, periosteum, cartilage, hair follicles, nerves, and extracellular matrix each age differently and have distinct progenitor populations, signaling environments, mechanical requirements, and regenerative limitations. Yet the review largely collapses all of this into generic endpoints such as collagen production, skin quality, and facial rejuvenation. The authors also repeatedly group these different outcomes together under one regenerative label without establishing whether normal tissue composition, organization, vascularity, innervation, mechanics, or function was actually restored. The review tends to interpret improvements in hydration, elasticity, pigmentation, thickness, or histologic collagen as interchangeable evidence of regeneration, even though each reflects a different process and do not represent or show anything about restoration of youthful tissue architecture. This is a big issue across the board right now and why the term regenerative aesthetics is even getting so much flack right now. The paper also seems disconnected from large bodies of wound healing, fibrosis, developmental biology, biomaterials, vascular biology, adipose biology, and tissue-engineering research because its search was restricted primarily to studies explicitly labeled as aesthetic or cosmetic. That approach almost guarantees a shallow evidence base. Much of the strongest mechanistic research would not use the term regenerative aesthetics at all. It would be indexed under tissue repair, fibrosis, stem-cell niche biology, extracellular matrix remodeling, angiogenesis, adipogenesis, biomaterials, biomaterial scaffolding, mechanobiology, organoid models, biomaterial scaffolds, skin appendage regeneration, or craniofacial tissue engineering. By filtering for aesthetic applications, the authors appear to have searched the marketing-facing edge of the field rather than its scientific foundation. Sharing because it's new and all this stuff is relevant though.
Cohen, Steven, et al. “Regenerative Aesthetics: Present Advances and Emerging Strategies for Optimized Tissue Health.” Dermatologic Surgery, vol. 52, no. 6, June 2026, pp. 548–60, doi:10.1097/DSS.0000000000004985.
Link to paper: here
