Regenerative Aesthetics Are On The Rise

Experts unpack these controversial skin treatments.

by Tatiana Boncompagni
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regenerative skin treatments

Step into Sephora for a new serum or scroll through your favorite dermatologist content creator’s Instagram feed, and chances are you’ll stumble across arguably the biggest — and most controversial — skin care trend. Dubbed ‘regenerative beauty,’ these in-office treatments and at-home topical products borrow from cutting-edge medical science to turn back the clock by doing everything from replacing lost volume and improving elasticity to stimulating new hair growth. And this category achieves all of the results by simply using your own cells to heal skin from the inside out.

According to Medical Insight, a market research firm focused on medical aesthetics, the North American market for selected regenerative aesthetics (which includes PRP, fat transfers, stem cells, and exosomes) was estimated to be worth $169 million in 2022, with annual growth forecasted at 16.2% through 2027. “The aesthetic regenerative medicine market is in its infancy globally,” says Michael Moretti, the research group's CEO.

Ahead, leading skin care experts define regenerative aesthetics, plus break down the best treatments to get for common skin and hair concerns.

What Is Regenerative Aesthetics?

While some aesthetic treatments use foreign substances — think hyaluronic acid fillers or neuromodulators like Botox — to create a certain desired outcome in your appearance, regenerative aesthetics involves “the power of using your own cells to rejuvenate tissues from the inside out,” says Lauren Abramowitz, a board-certified physician associate and founder of Skin Solutions Collective in New York City.

What’s more, unlike laser or radio-frequency treatments which work by delivering energy that then prompts fresh collagen formation as part of the healing process, these regenerative therapies generally don’t rely on harming tissue to create positive results. “The idea is to restore,” says Dr. Nathan Newman, M.D., a plastic surgeon in Beverly Hills who performs non-surgical stem cell facelifts and has created a topical serum derived from plant stem cells that pledges to even skin tone, minimize wrinkles, and boost elasticity.

The treatments that typically fall under the regenerative category include: platelet-rich plasma (also known as PRP), made by spinning growth factors out of a patient's blood; biostimulatory fillers such as Radiesse and Sculptra; exosomes, which are nano-vesicles often harvested from stem cells; and stem-cells harvested from a person’s own fat-rich areas on the skin, which is then re-planted to stimulate the surrounding tissues. Exosome therapy for aesthetic treatment, which has garnered a lot of attention as of late, consists of exosomes being applied topically to the skin, often post-laser or microneedling treatment. However, there are currently no FDA-approved exosome products. Some stem cell treatments, meanwhile, are FDA-approved and regulated, but only blood-forming stem cells that are derived from umbilical cord blood, and even that is only approved for patients with blood production disorders and not other uses (chemical processes are in “regulatory gray zone” says Dr. Newman).

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Which Regenerative Skin Treatment Is Right For You?

There are a handful of regenerative treatment options, and determining which one to invest in depends on what skin (or hair) concern you are addressing as well as your budget. One big factor to keep in mind is that these treatments don’t yield overnight results and often require multiple visits to your provider to experience the full potential benefits. Arguably, an even bigger factor is the lack of evidence and regulation of these treatments.

For skin issues like melasma and fine lines, PRP combined with microneedling is a good starting point. There’s also PRF, which stands for platelet-rich fibrin, and has a higher percentage of growth factors that stimulate new tissue growth and cell rejuvenation. Like PRP, it’s made from your own blood, but it’s spun at a lower speed, which allows some of the white blood cells and more stem cells to remain within the final product. In turn, some reports show, this creates the potential for better results. Abramowitz says PRF contains more healing factors than PRP and she likes injecting it under the eye area to treat dark circles and hollows instead of filler. Results for both can be seen starting after four to six weeks and typically three to five visits are required.

She also likens Sculptra, an injectable made of poly-L-lactic acid (the material surgeons use in dissolvable sutures), to a “401k for your skin.” Abramowitz often injects it into the temples and an area by the ears called the preauricular area to restore lost volume, which commonly starts in your early 40s, in a way that doesn’t distort facial features and also provides a “healthy, fresh glow” to the skin. According to Sculptra’s clinical trials, 95% of users reported an improvement in skin glow two years post-procedures. The one thing to keep in mind? Expect it to take one month to start seeing results, and to undergo at least two treatments, spaced four to six weeks apart. Aside from time, Sculptra is also a monetary investment — a vial can run you around $1500 depending on your practitioner.

New York City-based dermatologist Dr. Marina Peredo, M.D. says she’s been using Sculptra not just for faces but in the chest and knees to manage both wrinkles and texture. If a patient needs both filler and a laser to tackle volume and texture problems but doesn’t want to do both, she suggests Sculptra to accomplish their desired results in one swoop.

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Similarly, another biostimulator filler, Radiesse, is an injectable made of calcium hydroxylapatite in a water-based gel. Miami dermatologist, Dr. Roberta Del Campo, M.D., helped author a 2021 study in the Aesthetic Surgery Journal showing that, when used in a hyper-dilute solution, Radiesse can help tighten and smooth skin in the treatment area by promoting elastin stimulation.

Using a cannula, Del Campo is injecting the diluted Radiesse into the face, neck, chest, and hands of her patients. “There’s no volume, just tightening,” Del Campo says of the results. Patients can expect to pay $1,400 per vial with her and typically undergo a minimum of two treatments to an area, spaced four to six weeks apart, with final results three to four months after the final treatment.

Post-procedure, exosomes can help calm redness and irritation and boost results. Peredo uses a serum from Exocel Bio post microneedling in the scalp to stimulate hair regrowth and after facial lasers to “cut down on inflammation and pain by 50%,” says Peredo, who suggests three to five treatments, each spaced four to six weeks apart to treat hair loss. “I think of exosomes as little space shuttles of growth factors, signaling skin cells to normalize themselves. We see new collagen form; it’s definitely newer and more potent than PRP.” (Exocel Bio says a post-procedure add-on of one of their treatments generally costs around $300-$500.) According to studies published in the Journal of Drugs in Dermatology (co-authored by Peredo) exosomes show potential for use in expedited healing post-trauma.

And then there’s the gold standard of all regenerative medicine: stem cells. In aesthetics that involves the use of stem cells harvested from adipose tissue and transferred to the face or any part of the body where you want to see healthier, younger looking skin. Newman discovered the transformative power of stem cells in the early 2000s after treating a patient with skin cancer. “Every time I injected my cosmetic patients with their own fat for volume, the skin was getting better in weeks.” Newman opened a lab dedicated to studying stem cells and transformed his practice to focus on stem-cell-only facelifts (which cost on average $45,000), Brazilian butt lifts, and other treatments.

The Risks Vs. Rewards Of Regenerative Skin Treatments

“Unlike filler, PRP and PRF results vary from patient to patient as results take six months to a year to fully kick in,” says Abramowitz. When it comes to exosomes, “not all are created equal,” cautions Peredo, who urges patients to ask where the exosomes are derived from (human sources are widely considered the most potent). So-called mesenchymal stem cells (MSCs) which come from placenta and bone marrow cells, for example, are the best sources as they contain the most growth factors, explains Peredo. “It is also important to know how they were extracted and preserved and how the manufacturing facility is testing the source of exosomes for safety,” she says.

Stem cell facelifts, meanwhile, may not deliver results on par with a classical facelift or a facelift combined with a stem cell transplant, which is what San Diego-based facial plastic surgeon Dr. Amir Karam, M.D., argues yields the best results for his patients. “I do it basically in every case,” Karam says of incorporating fat transfers in his signature vertical restore facelift. “It not only improves volume, you also see the skin looks brighter and better.” To clarify, fat transfers simply move fat from one part of the body to another to increase volume while stem cell transfers involve removing or separating out the stem cells from the “stroma” or space between fat cells in adipose tissue and injecting that.

Karam cautions that there are risks with both fat and stem cell transfers, such as irregular contours or an undesirable outcome, and removing fat once it has been placed is very difficult. Additionally, he flags that biostimulatory fillers like Sculptra and Radiesse can’t be dissolved like hyaluronic acid fillers (such as Juvéderm and Restylane) and because injectors don't know the final results when they are injecting (the body responds by building collagen and elastin), it’s not all that hard to overdo it. He advises using Sculptra only in the temples and preauricular area and avoiding areas close to the mouth like in the nasal labial folds.

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Regenerative Skin Treatments At Home

And say you just want to dip your toe in some of the so-called stem cell and exosome skin care products available in the marketplace. “Unfortunately there are many snake oil players who avoid the FDA warnings and sell unknown substances at very high prices with no approvals or scientific studies,” says Medical Insight’s Moretti. Make sure you look for compelling data and research and don’t fall for buzzy marketing-speak. With these products, it’s a good idea to have a recommendation from a practitioner.

One of the market leaders is Elevai Labs, which is sold primarily through doctors offices and went public on the Nasdaq recently under the ticker symbol ELAB. The company’s founder Jordan Plews was doing post doctoral research at Stanford University when he became interested in using regenerative medicine to revolutionize the science of skin care. Elevai currently has two products, a post-procedure professional treatment and an at-home serum that combines exosomes with ceramides, vitamin C, glutathione, and peptides to address skin concerns such as redness, pigmentation, and fine lines. The proprietary blend is patent-pending.

In her Tribeca practice, Abramowitz is a fan of Plated, an exosome-powered serum that came out of the Mayo clinic in Minnesota, to help enhance the results of ablative procedures and microneedling. Research published in the Aesthetic Surgery Journal, found that study participants who applied Plated’s exosome serum twice daily for six weeks saw improvement in redness, brown spots, luminosity, skin tone, and fine lines.

As for the future of regenerative aesthetics overall: “I think we are just scratching the surface in terms of what these treatments can do,” Abramowitz says.