The dichotomy of dermal fillers: when does the biostimulatory response become one of regeneration versus one of replacement?

Abstract

Many dermal fillers are classified as biostimulatory, meaning they stimulate the dermis to create new collagen, elastin, and other components of the extracellular matrix. Normal wound healing is also a biostimulatory process. It can be one of tissue replacement with scar formation, or one of true regenerative healing with functional restoration of the tissue. Dermal fillers can stimulate both types of healing, but to different degrees. This paper reviews this mechanism, exploring why some fillers seem to favour replacement, and some true regeneration. The patient's and the filler's propensity for late inflammatory reactions and their relationship to the biostimulatory characteristics of the product are examined as well.