Experience the Next Generation of Skin Rejuvenation
The HoneyComb® Lift protocol offers a novel approach to face and neck tightening, achieving optimal lifting effects while enhancing skin quality and appearance. This innovative treatment combines the Fotona SMOOTH® modality with the advanced T-Runner® scanner and proprietary HoneyComb® (HC6) optics for an exceptional, natural-looking anti-aging effect with minimal-to-no downtime.
AS AESTHETIC MEDICINE CONTINUES TO EVOLVE, SO TOO DOES OUR understanding of how to blend techniques, tools, and therapeutic innovations for optimal patient outcomes. In this issue, we take a look at the power of synergy between innovation and application, and treatment modalities that are more effective when combined than when used in isolation.
Our cover feature looks into the intersection of mesotherapy and energy-based devices, a pairing that is gaining traction among practitioners worldwide. As demand grows for skin rejuvenation treatments that offer both efficacy and minimal downtime, clinicians are increasingly turning to protocols that marry microinjections of skin-nourishing ingredients with the collagen-boosting capabilities of radiofrequency, ultrasound, and laser-based technologies. We explore the science behind these protocols and the clinical rationale that’s driving this new wave of combination therapies.
Looking ahead, the field of regenerative medicine continues to expand its footprint in aesthetics. In this issue, we spotlight 3D bioprinting, a technology once confined to laboratories that is now inching closer to clinical relevance. With researchers making strides in fabricating biomimetic skin layers, bioprinted tissue holds promise not only for reconstructive applications but also for customised aesthetic procedures and advanced wound healing.
Staying within the regenerative theme, injectable and topical peptides are enjoying renewed attention as versatile tools for integrative practitioners. Dr Raheleh Sarbaziha and Dr David J. Goldberg guide us through the mechanisms, clinical applications, and future promise of peptides—from stimulating collagen and managing fat metabolism to supporting cognitive clarity and skin integrity. As patients seek outcomes that transcend surface aesthetics, peptides are poised to become a foundational part of the modern aesthetic and wellness toolkit.
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We also introduce readers to the AQUALUNA NEXT-Plus protocol a comprehensive, non-surgical approach to neck rejuvenation that bridges anatomical insight with clinical technique. By evaluating the neck through layered, zone-specific diagnostics and treatment strategies, practitioners can better customise care and enhance long-term results in an area notoriously resistant to conventional treatment.
In addition to these forward-looking topics, this issue will receive bonus distribution at AMWC Dubai, offering our global readership an opportunity to engage with the latest research and real-world insights at one of the region’s most important aesthetic congresses. I hope to see many of you there.
Balraj Juttla Editor, PRIME balraj.juttla@informa.com
Lead the future of aesthetic medicine with AURA - 3D facial analysis technology
By seamlessly combining awardwinning hardware with intuitive software, Aura transforms 3D facial analysis into a visual, collaborative experience. With a single capture, it generates a photo-realistic digital twin of a patient’s face and neck, empowering dermatologists, plastic surgeons, and aesthetic clinicians with the clarity they need to analyze, plan, dermatologists, plastic surgeons, and aesthetic clinicians with the clarity they need to analyze, plan,and communicate with confidence.
September/October 2025
NEWS
10 22 14
7 Allergan Aesthetics unveil new education campaign on HA fillers
8 Galderma reports lasting efficacy of injectable portfolio postweight loss
INDUSTRY INSIDER
10 Smart skin synergy: Pairing mesotherapy with energy devices PRIME explores how practitioners are combining mesotherapy with energy-based technologies to deliver enhanced skin rejuvenation results with minimal downtime, improved precision, and better outcomes
14 Need tissue? Bioprinting could be the solution 3D bioprinted skin is advancing in studies with the potential to become a next-generation solution in aesthetics and regenerative medicine
AESTHETIC FEATURES
18 Injectable and topical peptides in aesthetic medicine: Mechanisms, clinical applications, and future potential From collagen stimulation to fat metabolism and neuroregeneration, peptides are redefining aesthetic medicine. Raheleh Sarbaziha, MD and David J. Goldberg, MD, explore their mechanisms, delivery routes, and clinical synergy
22 AQUALUNA NEXT-Plus: A comprehensive non-surgical approach for neck rejuvenation
Introducing a structured, multi-layered strategy that considers anatomy, function, and aesthetics to deliver personalised and effective non-surgical outcomes
PRIME PROMOTION
32 Precision energy, versatility and ROI meet the needs of busy practitioners
As the demand for multi-functional, high-performance devices grows, VYDENCE® Medical's compact, scalable platforms are redefining what practitioners can achieve from first-time laser users to global key opinion leaders
36 A multi-layered approach to facial ageing: Rejuvenate from the inside out
A new era in facial rejuvenation begins with the powerful synergy of EMFACE and EXION. Together, they target every layer of the face, enabling personalised treatments that address the full spectrum of patient concerns at every age and stage of ageing
38 Anatomy-based facial remodelling with micro-focused ultrasound using MP mode
Ramon Tardin, MD, unveils a structured, multi-layered approach for precision lifting and submental contouring
40 LENISNA: The trusted choice for safe and effective body volumising
As body contouring becomes more nuanced, LENISNA offers a scientifically advanced alternative to traditional fillers. Ernesto Perez, MD, outlines his detailed injection strategy and post-care tips for restoring volume and firmness after weight loss
42 Anatomy-based filler placement in the temple using e.p.t.q.®: The role of ultrasound imaging
Edmond Lau, MD, explores how real-time ultrasound guidance and e.p.t.q.®’s tailored HA fillers combine to offer safer, more targeted aesthetic outcomes
46 Restoring the forehead ECM: An advanced strategy for wrinkle correction and myomodulation
Kolmakov Konstantin Sergeevich, MD, outlines a dual strategy combining precise intradermal filler placement with botulinum toxin to achieve natural-looking results, preserve facial expression, and minimise complications
50 COD-LAGEN: Redefining skin longevity
A new chapter in skin longevity is here. Promoitalia’s COD-LAGEN delivers next-generation skin rejuvenation with unmatched purity and results. Through an exclusive collaboration, e-FILLERS is bringing this innovation to the EU and UK market, redefining how premium aesthetic products reach professionals
52 Healing matters: The rise of medical-grade aftercare
Advanced treatments demand clinical-grade recovery epicite® CALM meets the moment with sterile, soothing care
EVENTS
58 A round-up of the major industry events around the world over the next 12 months 18
NEWS
A
round-up of news stories in the aesthetic and anti-ageing medicine industry
GALDERMA REPORTS LASTING EFFICACY OF INJECTABLE PORTFOLIO POST-WEIGHT LOSS
RESULTS BASED ON FACIAL CHANGES RESULTING FROM MEDICATION-INDUCED WEIGHT LOSS
alderma has revealed positive final data from a phase IV first-of-its-kind trial exploring the benefits of Restylane Lyft or Contour in combination with Sculptra to address the aesthetic concerns of patients experiencing facial volume loss associated with medication-driven weight loss1 These data reinforce that this treatment regimen can effectively improve facial aesthetic appearance with high patient satisfaction over nine months1
Rates of medication-driven weight loss have increased rapidly in recent years and can be associated with facial alterations of variable magnitude2-4. Patients may experience facial changes such as dry, dull or sagging skin, a gaunt or hollowed-out facial appearance, or other unwelcome alterations to facial structure and balance3,4. As the pure-play dermatology category leader, Galderma is spearheading efforts to identify and address the most predominant aesthetic concerns of patients along their weight loss journey. In the phase IV clinical study conducted in the US, Galderma investigated the aesthetic outcomes and appearance, and patient satisfaction of Restylane Lyft or Contour in combination with Sculptra for cheek or jawline augmentation and correction of contour deficiencies in patients experiencing facial volume loss associated with medication-driven weight loss1. The trial used the SHAPE Up Holistic Individualised Treatment
(HIT™) an individualised treatment approach which enables injectors to leverage their expertise with Galderma’s Sculptra and its Restylane portfolio to optimise aesthetic outcomes while prioritising patient satisfaction.
Patients were treated with Sculptra and either Restylane Lyft or Contour for their first treatment, a second treatment of Sculptra with an optional touch-up of Restylane Lyft or Contour at Week 4, and an optional third treatment of Sculptra at Week 81.
Following the interim analysis at three months presented earlier this year, a six-month extension study was conducted to capture the durability of treatment effects after nine months. In the extension study, follow-up visits took place at Weeks 32 and 44 for those who received the third Sculptra treatment and at Weeks 28 and 40 for those who did not, corresponding to nine months after their first Sculptra treatment1
Results at nine months demonstrated that the combination of Sculptra and Restylane Lyft or Contour effectively improved the aesthetic appearance of patients experiencing facial volume loss associated with medication-driven weight loss, further supporting the benefits of the SHAPE Up HIT:1
■ The combined Sculptra and Restylane Lyft or Contour regimen demonstrated skin quality improvements, with Restylane improving skin hydration and Sculptra significantly improving skin radiance through to Month 9
■ Subject satisfaction which was reported by
the majority of patients as early as Week 4 was maintained through to Month 9:1
■ 85.7% of patients said their face looked less gaunt/sunken
■ 88.6% said they ‘loved’ how the treatment maintained their facial structure
■ 88.6% of patients said they ‘loved’ the regenerative effects of Sculptra treatment
■ 88.6% felt they looked better than before the injection regimen
■ 91.4% said they would recommend the injection regimen to others after weight loss and to those with loose, sagging facial skin
Safety was in line with previous pivotal trial data for Sculptra, Restylane Lyft and Contour, with no treatment-related adverse events reports1
Galderma is spearheading multiple additional initiatives to identify and address the most predominant aesthetic concerns of patients who have experienced medication-driven weight loss through data-driven, innovative approaches in close collaboration with leading healthcare practitioners.
*Restylane Contour is known as Restylane® Volyme™ in countries outside of the US
References
1. Galderma. Data on file. Somenek M and Lorenc P. A multi-center, open-label study to evaluate the synergistic effects of biostimulator and dermal fillers for cheek augmentation and correction of contour deficiencies: Nine-month topline results.
2. Mansour MR, et al. The rise of “Ozempic Face”: Analysing trends and treatment challenges associated with rapid facial weight loss induced by GLP-1 agonists. JPRAS. 2024;96:225-227. doi: 10.1016/j.bjps.2024.07.051
3. Tay JQ. Ozempic face: A new challenge for facial plastic surgeons. JPRAS. 2023;81:97-98. doi: 10.1016/j.bjps.2023.04.057
4. Humphrey CD and Lawrence AC. Implications of Ozempic and other GLP-1 receptor agonists for facial plastic surgeons. Facial Plast Surg. 2023;39:719-721. doi: 10.1055/a-2148-6321
ALLERGAN AESTHETICS UNVEIL NEW EDUCATION CAMPAIGN ON HA FILLERS
AIMS TO CORRECT MISINFORMATION AND CELEBRATE SAFE OUTCOMES
Allergan Aesthetics, has launched the ‘Naturally You with Injectable Hyaluronic Acid Fillers’ campaign, aimed to provide clear, factual education about HA injectable fillers. This initiative focuses on correcting misinformation to elevate understanding and celebrate the safe, naturallooking outcomes possible with hyaluronic acid injectable fillers.
‘Our goal with Naturally You with Injectable Hyaluronic Acid Fillers campaign is to set the record straight on hyaluronic acid injectable fillers for our healthcare providers, our patients and the category,’ said Glen Curran, Senior Vice President, US Aesthetics, Allergan Aesthetics. ‘By providing facts, real-world satisfaction data and expert insights, we hope to truly show how HA fillers are a safe and effective way to address aesthetic concerns.’
The report draws from extensive research, including analysis of consumer and business media, cultural conversations, social trends, and proprietary US data from Allergan Aesthetics, the market-leader in HA injectable fillers. Insights were further validated through interviews with four leading aesthetics experts from key US markets: Brittony Croasdell, NP, Chicago, IL; Lisa Espinoza, MD, PA; Emily Hu, MD, Portland, OR; and Terrence Keaney, MD, Washington, DC and a foreword by award-winning beauty journalist, Jamie Rosen, reflecting on how far the aesthetics category has come and what’s ahead.
HA is here to stay. It’s our best friend in aesthetic medicine. You might use it in different areas or a little more conservatively, but it’s a staple in a tool belt.
Brittony Croasdell, NP
The Hyaluronic Acid Injectable Fillers Report is the first in the Aesthetics Evolution Report Series, which will continue to provide insights into the aesthetics industry.
The new report, The Hyaluronic Acid Injectable Fillers Report, is at the centre of the campaign and sheds light on the current use, opinions and personal experiences around HA injectable fillers.
Key stats include:
■ Nearly 90% of consumers indicate they are satisfied with the outcome, noting naturallooking results as their top satisfaction point1
■ 78% of consumers strongly agree that today, people want a more natural look
■ Over two-thirds of consumers use social media and online videos to learn about HA fillers
■ Over 75% of consumers believe that more people will use injectable HA fillers in the future2
■ The 40-54 age group accounted for 50% of HA injections in 2024.
As part of the Naturally You with Injectable Hyaluronic Acid Fillers campaign, Allergan Aesthetics will partner with healthcare providers and consumer influencers to support education on the category and promotion of healthy, natural-looking outcomes consumers desire today.
Visit www. naturallyyouwithHA. com to learn more and download your copy of The Hyaluronic Acid Injectable Fillers Report
Over 75% of consumers believe that more people will use injectable HA fillers in the future.
ALMA RELEASE UNIQUE AI SKINCARE SYSTEM
Alma has launched Universkin by Alma, a groundbreaking, medical-grade skincare line designed to meet the dynamic needs of today’s patients and the physicians who care for them. Moving beyond the one-size-fits-all skincare model, Universkin by Alma is setting a new benchmark in personalised treatment with the world’s first AI-assisted medical skincare line, offering providers a smarter approach to recommending the use of 18 essential BioActives.
At the core of Universkin by Alma is AI-assisted analysis software designed to streamline clinical decision-making. In under a minute, providers can capture a facial image, perform intelligent skin analysis, and generate a personalised formulation for approval selected from 487,678 combinations and nearly 12 million unique outcomes — precisely tailored to each patient’s skin profile and concerns. ‘Universkin by Alma brings medicalgrade personalisation to the forefront of patient care,’ said Lior Dayan, CEO of Alma. ‘By integrating advanced, science-backed ingredients with a personalised, smarter approach, we’re empowering physicians to extend the impact of aesthetic care beyond the clinic and into every patient’s daily routine. As the first AI-assisted system of its kind, Universkin by Alma also lays the foundation for a broader intelligent infrastructure, one designed to optimise the patient experience, elevate clinical outcomes, and transform aesthetic care into a personalised, continuous journey.’
‘Universkin by Alma reflects our core value of innovation through care, offering a treatment experience that delivers personalised results,’ said Keith Adams, the President of Alma North America. ‘We’re committed to ensuring our customers remain at the forefront of aesthetic medicine with solutions that cater to each patient’s unique needs.’
The DE|RIVE® Hair Wellness System is a plant-based solution ideal for patients with thinning hair or early hair loss. Start with the in-office Hair Support Serum , then continue care at home with:
SMART SKIN SYNERGY PAIRING MESOTHERAPY WITH ENERGY DEVICES
STORYCOVER
PRIME explores how practitioners are combining mesotherapy with energybased technologies to deliver enhanced skin rejuvenation results with minimal downtime, improved precision, and better outcomes
IN THE EVER-EVOLVING FIELD OF AESTHETICS, professionals strive to meet the growing demand for radiant, healthy skin with minimal downtime. Today, aesthetic outcomes thrive on the synergies of multimodal treatments, creating an ideal landscape for non-invasive and minimally invasive solutions. Among the latest advancements driving this trend are mesotherapy and energy-based devices (EBDs), two modalities that are redefining how practitioners approach aesthetic treatments, creating new possibilities for delivering results that not only transform skin but also enhance patient satisfaction.
As the global demand for minimally invasive aesthetic treatments with proven results is steadily increasing, mesotherapy and energy-based treatments are gaining significant traction. Recent research1,2 indicates that the mesotherapy market is projected to grow at a compound annual growth rate (CAGR) of 7-9% through the year 2030, while the energy-based aesthetic device market will grow at a CAGR of 13.86% from 2025 to 2030, thanks in part to the treatments’ accessibility to a wider range of patients. Mesotherapy is a targeted treatment that delivers specific solutions into
the middle layer of the skin to enhance skin hydration and promote cell regeneration. Some practitioners report that mesotherapy is particularly effective for addressing skin pigmentation issues, while offering a greater ability to tailor treatments for other individual skin concerns, as well. EBDs utilise various modalities such as light, heat, ultrasound, and electrical stimulation to achieve aesthetic rejuvenation goals such as skin tightening, and are favoured for their versatility and effectiveness, while offering significant results with less downtime than traditional surgeries.
‘Mesotherapy was first developed by the French physician Dr Michel Pistor,’ reported dermatologist Dr Rieko Tsubouchi, director of Ginza Skin Clinic (Tokyo, Japan). ‘His original aim was to treat pain and vascular disorders by injecting medications directly into the mesoderm, or middle layer of skin. At the time, the introduction of an extremely fine needle (30 G) enabled him to deliver small amounts of medication precisely to the targeted area, thereby minimising systemic side effects. Today, advancements in technology have expanded our options for mesotherapy beyond the manual technique and traditional mesotherapy guns, offering a wider range of delivery methods.’ The latest evolutions of needle-free
RIEKO TSUBOUCHI, MD, director of Ginza Skin Clinic, Tokyo, Japan; KAVEH KARANDISH, MD, board-certified internal medicine physician, medical director of PCH MedSpa, Corona Del Mar, CA USA; PAWNTA ABRAHIMI, RN, CANS, aesthetic nurse specialist at Skinspirit, Beverly Hills, CA, USA; NANA SUN, MD, director of the Cosmetic Dermatology Department, Affiliated Hospital of Zunyi Medical University, Zunyi, China
Mesotherapy targets different biological pathways compared to EBDs, allowing for a synergistic effect that improves both skin tone and texture.
Rieko Tsubouchi, MD
A B
A B C
(A) Before and (B) after seeking treatment for melasma with laser therapy the overall skin tone brightened but the reticular brown pigmentation worsened following the laser treatments. (C) After two sessions of mesotherapy with vitamin C and Cytocare®️ using the nappage technique, the reticular brown spots remained but showed noticeable improvement, along with enhanced skin texture and radiance.The patient was satisfied with the results, and the treatment was concluded. This case illustrates that energy-based devices are not always the optimal choice for treating melasma.
mesotherapy devices utilise electroporation and sonophoresis (ultrasound waves), which are gaining momentum among some aesthetic manufacturers.
‘Mesotherapy targets different biological pathways compared to EBDs, allowing for a synergistic effect that improves both skin tone and texture and amplifies the benefits of both modalities,’ Dr Tsubouchi continued. ‘Mesotherapy is also valuable in helping the skin recover from invasiveness associated with some EBD procedures, promoting faster healing and maintaining skin barrier function. For some patients, mesotherapy serves as a firstline, minimally invasive option when EBDs may be too aggressive or not indicated. I also often recommend mesotherapy to patients who have seen limited improvement with conventional treatments. We also recommend mesotherapy as a stress-free alternative that avoids the significant downtime typically associated with CO₂ fractional lasers, while still achieving effective outcomes. For resistant conditions like melasma or stubborn acne scars, I design a multimodal protocol where mesotherapy is layered strategically with EBDs over a series of sessions.’
Dr Tsubouchi shared some of her protocols that pair mesotherapy with EBDs, demonstrating the flexibility and
ability to tailor her treatments to a variety of patient concerns. ‘For melasma, I often combine pico laser toning with mesotherapy using tranexamic acid and vitamin C, along with a separate cocktail formulation containing hyaluronic acid, vitamins, and amino acids aimed at skin rejuvenation. For chronic post-acne erythema, I utilise IPL devices with wavelengths highly selective for haemoglobin absorption, such as PR530 on the Nordlys™ platform (Candela Medical, Marlborough, USA), combined with mesotherapy via microneedling devices like D’Liv™ (Jeisys Medical, Seoul, South Korea), delivering tranexamic acid and vitamin C. And for age-related concerns such as decreased skin elasticity, fine lines, and enlarged pores, I perform mesotherapy using either crosslinked or non-crosslinked hyaluronic acid (HA), as well as cocktail formulations that combine HA with amino acids, often in conjunction with monopolar radiofrequency (RF) or high-intensity focused ultrasound (HIFU) treatments.’
The combination of mesotherapy and an energy-based device is gaining traction in research, with a pilot study3 demonstrating that the combined effects of bipolar RF with HA mesotherapy treatments yielded greater improvements in skin hydration and firmness compared to RF alone. Additionally, the combination treatment seemed to improve keratinocyte differentiation, as well as increase epidermal thickness and density, indicating a synergistic effect on epidermal homeostasis and barrier function. It was also noted that both treatments were well tolerated and led to improvements in facial appearance.
Targeted treatments
According to board-certified internal medicine physician and minimally invasive aesthetic and cosmetic specialist Kaveh Karandish, MD, mesotherapy can be used to introduce a number of advanced technologies, including peptides, growth factors, polydeoxyribonucleotide (PDRN), skin boosters and hydrating agents to the dermis layer of the skin. ‘Of course, the traditional method is to inject the products superficially into the dermis using a tiny, shorter needle, such as a 31-gauge. We microchannel the skin with a regular microneedling device or laser and then apply the products topically for superficial absorption through the created channels,’ he explained. Often used for skin rejuvenation, a fractional laser treatment is an advanced technique that uses fine laser beams to create microchannels in the skin.
Dr Karandish reported that he uses mesotherapy for a variety of skin concerns, such as to hydrate skin tissue, improve texture and glow, as well as pigmentation and melasma, and combines it with various laser treatment applications. ‘We often use the combination to treat hyperpigmentation and melasma, during which we combine microchanneling and laser biomodulation simultaneously. We first do microchanneling utilising brightening and antioxidant agents to attack the melasma and pigment, while the laser energy works synergistically to improve pigmentation and brighten the skin. The laser stimulates the extracellular matrix and its cells to improve darkness and pigmentation.’ He prefers to commit patients to 3-5 sessions, once every couple of weeks, for the best outcomes.
(A) Before and (B) 1 week after one treatment with micro-channelling, brightening boosters and PDRN plus 1470 nm laser biomodulation.
Energy treatments have become a cornerstone in many modern aesthetic practices, offering a wide range of procedures for skin rejuvenation through tissue remodelling. Pawnta Abrahimi, RN, CANS, aesthetic nurse specialist at Skinspirit (Beverly Hills, CA) explained that energy treatments activate heat shock proteins (HSPs) to stimulate collagen production and tissue remodelling, growth factors that promote collagen production, and nitric oxide (NO) to increase blood flow and tissue oxygenation, for a powerful impact on skin tightening, lifting, and pigmentation issues. She added that mesotherapy can help reduce inflammation, improve skin texture and scalp health and even reduce the appearance of cellulite by breaking down fat cells and improving circulation.
Ms Abrahimi uses advanced meso-needling energy tools like RF or laser therapy to create microscopic channels in the skin.
‘Energy treatments like RF or ultrasound are the secret weapons to tighten, lift, and stimulate collagen from within. Combining this with mesotherapy creates a synergy that tackles everything from fine lines and sagging to pigmentation and dullness all in one treatment,’ she said.
Ms Abrahimi has created a personalised protocol that utilises the power of mesotherapy with energy devices to address the increased need for filler removal due to post-COVID reactions and the emerging trend toward more natural aesthetic results.
‘Using targeted enzymes like hyaluronidase, I carefully dissolve unwanted or misplaced dermal fillers. This process clears the way for natural rejuvenation and prepares the skin for a fresh start,’ she explained. ‘While the filler is dissolving and the patient’s skin heals, it’s crucial to nourish and regenerate the tissue. I recommend a tailored combination of advanced treatments such as PRF or PRP to stimulate natural tissue repair and boost collagen from within.’ Ms Abrahimi follows this with superficial meso-needling (0.03mm) to infuse high-grade vitamins, peptides, and antioxidants to promote hydration and healing, as well as polynucleotides to accelerate tissue regeneration, reduce inflammation, and maintain skin quality during the transition.
According to Dr Nana Sun, director of the Cosmetic Dermatology Department, Affiliated Hospital of Zunyi Medical University, skin ageing is a complex manifestation driven by multiple factors; therefore, combining mesotherapy’s characteristics with energy-based physical therapies holds significant value in addressing skin ageing. ‘I encounter a significant number of patients with hyperpigmentary disorders,’ Dr Sun reported. ‘Guizhou, located in the Yunnan-Guizhou Plateau region, experiences intense ultraviolet (UV) radiation, leading to prominent photoaging signs such as dull complexion, uneven skin tone, melasma, and varying degrees of pigmentation
accompanied by enlarged pores. For this patient population, my clinical experience suggests avoiding aggressive energybased therapies as a first-line intervention. Instead, I adopt a preconditioning strategy utilising mesotherapy to deliver active ingredients like tranexamic acid and non-crosslinked hyaluronic acid to improve the dermal microenvironment, reduce inflammatory activity, and minimise the adverse effects associated with energy-based devices.’
Dr Sun incorporates a protocol that begins with microneedling and a compound sodium hyaluronate solution administered every 4–6 weeks, with pulsed-dye 59nm laser therapy for vascular targeting between mesotherapy sessions. ‘The frequency of mesotherapy should not be excessive. Depending on the patient’s specific pigmentation severity, adjuvant photo-biomodulation can be incorporated. Post-procedure skin barrier protection is critical: both immediately after treatments and during at-home care.’
What does the future hold?
Energy treatments like RF or ultrasound are the secret weapons to tighten, lift, and stimulate collagen from within.
Pawnta Abrahimi, RN, CANS
The future of mesotherapy is poised to revolutionise aesthetic treatments with innovations that prioritise patient comfort, efficiency, and enhanced outcomes. Needle-free delivery systems are at the forefront, offering a painless alternative to traditional injections, which will make mesotherapy accessible to more patients and reduce procedure-related anxiety, while energy device technologies are evolving in ways that can enhance mesotherapy protocols. These updates are expected to offer more targeted and personalised treatments, ensuring improved efficiency and adaptability to diverse skin concerns. Together, these advancements herald a new era where mesotherapy and energy-based technologies converge to deliver cutting-edge, holistic aesthetic solutions.
Written by Cindy J. Papp, contributing editor
NEED TISSUE?
BIOPRINTING COULD BE THE SOLUTION
3D bioprinted skin is advancing in studies with the potential to become a next-generation solution in aesthetics and regenerative medicine
SCIENTISTS IN THE U.S., SOUTH AMERICA, Europe, and elsewhere are in their labs studying how to create 3D bioprinted skin and other tissues that can safely and effectively improve outcomes in reconstructive surgery, wound healing, and other applications.
A bioengineering feat, bioprinting is expected to transform dermatology and aesthetic surgery over the next decade by enabling the creation of customised skin grafts, engineered tissues and even entire skin equivalents, says Viviane Abreu Nunes, PhD, an author of one of those recent studies and associate professor II at the School of Arts, Sciences and Humanities, University of São Paulo, in São Paulo, Brazil.
‘This will enhance treatment options for burns, scars, wounds, and age-related skin deterioration. In aesthetic practice, bioprinting could allow for patient-specific fillers or implants made from biocompatible tissue rather than synthetic materials, improving both safety and outcomes,’ says Dr Nunes, who is currently a visiting professor in the wound healing and regenerative medicine
Bioprinting could allow for patient-specific fillers or implants made from biocompatible tissue rather than synthetic materials, improving both safety and outcomes.
Viviane Abreu Nunes, PhD
research program at the department of dermatology and cutaneous surgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Dr Nunes led an international team of researchers publishing the paper ‘Advances in regenerative medicinebased approaches for skin regeneration and rejuvenation,’ in Frontiers in Bioengineering and Biotechnology, looking among other innovations at biological skin substitutes.
‘These innovations aim to reduce morbidity from both acquired and congenital skin diseases, as well as replace or regenerate soft tissues lost or damaged due to ageing, injuries, scars, or wrinkles. The ultimate goal is to restore a rejuvenated, natural, and aesthetically pleasing appearance to the skin,’ the authors write.
Aesthetic and regenerative applications
Bioprinted tissue can be used for grafting in burns and chronic wounds, for reconstructive surgery following trauma or tumour removal, and potentially for aesthetic skin rejuvenation, according to Dr Nunes.
Surgeons, for example, could apply bioprinted dermalepidermal composites directly to wounds, allowing for improved integration and reduced scarring, she says.
‘In the future, printed skin patches with embedded hair follicles, sweat glands, or pigment-producing cells may also be used for more complete functional and cosmetic restoration,’ Dr Nunes says.
Dino J. Ravnic, DO, MPH, MSc, professor of surgery, division of plastic surgery, Penn State College of Medicine, and co-authors recently reported in a study published in Bioactive Materials that fat tissue holds the key to 3D printing layered living skin and potentially hair follicles. The researchers harnessed fat cells and supporting structures from clinically procured human tissue to precisely correct injuries in rats. The patented bioprinting technology could have implications for reconstructive facial surgery and even hair growth treatments for humans, according to a Penn State press release.
In essence, the Penn State team created skin using stem cells, retrieving those stem cells from patients’ fat.
Stem cells have the ability to go into multiple tissue lines, as well as self-replicate and maintain their lines, Dr Ravnic explains.
‘So, you’re able to grow these stem cells in a petri dish with the appropriate nutrients … and they can expand
VIVIANE ABREU NUNES, PHD, associate professor II at the School of Arts, Sciences and Humanities, University of São Paulo, Brazil; DINO J. RAVNIC, DO, MPH, MSC, professor of surgery, division of plastic surgery, Penn State College of Medicine, USA
themselves. Then, when you change the nutrients that they’re exposed to, you can differentiate them into skin or fat or bone or blood vessels. A whole slew of different tissue types,’ he says.
Researchers used this approach intraoperatively, printing the skin and applying it in the OR (albeit in an animal model). Theoretically, in human studies, clinicians would bring the bioprinter into the OR and use computer programming to design where the cells need to go.
‘The bioprinter usually has a number of different print heads, and you can deposit the kinds of cells—layer by layer and the type of cell that you want, exactly where you need it to be. We look at the area that we’re trying to rebuild in the operating room, and then, on demand, we
basically build it. There’s no prefabrication. Everything is on the spot,’ Dr Ravnic says.
Again, theoretically, because it hasn’t been tested in humans, patients’ bodies would not reject bioprinted skin made with their own cells. But that remains uncertain.
Hydrogel is the medium of the bio-ink that cells are deposited in, says Dr Ravnic. In this case, the researchers created the hydrogel component by taking the extracellular matrix from adipose and using it to make a bio-ink.
‘We saw that when you source the stem cells and extracellular matrix, and you deposit it in a layer-by-layer fashion, you can also achieve some hair follicle growth,’ he says.
In three sets of rat studies, the researchers achieved the hypodermis and dermis layers, with the epidermis forming within two weeks, according to Ibrahim T. Ozbolat, PhD, professor of engineering science and mechanics, of biomedical engineering and of neurosurgery at Penn State, who led the study.
‘… we found the co-delivery of the matrix and stem cells was crucial to hypodermal formation,’ Dr Ozbolat said in the press release. ‘It doesn’t work effectively with just the cells or just the matrix — it has to be at the same time.’
They also found that the hypodermis contained downgrowths, the initial stage of early hair follicle formation. According to the researchers, while fat cells do not directly contribute to the cellular structure of hair follicles, they are involved in their regulation and maintenance, according to the Penn State press release.
‘In our experiments, the fat cells may have altered the extracellular matrix to be more supportive for downgrowth formation,’ Dr Ozbolat said. ‘We are working to advance this, to mature the hair follicles with controlled density, directionality, and growth.’
Next in this research, the team will study the approach in a sheep model, according to Dr Ravnic, who says this type of tissue engineering represents the next era of reconstruction.
Figure 1 Histological analysis of 3D skin models stained with Hematoxylin and Eosin (H&E). Panels show cross-sections of reconstructed human skin equivalents, highlighting the epidermal and dermal architecture.
Figure 2 Miji Yeo, a postdoctoral researcher at Penn State, checks the bioink cartridges on a 3D printer developed to intraoperatively print layers of skin.
Droplet-based bioprinting is similar to inkjet printing. It ejects small droplets of bio-ink through a nozzle, usually using thermal or acoustic energy.
Viviane Abreu Nunes, PhD
Bioprinting nuances and differentiators
In their paper, Dr Nunes and colleagues mention droplet-based, laser-assisted, and extrusion-based bioprinting.
‘Droplet-based bioprinting is similar to inkjet printing. It ejects small droplets of bio-ink through a nozzle, usually using thermal or acoustic energy. It’s ideal for highresolution, low-viscosity applications but limited in cell density,’ she says. ‘Laser-assisted bioprinting uses a focused laser to transfer bio-ink from a donor layer to the substrate. It’s highly precise and does not clog, making it suitable for delicate or high-density cell applications, though it is expensive and complex. Extrusion-based bioprinting pushes bio-ink through a nozzle using pneumatic or mechanical force. It’s the most commonly used method and can print high-viscosity materials and large volumes, but with less resolution than the other two.’
Common biomaterials that could go into making the tissue include collagen, gelatin, hyaluronic acid, alginate, and fibrin, all of which can be combined with patientderived cells like fibroblasts and keratinocytes, according to Dr Nunes.
‘Synthetic polymers like PCL or PLA may also be used as scaffolds. While we’re not quite there yet, the concept of office-based bioprinting is plausible within the next decade, especially for small grafts or personalised tissue patches. Point-of-care bioprinters are already being prototyped for battlefield and emergency use, suggesting clinical scalability,’ she says.
Challenges to overcome
While exciting and promising, obstacles remain for translating bioprinted tissue to mainstream practice.
Key obstacles, according to Dr Nunes, include:
■ Regulatory approval: Bioprinted tissues must meet strict FDA and EMA standards for safety, efficacy, and reproducibility.
■ Vascularisation: Successfully integrating printed tissues with the patient’s circulatory system remains a major challenge.
■ Standardisation and cost: Protocols must be standardised for broader use, and bioprinters must become more affordable and user-friendly for clinical settings.
■ Training: Surgeons and clinicians will need training to operate bioprinters and handle living materials safely and effectively.
‘Despite these hurdles, integration into routine care is accelerating, especially in advanced wound care and aesthetic centres,’ Dr Nunes says.
For now, plastic surgeons engaging in regenerative medicine or wound care should understand the basics of
tissue engineering, including cell sourcing, scaffold design, and the role of growth factors, according to Dr Nunes.
‘As bioprinting technologies evolve, familiarity with bio-inks and bioreactor systems will become increasingly relevant. To get started, clinicians can attend courses in regenerative medicine, join interdisciplinary conferences, and establish partnerships with academic or biotech labs that specialise in bioprinting,’ she suggests.
1. Dutra Alves NS, Reigado GR, Santos M, Caldeira IDS, Hernandes H dos S, Freitas-Marchi BL, et al. Advances in regenerative medicine-based approaches for skin regeneration and rejuvenation. Frontiers in Bioengineering and Biotechnology. 2025 Feb 12;13.
2. Kang Y, Yeo M, Derman ID, Ravnic DJ, Singh YP, Alioglu MA, et al. Intraoperative bioprinting of human adipose-derived stem cells and extracellular matrix induces hair follicle-like downgrowths and adipose tissue formation during full-thickness craniomaxillofacial skin reconstruction. Bioactive Materials [Internet]. 2024 Mar 1;33:114–28. Available from: https://www. sciencedirect.com/science/article/pii/ S2452199X23003493?via%3Dihub
3. 3D-printed skin closes wounds and contains hair follicle precursors | Penn State University [Internet]. Psu.edu. 2024. Available from: https://www.psu.edu/news/ research/story/3d-printed-skin-closeswounds-and-contains-hair-follicleprecursors
INJECTABLE AND TOPICAL PEPTIDES IN AESTHETIC MEDICINE MECHANISMS,
CLINICAL APPLICATIONS, AND FUTURE POTENTIAL
From collagen stimulation to fat metabolism and neuroregeneration, peptides are redefining aesthetic practice. Raheleh Sarbaziha, MD, and David J. Goldberg, MD, explore their mechanisms, delivery routes, and clinical synergy
RAHELEH SARBAZIHA, MD, Board certified internist, Beverly Hills, CA, USA; DAVID J. GOLDBERG, MD, JD, Medical Director, Skin Laser & Surgery Specialists, New York, NY, USA
Peptides have emerged as a transformative category in regenerative and aesthetic medicine, offering potentially targeted, minimally invasive solutions to a wide range of ageing and wellness concerns. As bioactive signalling molecules, peptides promote tissue repair, fat metabolism, neuroregeneration, and collagen synthesis through injectable, topical, intravenous (IV), and intranasal delivery methods 1–4. Their versatility allows for integration across multiple treatment modalities, including hormonal therapy, energy-based devices, microneedling, neuronal therapies and as an adjunct to traditional western medical therapies. Advances in peptide science now enable tailored protocols for patients of all skin types, ages, and health goals. From neuroactive peptides to growth hormone secretagogues, each formulation offers unique mechanisms to support
Tlongevity, skin integrity, mood, metabolism, and body composition.
Topical peptides have demonstrated efficacy in dermal remodelling, rhytid reduction, and post-procedural healing 5-7, while senolytic peptides represent an exciting frontier in cellular ageing reversal 8,9. Clinical experience with peptides has shown improvements in outcomes across concerns such as skin laxity, fatigue, cognitive clarity, and visceral fat 10-15. The growing body of evidence supports the safety and efficacy of peptides as both stand alone and synergistic aesthetic protocols. With continued advancements in compounding technology and clinical understanding, peptides are poised to redefine how integrative practitioners approach beauty, ageing, and vitality—positioning them as a foundational tool in the modern aesthetic and regenerative tool kit.
HE EMERGENCE OF PEPTIDES IN AESTHETIC AND REGENERATIVE medicine has marked a paradigm shift in how clinicians address ageing, skin health, and systemic vitality. These bioactive molecules— administered via injection, topical application, intravenous infusion, or nasal delivery offer targeted solutions for a wide spectrum of cosmetic and functional concerns, including skin laxity, inflammation, fat accumulation, hormonal imbalance, and cognitive decline 3,4,10–13, 16–18 .
However, it is crucial to recognise that not all peptides are created equal, and appropriate protocols, delivery methods, and clinical insight are essential to ensure optimal outcomes and patient safety. While some peptides are FDA-approved for specific indications, others are used off-label within a well-informed, integrative framework. Patient variability in metabolism, hormone levels, and tissue responsiveness means that personalisation is key when designing peptide-based protocols.
This review highlights the clinical applications, mechanisms of action, and synergistic opportunities of various peptides—both injectable and topical—based on emerging studies and practitioner experience. Drawing on case examples and current data, we aim to illustrate how peptides can safely enhance results across diverse skin types and
Available in injectable, topical, intravenous, intranasal, and oral forms, peptides have demonstrated safety and efficacy in multiple regenerative and aesthetic protocols.
demographics, with a particular emphasis on integrative, cellular-level rejuvenation.
What are peptides?
Peptides are defined as short chains of amino acids that act as biological messengers. Depending on their sequence and structure, they influence diverse physiological functions such as collagen production, lipolysis, neurochemical balance, and immune modulation1–3,5,6,19. Available in injectable, topical, intravenous, intranasal, and oral forms, peptides have demonstrated safety and efficacy in multiple regenerative and aesthetic protocols.
Injectable peptides in aesthetic medicine
Injectable peptides such as BPC-157, GHK-Cu, TB-500, CJC1295, Ipamorelin, and Tesamorelin target tissue repair,
Table 1 FDA-Cleared Peptides
PEPTIDE
Tesamorelin GHRH analogue; reduces visceral fat and improves cognition
Selank Modulates GABA and neuropeptide Y; reduces anxiety, improves cognition and sleep
Semax Increases BDNF; promotes neuroprotection, recovery, and cognitive enhancement
Melanotan II MC1/MC4 receptor agonist; stimulates tanning and libido, but may cause hyperpigmentation and side effects
Cerebrolysin Peptide-based neurotrophic complex; enhances cognitive recovery, used post-stroke and in neurodegeneration.
Subcutaneous injection Not FDA cleared
Subcutaneous injection Not FDA cleared
Subcutaneous injection Not FDA cleared
Subcutaneous injection Not FDA cleared Previously FDA cleared for GH deficiency in children
Subcutaneous injection Not FDA cleared
Subcutaneous, Oral, or topical Not FDA cleared
Injectable, Topical Not FDA cleared / Cosmetic use
Subcutaneous injection Not FDA cleared
Subcutaneous injection Not FDA cleared
Subcutaneous injection Not FDA cleared
IV, IM, oral, topical Not FDA cleared as drug (cosmetic/ supplement use)
Intranasal, Subcutaneous Injection, Oral
Intranasal, subcutaneous injection, sublingual
GLP-1 receptor agonists such as semaglutide and tirzepatide promote weight loss, with synergistic benefits when combined with peptides that preserve muscle mass
Not FDA cleared (used clinically in Russia)
Not FDA cleared (used clinically in Russia)
Subcutaneous injection Not FDA cleared
IV or IM injection Not FDA cleared in U.S. (approved in EU/Asia)
skin rejuvenation, fat loss, and cognitive support. For example, BPC-157 supports angiogenesis and wound healing1,2, while GHK-Cu promotes fibroblast activation, collagen synthesis, and hair regrowth3. CJC-1295 and Ipamorelin stimulate endogenous growth hormone, improving skin tone and fat metabolism10,20. Tesamorelin, FDA-cleared for lipodystrophy, reduces visceral fat and supports cognitive function11. Additionally, GLP-1 receptor agonists such as semaglutide and tirzepatide promote weight loss, with synergistic benefits when combined with
peptides that preserve muscle mass12–14,18. Other advanced agents include FOXO4-DRI, a senolytic that targets ageing cells8,9,21, and IGF-1 LR3 for muscle and skin health22,23
Topical peptides
Topical peptides such as GHK-Cu, Argireline (Lubrizol Wickliffe, Ohio, USA), Matrixyl (Sederma, France), and Snap-8 (Lubrizol Wickliffe, Ohio, USA) offer anti-ageing benefits when applied post-procedure or on their own. They reduce dynamic rhytides, promote dermal remodelling, and enhance hydration3,5–7
Exosomes can also carry peptides and amino acids and can further boost outcomes by delivering growth factors and RNA fragments to stimulate regeneration. In combination with peptides and energy-based modalities, they optimise recovery and collagen renewal24.
Discussion
Peptides offer a promising therapeutic strategy in aesthetics but must be used judiciously. While agents like PT-141 are FDA-cleared for specific indications25, others, such as Melanotan-II, are not and pose risks such as hyperpigmentation25. However, regardless of regulatory oversight, the black market for peptide use is thriving and unlikely to diminish. Patients are obtaining significant results with peptides, often without medical supervision, due to their perceived safety and efficacy. As clinicians, our role is not only to understand these agents but also to guide patients toward safer, evidence-based choices. By staying educated, we can help patients navigate the growing availability of peptides and steer them away from potentially harmful or poorly formulated products. Moreover, because peptides are simply short chains of amino acids—foundational building blocks of proteins— they may be considered closer to nutraceuticals or functional supplements rather than traditional pharmaceuticals, depending on structure, route of use, and regulation3,24. As we move forward, the integration of peptide therapies with hormonal support, appropriate diagnostics, and personalised protocols will be essential to optimise safety and patient outcomes.
Conclusion
Peptides are powerful tools that bridge the gap between traditional aesthetic procedures and regenerative medicine. Their clinical integration—particularly when combined with technologies such as exosomes, microneedling, and energybased devices—offers a patient-centred, biological approach to skin health, body composition, and overall vitality. As the field evolves, so too must our understanding and responsible use of these therapies.
Declaration of interest None
Key points
Peptides offer multi-functional benefits, including collagen synthesis, tissue repair, neuroregeneration, fat metabolism, and improved skin health
Personalisation is essential: Due to variations in metabolism, hormone levels, and skin types, peptide protocols must be customised for safety and efficacy
Peptides can be used alongside exosomes, energy-based devices, microneedling, and hormone therapy for enhanced, regenerative results
References
1. Sikiric P, Seiwerth S, Rucman R, et al. Stable gastric pentadecapeptide BPC‑157: an overview of experimental research on its pleiotropic effects. Curr Pharm Des. 2011;17(16):1612–1632.
2. Pevec D, Sikiric P, Zoricic I, et al. Therapeutic effects of BPC‑157 on muscle, tendon, ligament, and bone injuries. Curr Pharm Des. 2011;17(16):1697–1712.
3. Pickart L, Margolina A. Regenerative and protective actions of the GHK‑Cu peptide in the light of the new gene data. Clin Cosmet Investig Dermatol. 2015;8:1–12.
4. Zempo H, Sugino T, Kimura K, et al. Mitochondrial‑derived peptide MOTS‑c is a regulator of muscle and fat metabolism. Aging Cell. 2015;14(3):358–367.
5. Blanes‑Mira C, Clemente J, Jodas G, et al. A synthetic hexapeptide (Argireline) with anti wrinkle activity. Int J Cosmet Sci.
Table 3 Investigational Peptides
PEPTIDE
Retatrutide
Kisspeptin
FOXO4-DRI
SS-31 (Elamipretide)
Triple receptor agonist (GLP-1, GIP, glucagon); promotes maximal fat loss and muscle retention.
Stimulates GnRH → regulates fertility and hormonal balance.
Senolytic; targets and eliminates senescent cells to reduce SASP, inflammation, and slow biological aging.
Mitochondrial tetrapeptide; stabilizes cardiolipin and enhances ATP production for tissue energy and repair
STATUS
Subcutaneous injection Investigational
Subcutaneous injection Investigational
Subcutaneous injection Investigational
Subcutaneous injection Investigational
2002;24(5):303–310.
6. Blanes‑Mira C, Clemente J, Jodas G, et al. A synthetic peptide that mimics the N terminal end of SNAP 25 reduces facial expression wrinkles. Int J Cosmet Sci. 2002;24(3):153–160.
7. Robinson LR, Fitzgerald NC, Doughty DG, et al. Topical palmitoyl pentapeptide provides improvement in photoaged human facial skin. Int J Cosmet Sci. 2005;27(3):155–160.
8. Huang Y, He L, Makarcyzk MJ, Lin Z. FOXO4‑DRI selectively removes senescent chondrocytes and improves cartilage quality in vitro. Front Bioeng Biotechnol. 2021;9:677576.
9. Huang Y, He L, Makarcyzk MJ, Lin Z. FOXO4‑DRI improves Leydig cell senescence and testosterone levels in aged mice. Aging (Albany NY). 2021;13(16):202682.
10. Teichman SL, Neale A, Lawrence B, et al. Prolonged stimulation of GH and IGF‑1
GHK-Cu (Topical)
Argireline
Matrixyl
Epidermal Growth Factor
Pentapeptide-18
Tripeptide-1
Copper peptide used post-procedure to regenerate skin, reduce redness, stimulate collagen and angiogenesis
Neurotransmitter-inhibiting peptide; softens wrinkles by reducing muscle contraction (Botox-like effect)
Pentapeptide that boosts collagen and hyaluronic acid
Epidermal growth factor; accelerates wound healing and fibroblast proliferation
Supports extracellular matrix regeneration; improves elasticity and skin barrier.
OF APPLICATION
STATUS
Topical Cosmetic use only
Topical Cosmetic use only
Topical Cosmetic use only
Topical Cosmetic use only
Topical Cosmetic use only
Topical Cosmetic use only
Peptides are powerful tools that bridge the gap between traditional aesthetic procedures and regenerative medicine.
secretion by CJC‑1295, a long‑acting GH‑releasing hormone analog. J Clin Endocrinol Metab. 2006;91(3):799–805.
11. Falutz J, Mamputu JC, Potvin D, et al. Long‑term safety and effects of tesamorelin in HIV patients with abdominal fat accumulation. J Acquir Immune Defic Syndr. 2010;53(3):311–322.
12. Wilding JPH, Batterham RL, Calanna S, et al. Once‑weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989–1002.
13. Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022;387(3):205–216.
14. Lin HV, Zhang J, Wang H, et al. Tirzepatide improves metabolic dysfunction in diet‑induced obese mice. PLoS One. 2023;18(2):e0281372.
for obesity – a phase 2 trial. N Engl J Med. 2023;389(13):1151–1164.
16. Lee C, Zeng J, Drew BG, et al. The mitochondrial‑derived peptide MOTS‑c promotes metabolic homeostasis and insulin sensitivity. Cell Metab. 2015;21(6):896–908.
17. Lee C, et al. MOTS‑c prevents obesity and insulin resistance in mice. Sci Rep. 2015;5:113–115.
18. Singh AK, Singh R. Efficacy and safety of semaglutide in patients with obesity: lessons from the STEP trials. J Investig Med. 2022;70(1):5–10.
19. Goldstein AL, Hannappel E, Kleinman HK. Thymosin β4: actin‑sequestering protein moonlights to repair injured tissues. Ann N Y Acad Sci. 2012;1270(1):17–25.
20. Kraemer WJ, Ratamess NA, French DN, et al. Dose responses of GH‑releasing peptides
combined with resistance exercise in men. J Appl Physiol. 2005;98(6):2251–2259.
21. Baar MP, Brandt RMC, Putavet DA, et al. Targeted apoptosis of senescent cells by a FOXO4‑DRI peptide improves healthspan in mice. Cell. 2017;169(1):132–147.e16.
22. Laron Z. Insulin‑like growth factor 1 (IGF‑1): a growth hormone. Mol Pathol. 2001;54(5):311–316.
23. Yakar S, Rosen CJ, Beamer WG, et al. Circulating levels of IGF‑1 directly regulate bone growth and density. J Clin Invest. 2002;110(6):771–781.
25. Wessells H, Grimes M, Hadley M, et al. Melanocortin receptor agonists for erectile dysfunction: preclinical and clinical results with Melanotan‑II. J Urol. 2000;163(2):456–463.
Table 4 Peptides Cleared for Cosmetic Use Only
AQUALUNA NEXT-PLUS A COMPREHENSIVE NON-SURGICAL APPROACH FOR NECK REJUVENATION
Introducing a structured, multi-layered strategy that considers anatomy, function, and aesthetics to deliver personalised and effective non-surgical outcomes
email: liaoyong8337@sina.cn
ABSTRACT
The AQUALUNA NEXT-Plus protocol presents a comprehensive, non-surgical solution for neck rejuvenation by combining detailed anatomical analysis with targeted aesthetic treatment strategies. Recognising the structural complexity of the neck, this approach evaluates ageing patterns across skin, fat, muscle, fascia, and bone within three anatomically distinct zones: the anterior cervical zone, X-dynamic zone, and posterior cervical zone.
WITH GROWING AESTHETIC
demand, the significance of the neck in overall appearance is becoming more widely acknowledged1. However, current rejuvenation strategies are often insufficient, failing to address the neck's structural complexity and the need for personalised interventions2 . This necessitates a more systematic and integrated clinical approach.
The AQUALUNA NEXT-Plus approach provides a structured, non-surgical pathway for assessing and treating the ageing neck from both medical and aesthetic perspectives. Based on patient concerns, it integrates aesthetic evaluation with anatomical and functional analysis to formulate tailored therapeutic strategies. By combining injectables, neuromodulators, and energybased devices, this approach aims to standardise practices, enhance efficacy, and achieve comprehensive improvement in both neck aesthetics and function.
Anatomical basis for the aesthetic and functional evaluation of the neck
KEYWORDS AQUALUNA NEXT-Plus
The neck's complex anatomy consists of multiple tissue layers, from skin to bone, each with distinct ageing patterns3. Key aesthetic indicators like skin texture and the cervicomental angle depend on the integrated support of all these layers4,5. Because ageing and mechanical stress
Using the N-E-X-T framework—identifying signs (N), evaluating severity (E), analysing zonal features (X), and tailoring treatment (T)—clinicians can personalise interventions for more effective outcomes. The method combines injectables, neuromodulators, and energy-based devices, ensuring region- and layer-specific synergy. Designed for long-term efficacy and aesthetic harmony, the AQUALUNA NEXT-Plus system bridges clinical precision with patient-specific goals in rejuvenating the ageing neck.
affect each layer differently, a multidimensional assessment is essential for designing precise treatment strategies6.
Skin
The neck skin differs significantly from facial skin in its anatomical composition, directly influencing both the aesthetic and functional attributes of the neck7. It is thinner (approximately 80% the thickness of cheek skin), with fewer and less active sebaceous glands, and a relatively weaker epidermal barrier, making it more vulnerable to environmental insults8. The frequent movements of the neck—turning, flexing, and stretching—subject the skin to continuous dynamic tension, accelerating the degeneration of dermal collagen and elastic fibres9. From an aesthetic standpoint, the condition of neck skin is a major determinant of perceived youthfulness: smooth, firm, and evenly toned skin appears more youthful and healthy. However, with ageing-related loss of dermal collagen and degenerated elastin, skin elasticity diminishes and laxity increases, leading to surface roughness and the development of horizontal neck lines. These changes further contribute to the overall aged appearance of the neck10.
Subcutaneous fat
Subcutaneous fat plays a vital role in both the aesthetic appearance and functional structure of the neck. Anatomically, it is divided into superficial fat (located
YUXIAOXIAO LUO, MD; YONG LIAO, MD; Department of Medicine, Bloomage Biotechnology Corporation Limited, Beijing 100000, China
Neck rejuvenation is not a one-time procedure—it requires a personalised, multi-layered strategy that blends anatomical precision with long-term patient care.
between the platysma and skin) and deep fat (beneath the platysma, adjacent to the deep fascia)11. These fat compartments are interconnected by fibrous septa, forming a complex three-dimensional network that supports and cushions the cervical soft tissues. With ageing, superficial fat volume tends to diminish, resulting in skin laxity and deepened wrinkles, whereas deep fat may accumulate and sag, distorting the neck contour12 Furthermore, age-related redistribution of fat can lead to localised protrusions or depressions13. These changes often obscure the cervical profile, contributing to signs of ageing such as the formation of a 'double chin.'
Superficial musculoaponeurotic system (SMAS)
The cervical SMAS, situated between the skin and the deep fascia, comprises loose connective tissue and the platysma muscle. It envelops the platysma and connects with the deep cervical fascia, transmitting forces through fibrous septa that link the skin, fat, and muscle layers, thereby maintaining dynamic contour stability. Vertical fibrous septa, oriented perpendicularly to the skin, provide structural linkage and tensile transmission between the SMAS and platysma14. These structures also form the anatomical basis for wrinkle development. In youth, the SMAS is compact and elastic, enabling stable support and the smooth gliding of soft tissues. With age, these septa undergo asynchronous degeneration and laxity, weakening the support capacity of the SMAS. As a result, superficial fat, no longer adequately anchored, descends under gravity, blurring the cervical contour Simultaneously, isometric contraction of the platysma in specific regions may cause localised thickening and stiffness, further compromising the contour and promoting platysmal band formation tight coupling between the skin and SMAS also contributes to dynamic wrinkle formation during muscle contraction. Additionally, loss of coordinated fascia-muscle tension increases compensatory tension in the platysma, which exacerbates thickening and rigidity, further disrupting neck contour definition. Aesthetically, the support strength of the SMAS and volume integrity of the fat layer jointly determine the surface smoothness and firmness of the neck. When the superficial fascia and fat support are inadequate, extensive laxity and indistinct contours may occur. Repetitive platysmal motion amplifies this effect, resulting in visible platysmal bands and loss of cervicomental angle definition, which compromise the youthful appearance of the neck.
Skeletal muscles
support cervical spine posture, and assist vital functions such as swallowing and respiration. Balanced muscular tension and coordination are essential for maintaining harmonious cervical and mandibular contours. Hypertrophy or atrophy of specific muscle groups can lead to imbalances in dynamic and static cervical profiles 17. The SCM, which runs along both sides of the neck, is one of the largest cervical muscles and critically shapes the lateral cervical contours. Together with the platysma, it forms a crisscross dynamic zone; their tension dynamics significantly affect contour aesthetics. The broad, flat trapezius connects the skull, cervical spine, and shoulders, playing a key role in posture and the posterior cervical contour. Chronic tension in this muscle can cause rigid cervical-shoulder transitions and visually unappealing bulges. With ageing, muscular remodelling includes fibre hardening, loss of elasticity, and decreased regulatory capacity, manifesting as blurred contours and harsh cervical-shoulder transitions18. Additionally, age and lifestyle factors contribute to the increasing prevalence of forward head posture (FHP), characterised by weakened deep flexors and hyperactive superficial extensors19. This results in excessive cervical lordosis and compensatory pain syndromes. Such postural degeneration is both a consequence and an accelerator of cervical muscle ageing, further degrading the neck's aesthetic profile20
Deep fascia
The cervical musculoskeletal system comprises both superficial muscles such as the sternocleidomastoid (SCM) and trapezius and deep flexor muscles (e.g., longus colli, longus capitis, and rectus capitis anterior and posterior). These muscles maintain head movement,
With ageing, muscular remodelling includes fibre hardening, loss of elasticity, and decreased regulatory capacity, manifesting as blurred contours and harsh cervicalshoulder transitions.
The deep cervical fascia is a dense connective tissue layer that encases deep neck structures and is divided into three components: the superficial layer (surrounding the SCM and trapezius), the visceral fascia (enveloping the trachea, oesophagus, thyroid, and other viscera), and the prevertebral fascia (covering the cervical vertebrae and deep muscles). These fascial layers anchor muscles, nerves, and vessels, while also allowing intertissue gliding. In youth, the fascia is taut and elastic, stabilising fat compartments and maintaining proper muscular alignment, thereby shaping cervical posture and contour. However, with ageing and cumulative mechanical stress, the fascia loses elasticity and becomes fibrotic, compromising its supportive function21. This fascial relaxation facilitates fat displacement and sagging, deepening cervical grooves and blurring contours. Furthermore, SMAS and muscular degeneration interact with fascia ageing: loss of deep fascial tension reduces platysmal support, promoting platysmal banding, and insufficient deep fascial anchorage of the SMAS accelerates superficial tissue sagging22.
Skeletal structures
The cervical spine and mandible form the bony framework of the neck, playing essential roles in supporting cranial
weight, protecting the spinal cord, and maintaining postural alignment. Aesthetically, the curvature and alignment of the cervical vertebrae determine neck length and posture, while the structural composition of the mandibular margin affects the cervicomental angle and contour clarity. Under normal conditions, a well-defined mandibular border and physiological cervical lordosis contribute to a smooth cervical profile. With ageing or poor posture, the spine and joints may undergo degenerative changes straightening or excessive anterior curvature of the cervical spine and protrusion of the seventh vertebra are common23. Mandibular bone resorption may cause chin retraction or mandibular angle blunting. These changes reduce the skeletal support for overlying tissues, resulting in disproportionate neck dimensions, anteriorly displaced curvature, blurred mandibular borders, and loss of cervicomental angle definition24. The combined effects of cervical spine anterior shift, mandibular retraction, fascial laxity, and muscular atrophy compound the ageing appearance of the neck.
Interplay between tissue layers
Neck ageing is a complex process where the degeneration of one layer exacerbates changes in others through mechanical and structural interdependence. For instance, the loss of foundational support from deep fascia and skeletal structures weakens the entire soft-tissue envelope21,24. This compromised deep support, combined with the laxity of the SMAS, accelerates the descent of subcutaneous fat and promotes the formation of platysmal bands15,22,26. Consequently, the overlying skin, which is already predisposed to collagen loss, develops more pronounced wrinkles and laxity10,25 Similarly, postural shifts, such as forward head posture (FHP), create chronic tension in superficial muscles, further altering the neck's contour and mechanical balance19,20. Therefore, singlelayer interventions often yield suboptimal results; only a multi-layered therapeutic strategy that addresses these interactions
Neck ageing is a complex process where the degeneration of one layer exacerbates changes in others through mechanical and structural interdependence.
Figure 1
Zonal classification of the neck with the AQUALUNA NEXT-Plus approach. The neck is subdivided into three functional and aesthetic regions based on anatomical landmarks that form 'N' and 'X' shapes from a lateral view. This figure highlights the X-dynamic zone (blue), which corresponds to the 'X'-shaped intersection of the platysma and sternocleidomastoid (SCM) muscles, as well as the posterior (red) and anterior (yellow) cervical zones.
can achieve comprehensive aesthetic and functional restoration.
Core concept of the AQUALUNA NEXT-Plus Approach
The AQUALUNA NEXT-Plus methodology establishes a standardised clinical pathway for addressing the multilayered and region-specific changes of neck ageing. It integrates quantifiable evaluation with targeted treatment strategies grounded in aesthetic anatomy.
The approach subdivides the neck into three functionally and aesthetically relevant regions based on key anatomical landmarks. From a lateral view, the contours of the neck resemble the letter 'N,' while the platysma and sternocleidomastoid (SCM) muscles form an 'X'-shaped intersection. Based on these patterns, the neck is divided into the anterior cervical zone, the X-dynamic zone, and the posterior cervical zone (Figure 1).
These zones differ markedly in structural composition, ageing mechanisms, and clinical presentation, thus requiring tailored assessment models and targeted treatment strategies. Based on this regional division, the approach further overlays a vertical layering model encompassing the dermis, subcutaneous fat, SMAS, muscular layer, deep fascia, and bony support structures. This dual-axis diagnostic pathway (anatomical zone × vertical layer) establishes a system to identify the main ageing mechanisms and phenotypes associated with each layer combination.
For the anterior cervical zone, the diagnostic pathway addresses its unique anatomy, which includes thin skin, attenuated SMAS, and limited muscular support. These features contribute to clinical signs like deep static neck wrinkles, skin laxity, and a blunted cervicomental angle, primarily affecting the skin, fat, and SMAS layers. Evaluation in this area prioritises assessing wrinkle depth, skin texture, and the contour of the cervicomental angle. The corresponding treatment direction focuses on dermal matrix remodelling and restoring superficial fat volume to improve horizontal wrinkles, overall skin quality, and contour clarity.
In the x-dynamic zone, which is covered by the
Table 1 NEXT-Plus Neck Ageing Severity Scoring System
LAYER / FEATURE SCORE
Skin –
Neck Wrinkles
GRADING CRITERIA
0 No horizontal neck wrinkle is visible at any angle
1 Mild: Superficial horizontal neck wrinkles visible only at 0°; completely improved at 45° head tilt.
2 Moderate: Visible horizontal neck wrinkles at 0°; partially improved at 45° head tilt; completely improved at extreme head tilt.
3 Severe: Deep horizontal neck wrinkles visible at 0°; no significant improvement at 45° head tilt; partially improved at extreme head tilt.
4 Extremely severe: Visible horizontal neck wrinkles at all angles; no significant improvement in dynamic evaluation, with obvious laxity.
Skin –
Overall
Ageing
Fat Distribution
0 Firm, elastic, evenly toned skin with healthy glow
1 Slight elasticity loss; even tone; minor dryness
2 Noticeable elasticity loss; rough texture; uneven tone
3 Poor elasticity, coarse texture, pigmentation
4 Severe laxity, coarse texture, obvious signs of photodamage
0 Even, moderate volume; clear contour and cervicomental angle
1 Mild accumulation or loss; contour largely preserved
2 Local bulges or depressions; mildly irregular contour
3 Obvious sagging or uneven fat; noticeable contour disruption
4 Fat bulging or tissue ptosis; blurred cervicomental angle
SMAS Function 0 Firm fascia; stable soft tissue support
1 Slight superficial laxity; no soft tissue distribution
2 Apparent fascia laxity with mild soft tissue distribution
3 Reduced support with visible platysmal bands or localised depression
4 Severe SMAS laxity or rupture; obvious platysmal protrusion and sagging
Platysma
Muscle 29
0 No visible platysmal bands at rest or during dynamic movement; neck contour remains smooth and uninterrupted.
1 Mild, transient platysmal bands visible only during forceful contraction (e.g., neck extension); absent at rest.
2 Intermittent platysmal bands evident during routine activities (e.g., swallowing, speech); minimal elevation from surrounding tissue; resolve at rest.
3 Persistent bands visible at rest, extending vertically along the anterior neck; clearly accentuated with motion; associated with early distortion of cervicomental definition.
4 No visible platysmal bands at rest or during dynamic movement; neck contour remains smooth and uninterrupted.
Skeletal Support 0 Normal cervical curvature; clear mandibular support
1 Slight vertebral shift or curvature straightening
2 Mild support loss; blurred cervicomental angle
3 Chin retrusion or cervical lordosis; distorted proportion
4 Severe degeneration; structural collapse; visibly aged contour
platysma and SCM muscles, the key ageing features are related to its high mobility and weak superficial fat support. This leads to progressive dynamic wrinkles and visible platysmal bands, with the fat, muscle, and SMAS layers being most affected. The evaluation, therefore, emphasises dynamic changes, such as platysmal contraction and its effect on the neck contour during movement. The therapeutic strategy is centred on focused neuromuscular modulation and SMAS reinforcement to relieve bands and dynamic wrinkles, ultimately restoring contour harmony.
Finally, the posterior cervical zone is characterised by a thick trapezius muscle, well-developed fascia, and the effects of long-term postural load. Key clinical signs, which primarily involve the muscle and bone layers, include localised fat accumulation, trapezius hypertrophy, and abnormal cervical spine curvature. Assessment priorities are the smoothness of the posterior contour and the morphology of the trapezius. Treatment is directed at relieving muscle tension, adjusting fat distribution, and refining the trapezius contour to restore a natural transition from the neck to the thorax.
In addition, the NEXT-Plus approach integrates the three essential clinical stages evaluation, intervention, and maintenance into a systematic pathway. Targeted treatments are implemented based on accurate assessments, and the results are further enhanced and stabilised through scheduled post-treatment maintenance. This model elevates neck rejuvenation from localised correction to comprehensive reconstruction, achieving structural restoration, functional recovery, and aesthetic refinement.
The therapeutic strategy is centred on focused neuromuscular modulation and SMAS reinforcement to relieve bands and dynamic wrinkles, ultimately restoring contour harmony.
Implementation pathway of the NEXT-Plus approach
N: Neck identification and attribution of neck ageing features
The 'N' stage involves identifying specific manifestations of neck ageing and their anatomical origins. These are broadly classified into two categories:
■ Static ageing manifestations: these features, such as horizontal neck wrinkles, skin laxity, and pigmentation, are visible at rest and reflect progressive structural deterioration from factors like collagen depletion and loss of deep tissue support27
■ Dynamic features: these signs, including platysmal bands and dynamic wrinkles, emerge during movement or expression and are caused by muscle activity and biomechanical stress28.
This classification serves as the basic diagnosis for the next steps, where these features are linked to specific areas and layers of the anatomy.
■ Anterior cervical zone: characterised by thin skin and minimal muscular support, it is highly susceptible to static signs such as deep horizontal wrinkles, skin laxity, uneven pigmentation, and a blunted cervicomental angle due to prolonged mechanical strain and photoaging
■ X-dynamic zone: located at the intersection of the platysma and SCM, this area endures high dynamic loads. Reduced and uneven superficial fat, coupled with frequent motion, results in platysmal banding, dynamic-to-static wrinkle transition, and contour blurring due to SMAS weakening and fat displacement
■ Posterior cervical zone: dominated by the trapezius muscle and rich in soft tissue. Chronic poor posture can lead to compensatory muscle hypertrophy and localised fat accumulation, causing posterior neck bulging, cervical lordosis, and disrupted cervicothoracic transitions.
This systematic analysis forms the diagnostic foundation for subsequent evaluation (E), x-zone analysis (X), and targeted treatment (T) stages.
E: Evaluation — quantitative assessment
Because traditional neck assessment methods often lack objectivity, the 'E' phase introduces a regional, layered, and dynamic evaluation system. This approach ensures a holistic understanding of ageing patterns and facilitates standardised, repeatable assessments.
A 0–4 scoring system is used to grade the severity of
key ageing features across five anatomical layers. The detailed grading criteria are presented in Table 1
To support this quantitative grading, a static visual grading atlas was also developed (Figure 2). This imagebased guide provides a consistent reference for assessing skin laxity, contour blunting, and platysmal banding.
X: Zonal analysis
Following identification (N) and quantitative evaluation (E), the 'X' stage analyses the unique ageing profile of each cervical zone to guide precise, multi-layered intervention.
Anterior cervical zone
The anterior cervical zone, extending from the submental region to the supraclavicular fossa and bounded by the anterior borders of the platysma, is anatomically vulnerable to early ageing due to the absence of superficial muscular coverage. In this region, the skin, subcutaneous tissue, and SMAS are closely adherent, lacking intervening structural buffering. The skin is notably thin with diminished sebaceous and sweat gland density, which impairs barrier function and increases susceptibility to environmental stressors such as dryness, photoaging, and gravity. Beneath the skin, submental fat pads are often present particularly above the hyoid bone but these fat compartments are poorly supported by muscular structures, making them prone to age-related atrophy or positional redistribution. The SMAS in this zone is underdeveloped, providing limited tensile resistance or lifting capacity, while the underlying deep fascia demonstrates weak elasticity and minimal bony anchorage. Functionally, this region lacks active superficial musculature; only deep suprahyoid muscles transmit limited biomechanical forces during swallowing or phonation. Consequently, repetitive cervical flexion and extension accelerate skin degeneration and contribute to the early formation of static horizontal neck wrinkles.
Typical signs: Dermal collagen loss leading to laxity and deeper neck wrinkles; dry, coarse, and dull skin tone; submental fat atrophy/displacement forming a double chin; mandibular retraction resulting in cervicomental angle blunting.
Assessment priorities: Neck horizontal wrinkle severity, skin elasticity and firmness, fat distribution, and cervicomental angle definition.
X-dynamic zone
Because traditional neck assessment methods often lack objectivity, the 'E' phase introduces a regional, layered, and dynamic evaluation system.
The x-dynamic zone encompasses the lateral neck and cervicomandibular transition area, anatomically defined by the overlapping distribution of the platysma and the SCM. This region serves as the central axis of cervical dynamics, enabling neck rotation, flexion, lateral bending, and various expressive movements. Structurally, it is a multi-layered zone with distinct anatomical and biomechanical characteristics. The skin is moderately thick and tightly adherent to the superficial fascia, while the superficial fat layer is sparse, irregularly distributed, and continuous with adjacent submandibular and submental fat compartments. Deep fat compartments in this region provide foundational support to the
Figure 2 AQUALUNA NEXT-Plus Visual Grading Atlas for Cervical Ageing
A four-row visual guide illustrating standardised static grades (0–4) for skin laxity (Row 1), cervical contour in frontal (Row 2) and lateral (Row 3) views, and platysmal banding (Row 4). This visual aid supports rapid assessment and enhances consistency in ageing severity grading.
cervicomental angle. The SMAS is relatively welldeveloped, featuring dense fibrous septa that anchor the skin, subcutaneous fat, and platysma, contributing to baseline tissue tension. Functionally, this zone is subject to frequent contraction of the platysma and SCM during neck motion and facial expression, making it highly susceptible to the development of dynamic vertical bands and tension-related wrinkles. With ageing, platysmal contractions become disorganised, fascial tone diminishes, and fat redistribution contributes to surface irregularities. These alterations collectively result in visible banding, dynamic wrinkles, and blunting of the cervical contour. Over time, a compensatory mechanism may form between fascial fatigue and hyperactive platysmal engagement, leading to localised thickening, stiffness, and progressive disruption of cervicomandibular harmony.
Typical signs: Platysmal bands, transformation of dynamic wrinkles into static wrinkles, mandibular contour blurring, soft tissue descent, submental fat accumulation or atrophy.
Assessment priorities: Platysmal band severity, wrinkle progression, fat volume, and cervicomandibular contour smoothness.
Posterior cervical zone
The posterior cervical zone extends from the seventh cervical vertebra (C7) to the occipital bone, bounded vertically between the posterior hairline and the cervicothoracic junction. This region is covered by the trapezius muscle and plays a foundational role in supporting head posture and spinal alignment. Functionally, it is largely static and independent of facial expression. Structurally, it is the most biomechanically stable cervical zone. The skin is thick, rich in sebaceous and sweat glands, and highly resistant to friction, shear forces, and gravity. Subcutaneous fat pads are physiologically prominent especially along the midline and contribute to the natural fullness of the posterior neck. The superficial fascia is tightly integrated with the deep fascia, encasing the trapezius and anchoring the soft tissue envelope. Although this zone ages more slowly compared to anterior and lateral regions, chronic postural imbalances such as forward head position or thoracic kyphosis can lead to compensatory trapezius hypertrophy, localised fat accumulation, abnormal cervicospinal curvature, and a shortened or broadened posterior neck contour, thereby compromising overall cervicocranial aesthetics.
Table 2 Treatment strategy for the Anterior Cervical Zone
STRUCTURE MANIFESTATION ASSESSMENT TREATMENT
Dermis
Horizontal static neck wrinkles, partially reversible on extension
Skin roughness, laxity, uneven tone
Subcutaneous Fat Cervicomental angle blunting, submental volume loss
Bony Support / SMAS Blurred mandibular and submental contour
Line depth, width, and improvement at dynamic states
Texture, elasticity, hydration, and chromophore distribution
HA composite injection (intradermal and subcutaneous) and injectable Collagen (Type I/III) for direct line filling and scaffolding.
Non-crosslinked HA (skin boosters) for deep hydration and elasticity; IPL, laser, HA solution, collagen biostimulators, autologous PRP/ PRF, or chemical peels (for texture and tone); RF or HIFU for laxity; laser, chemical peels or mesotherapy for pigmentation
submental fat accumulation and hollowness, contour transition
Definition of mandibular line and cervicomental angle
Low-crosslinked HA and HA composite injection (subcutaneous); deoxycholic acid for volume reduction and reshaping
Crosslinked HA filler (supraperiosteal), thread lift for mechanical suspension and structural support
To address the various signs of neck ageing, different therapeutic modalities are selected based on their ability to target specific anatomical layers and concerns.
The 'T' stage translates the diagnostic findings from the N-E-X framework into a 'Zone-Layer-Therapy' pathway. This ensures that the chosen therapeutic modalities precisely target the identified ageing manifestations in each anatomical region and layer for optimal efficacy and safety. To address the various signs of neck ageing, different therapeutic modalities are selected based on their ability to target specific anatomical layers and concerns. For static wrinkles and contour abnormalities, several injectable options are available. Crosslinked hyaluronic acid (HA) fillers are used for dermal filling of deep lines and for providing structural support to improve the mandibular contour. Similarly, injectable collagen can directly fill wrinkles while providing a scaffold for neocollagenesis30. To improve overall skin quality, including texture, dryness, and fine lines, non-crosslinked HA products enhance deep dermal hydration, while HA composite solutions contribute to collagen induction and skin brightening31. Autologous options like platelet-rich plasma (PRP) and plateletrich fibrin (PRF) also refine texture by stimulating collagen and may help modulate pigmentation31,33 Dynamic concerns, such as
platysmal bands, are primarily treated with botulinum toxin (BoNT-A), which relaxes the platysma muscle34,35 BoNT-A is also used to regulate the tone of the platysma and trapezius muscles to improve contour. For long-term structural improvement, collagen biostimulators (such as PLLA, PDLLA, and CaHA) are used to regenerate dermal collagen, which helps treat static wrinkles, refine texture, and improve contour by adding support to dermal and
STRUCTURE MANIFESTATION ASSESSMENT TREATMENT
Skin Quality Reduced skin elasticity, firmness, resilience and wrinkles due to the degeneration of collagen and elastic fibers from frequent movement
Platysma Muscle Visible platysmal bands at rest or during movement
Addressing the complex ageing in the anterior neck requires a multi-layered combination approach. The targeted strategy for each structure is detailed in Table 2
X-dynamic zone: Muscle modulation, structural support, and contour refinement
Treatment in this zone targets both functional (muscle activity) and structural (SMAS, fat) ageing issues to restore lateral neck harmony, as detailed in Table 3
Posterior cervical zone: Releasing tension, balancing fat, and restoring posture
Intervention in this region focuses on releasing compensatory muscle tone and refining posterior contours (Table 4).
Guidance for clinical pathway design
During clinical implementation, the following principles are recommended:
■ Define primary complaint: Initiate treatment in the region of greatest patient concern most commonly the anterior or x-dynamic zone.
■ Prioritise based on assessment: Focus on structures or layers with the highest ageing score for initial intervention.
■ Match therapy to zone and related layer: Combine techniques appropriate for both the anatomical region and ageing mechanism. Ensure primary issues are addressed while considering secondary manifestations. In conclusion, each treatment modality targets regionrelated, specific layers and concerns. Effective rejuvenation requires customised combinations based on patientspecific ageing features. The NEXT-Plus approach advocates using the N-E-X-T model to integrate modalities for region- and layer-specific synergy. For same-day combination therapy, commonly energy-based noninvasive treatments are applied first, followed by injectable procedures. In staged approaches, deep structural correction should precede superficial refinements.
Conclusion
In clinical application, the formulation of a personalised treatment plan should incorporate individual patient characteristics including age, sex, lifestyle and genetic predisposition, even the culture. The NEXT-Plus approach advocates for the integration of clinical expertise with aesthetic judgment, aiming to deliver tailored therapeutic strategies that address both objective anatomical concerns and subjective patient aesthetic expectations. Moreover, neck rejuvenation is not a one-time procedure; rather, it typically requires a series of treatments combined with ongoing maintenance to achieve and sustain optimal
Table 3 Treatment strategy for the X-Dynamic Zone
outcomes. In this context, effective communication and mutual trust between the physician and the patient are essential. Physicians should thoroughly explain the proposed treatment plan, anticipated results, and potential risks. At the same time, patients must be wellinformed about the treatment process and actively participate by adhering to medical advice and engaging in appropriate post-treatment care.
In summary, the AQUALUNA NEXT-Plus approach offers a comprehensive and effective strategy for neck ageing through a scientifically grounded evaluation framework, precise zone-specific treatment, and personalised therapeutic design. With the continuous advancement of medical technologies and the evolution of aesthetic principles, the field of neck rejuvenation is poised to witness the emergence of
References
The field of neck rejuvenation is poised to witness the emergence of increasingly innovative approaches increasingly innovative approaches—ultimately delivering safer, more efficient, and more comfortable treatment experiences for patients.
Declaration of interest The authors of this manuscript are employed by Bloomage Biotechnology Corporation.
Key points
The AQUALUNA NEXT-Plus approach integrates anatomical and functional assessment across five tissue layers (skin, fat, SMAS, muscle, bone) to comprehensively evaluate neck ageing.
The neck is divided into the anterior, X-dynamic, and posterior cervical zones, each with distinct ageing patterns requiring zone-specific evaluation and treatment strategies
This model—Identify (N), Evaluate (E), Zonal Analysis (X), and Treatment (T)—enables precise, custom-tailored rejuvenation plans using injectables, neuromodulators, and devices
Outcomes depend on tailored interventions, structured maintenance, and strong physicianpatient communication, making this a comprehensive solution for neck rejuvenation
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“The portfolio makes it easy to customise the technology for whatever your needs may be. It’s a win-win.”
Harley Street in
ETHEREA-MX®
handPICO®
ProDeep®
DualMode®
PROMOTION
London. We have been using the ETHEREA MX® from VYDENCE for over a year now. I find it to be very effective for treating acne, acne scars, rosacea, melasma, photoaging, as well as tightening and laxity. The benefits of speed and efficiency in our busy international practice have been exceptional.
Our doctors and nurses can treat our diverse patients who come from all over the world with this system. It offers excellent, long-lasting results with minimal downtime, which is what our patients are looking for. The system is very versatile and offers good value for practices.
The VYDENCE system offers many options to meet our patients' needs, and the results we can achieve with this system are impressive.
Tess Mauricio, MD, FAAD, M Beauty Clinic by Dr. Tess, San Diego, CA, USA
We love VYDENCE ProDeep for hair, alone or in combination with our hair protocols. The VYDENCE ProDeep device offers a novel 1340 nm wavelength that targets deep in the scalp non-invasively to stimulate the hair follicles, increase circulation, and aid in hair restoration.
We educate all our hair loss patients about VYDENCE ProDeep treatments. We have seen it help patients with androgenetic alopecia, telogen effluvium, traction alopecia, hair loss associated with weight loss medications, and alopecia areata.
Many of our aesthetic patients seeking skin treatments are also interested in hair restoration. We can now treat their skin and hair very effectively. We have expanded our offerings and increased patient loyalty and satisfaction, which results in more referrals. There is a lot of interest in hair treatments from patients. It makes us feel good to be able to help patients regain confidence and improve their quality of life with these hair restoration treatments.
Michael Gold, MD, Gold Skin Care, Nashville, TN, USA
The compact systems we have seen from VYDENCE are impressive. They are very affordable and make a great choice for small practices and medical spas. The systems are also ideal for all practitioners and to delegate to nurses, aestheticians, and medical assistants who are just starting to use laser technology.
The reasonable pricing and exceptional engineering make these systems efficient, affordable, and safe in the hands of even first-time laser users. The handpieces are compact, which makes them easy to store and use, especially for small areas on the face and body. The smaller units are also helpful to use for the face, neck, chest, hands, hairline, legs and scalp with ease.
We have found the engineering of the VYDENCE portfolio to be highly effective and versatile to deliver excellent results for our patients.
Suneel Chilukuri, MD, FAAD, FACMS, Refresh Dermatology, Houston, TX, USA
I describe VYDENCE as the ‘Lexus of Lasers’ — their technology team has taken the best of each category of lasers and light-based devices, removed the pain points, and made the devices extremely effective and reliable.
The advantage of the current VYDENCE devices is the ability to customise each device to match your patient's needs. Their portfolio includes eight handpieces and four laser fibres for a wide range of treatments with the ability to treat erythema, pigmentation, actinic damage, photoaging, and hair. Best of all is the affordable device and handpiece pricing with no post-purchase consumables or hidden costs. Some highlights of the portfolio include a non-ablative 1340nm Er:YAP handpiece that optimises treatment of active acne, acne
scars, surgical scars, and skin rejuvenation. For further enhancement, one may choose to add the DualMode, an ablative Er:YAG that fires at two pulse energies to allow contraction of the skin while minimising downtime for the patient. As your practice expands, you may consider adding the handheld handPICO to address hyperpigmentation, including melanoma, lentigines, superficial seborrheic keratoses, and tattoos.
One of my new favourite handpieces is the LongPulse® Nd:YAG that allows me to treat deep and superficial vessels. I am now able to treat the periorbital veins that plague many of our maturing patients. Many practitioners start with one system with two or three handpieces and expand as their practice grows. The systematic, deliberate additions allow the practice owner to appropriately budget while meeting and exceeding patient expectations.
We have found the VYDENCE team to be very attentive and eager to help with training and assistance as needed. With several dedicated master trainers, VYDENCE customers are able to effectively use their systems with utmost patient safety. For a boutique practice like mine, it is important to note that the systems are compact and light, so they are easily moved from room to room as needed, which saves time and money.
I rarely recommend multi-use platforms to my colleagues as the devices end up being 'jacks of all trades but masters of none'. However, I commend the VYDENCE scientific team for creating powerful bases with well-engineered handpieces that provide excellent results. The portfolio makes it easy to customise the technology for whatever your needs may be. It’s a win-win.
Find out more at: www.vydence.com
ARIEL HAUS, MD , Dr Haus Dermatology, London, UK; TESS MAURICIO, MD, FAAD , M Beauty Clinic by Dr. Tess, San Diego, CA, USA ; MICHAEL GOLD, MD , Gold Skin Care, Nashville, TN, USA; SUNEEL CHILUKURI, MD, FAAD, FACMS , Refresh Dermatology, Houston, TX, USA
November 14-15, 2025
Prague Castle, Czech Republic
A E S T H E T I C
D I A L O G U E
Revolutionary, scientific concept of uniquely combining KOL speakers presentations alongside live injection treatments, live ultrasound demonstrations and live anatomy dissections all being combined to showcase aesthetic treatments and all happening simultaneously
The Aesthetic Dialogue 2025 will welcome an exceptional line-up of international speakers, bringing together leading experts from across the globe. Covering the latest advances in injectables, regenerative medicine, energy-based technologies, and surgical innovations, the programme offers delegates a unique opportunity to learn directly from pioneers shaping the future of aesthetic medicine. With diverse perspectives and extensive clinical experience, our speakers will provide both practical insights and forward- looking discussions, ensuring a rich and inspiring scientific exchange. The scientific programme has been meticulously curated to ensure the highest academic standards. Designed to foster critical exchange among leading experts and practitioners, the meeting provides a rigorous platform where science and clinical practice converge.
The Aesthetic Dialogue is expanding with the addition of a new exhibitor hall and the launch of the Innovation Stage This dedicated platform will highlight the latest technologies and industry developments, further strengthening the congress as a space for scientific exchange and innovation.
Prime Journal are warmly invited to attend the Aesthetic Dialogue Prague with an exclusive offer of €300 off the Main Symposium ticket. This exceptional opportunity provides access to two days of high-level scientific exchange within the prestigious setting of Prague Castle.
A MULTILAYERED APPROACH TO FACIAL AGEING: REJUVENATE FROM THE INSIDE OUT
A new era in facial rejuvenation begins with the powerful synergy of EMFACE and EXION. Together, they target every layer of the face, enabling personalised treatments that address the full spectrum of patient concerns at every age and stage of ageing
TODAY’S INFORMED
aesthetic patient knows that ageing is a complex, multilayered process — impacting everything from deep muscular support to dermal structure, and the skin’s surface. With this deeper understanding, patients are moving away from isolated, one-dimensional fixes and instead seeking holistic treatment solutions. They want non-invasive options that lift, smooth, firm, and restore radiance—delivering naturallooking results with minimal discomfort and little to no downtime.
Reflecting the ongoing shift toward personalised aesthetics, the synergy between EMFACE and EXION (BTL Industries) is not just effective it enables clinics to offer over 100 unique treatment combinations. With seven advanced facial procedures across both platforms, these technologies become exponentially more powerful when used in tandem, allowing practitioners to design truly individualised plans tailored to each patient’s facial needs.
Targeted action across all layers
EMFACE plays a crucial role in building a strong facial foundation by working deep beneath the surface. It's patented two-in-one technology specifically tones the elevator muscles and lifts the
connective tissue from within. The result is structurally enhanced, visibly lifted facial contours with volume repositioned to restore a more youthful appearance.
'EMFACE has completely changed the way we approach non-surgical lifting,' says Dr. Tristan Tan, the director and founder of Da Vinci Clinic, Malaysia. 'It builds muscle tone in a way that used to be achievable only with invasive techniques. The effect is subtle but transformative.'
EXION, meanwhile, delivers renewal and deep cellular stimulation across every layer of the dermis. By combining monopolar RF, targeted ultrasound, microneedling, and fractional resurfacing, each applicator is designed to act precisely on the epidermis, mid-dermis, and reticular dermis.
EXION addresses a wide range of skin concerns—from pigmentation and textural irregularities to deeper markers of intrinsic ageing.
EMFACE builds, while EXION refines
While EMFACE builds a firm foundation, EXION perfects the canvas. When used together, the technologies create comprehensive anti-ageing protocols that deliver both form and finish.
'EXION allows us to push the boundaries of skin regeneration,'
explains Miss Sherina Balaratnam, a UK-based surgeon and cosmetic doctor. 'It activates fibroblasts in a way I haven’t seen with other devices, leading to visible improvements in wrinkles, texture, and even hydration levels through endogenous hyaluronic acid stimulation.' By enhancing both muscular tone and skin function, this pairing enables clinics to offer more than just skin-deep solutions.
From prevention to restoration
One of the greatest advantages of combining EMFACE and EXION is how deeply they adapt to each person’s unique journey. Whether it’s the first signs of ageing in your 30s or more visible concerns like wrinkles, skin laxity, or sun damage later in life.
According to Miss Balaratnam, 'We can now tailor protocols across various age groups. Younger patients benefit from subtle contouring and prevention, while older patients see more dramatic rejuvenation. It’s a scalable system.' Protocols can be tailored to the individuality of each patient, depending on multiple and overlapping concerns and desired outcomes. By layering the treatments, clinicians gain new versatility in facial rejuvenation.
Efficiency, profitability, and loyalty
Beyond patient outcomes,
TRISTAN TAN, MD , founder and director Da Vinci Clinic, Kuala Lumpur, Malaysia; SHERINA BALARATNAM, MBBS, MRCS, MSC , Surgeon and Medical Director at S-THETICS, Beaconsfield, UK; INDIRA RIVAS, MD , aesthetic physician, Centro Europeo de Medicina Estética Nicaragua
EMFACE and EXION deliver significant business advantages. With over 100 facial treatment combinations, clinics can streamline treatment offerings while expanding revenue opportunities.
'From an operational standpoint, it’s one of the most intelligent investments we’ve made,' notes Dr Indira Rivas, clinic owner and aesthetic medicine specialist in Nicaragua. 'We saw a return on investment within months, but more importantly, our patients are thrilled and they keep coming back for more, discovering different procedures each time.'
The pairing enables bundled treatment packages that increase per-session value and foster repeat visits. Patients always begin the bundle treatments with EMFACE and follow up with EXION treatments that can be tailored to individual needs.
A complete solution for evolving aesthetic needs
Today’s patients want more than just results—they seek confidence, personalisation, a holistic approach, and a treatment plan that evolves with their needs. The combination of EMFACE and EXION delivers precisely that. Whether you already own one system or are considering your next technology upgrade, one thing is clear: together, EMFACE and EXION form the only solution designed to comprehensively rejuvenate all facial layers—from muscle to dermis to surface.
Find out more at: btlaesthetics.com
“The synergy between EMFACE and EXION is not just effective — it enables clinics to offer over 100 unique treatment combinations.”
Figure 1 (A) before and (B) 12 months after last treatment with EMFACE and EXION Clear RF. Photos courtesy of Chez Elaine.
Figure 2 (A) before and (B) 2 months after last treatment with EMFACE and EXION FRF. Photos courtesy of Dr Riekie Smit and Dr Natalia Novikova.
Figure 3 (A) before and (B) after fourth treatment with EMFACE and EXION Face. Photos courtesy of Dr Sherina Balaratnam.
ANATOMY-BASED FACIAL REMODELLING WITH MICRO-FOCUSED ULTRASOUND USING MP MODE
Ramon Tardin, MD, unveils a structured, multi-layered approach for precision lifting and submental contouring
FACIAL AGEING TYPICALLY presents in the form of sagging tissues, soft tissue descent, and submental fullness, particularly in the lower third of the face. These changes negatively impact aesthetic proportions, selfimage, and facial symmetry. For patients unwilling or unready to undergo invasive lifting procedures, non-invasive methods offering tissue contraction and contour definition have become increasingly popular.
Among energy-based devices (EBDs), micro-focused ultrasound (MFU) has been widely recognised for its ability to deliver thermal energy at precise depths, particularly at the level of the SMAS and subcutaneous fat. The micro-focused ultrasound (MFU) with MP (micro-pulse) mode
further enhances the capabilities of MFU by allowing denser thermal coagulation zones with controlled energy delivery, improving collagen remodelling and adipose tissue contouring without excessive discomfort or downtime1-4
This article introduces a layered, anatomy-based protocol using Ultraformer MPT (Classys®, Seoul, Republic of Korea) with Normal and MP mode, implemented in a female patient with complaints of lower-face laxity and submental fat. Emphasis is placed on targeting retro-ligamentous zones, using varied transducer depths and pulse densities, and tailoring treatment to facial anatomy. The outcomes demonstrate how the anatomical planning with MP mode energy delivery results in effective, safe, and reproducible facial remodelling.
Methods
Device and protocol
All procedures were performed using the Ultraformer MPT equipped with both Normal and MP mode cartridges. A layered energy delivery approach was employed, utilising 3.0 mm, 4.5 mm, and 6.0 mm cartridges for the lower face and submental region. The MP mode was selectively applied, especially in the submental and midface regions, to achieve higher pulse density without increasing energy output.
Patient selection
A female patient (age 47; Fitzpatrick types II–III) presented with varying degrees of lower-face sagging, loss of mandibular definition, and submental fat accumulation. The patient was evaluated and photographed using the VECTRA® H2 system (Canfield Scientific, Parsippany, NJ, USA) under standardised conditions. No anaesthesia was used, and informed consent was obtained for all procedures and clinical use of photographs.
Anatomical mapping and target zones
Prior to treatment, detailed anatomical mapping was performed to define safe zones and avoid critical neurovascular structures. Retro-ligamentous zones posterior to facial retaining ligaments, where tissue resistance is lower, were identified as key target regions. These zones are known to respond well to focused ultrasound and facilitate repositioning of sagging tissues by acting as vectors of contraction. Mapping was used to guide energy deposition with precision and reproducibility.
Case series summary
A 47-year-old female presented with mild skin laxity and moderate submental fullness. Treatment focused on layered energy application in the submental region using MP mode with the 6.0 mm cartridge,
followed by 4.5 mm and 3.0 mm cartridges to sequentially reach the subcutaneous fat and dermis. The midface was treated with half-normal, half-MP mode delivery, providing both structural lifting and dermal tightening. The patient reported mild discomfort (5/10) and transient oedema that resolved within 72 hours. At 60-day follow-up, jawline definition improved, with visible lifting of the midface.
Discussion
This series illustrates several key insights regarding the clinical application of MFU with MP mode:
The use of anatomical guidance allows the energy to be directed into low-resistance tissue planes that support facial repositioning. Retro-ligamentous zones respond effectively to MFU due to their capacity for thermal-induced contraction without compromising overlying structures.
Layered protocol with cartridge stacking
Layered application of 6.0 mm, 4.5 mm, and 3.0 mm cartridges facilitates three-dimensional tissue remodelling by sequentially targeting multiple anatomical layers, including the SMAS, deep fat, and dermis. This
MP mode enables high pulse density without aggression
Rather than increasing energy output, MP mode focuses on increasing the number of coagulation points, achieving better tissue contraction and adipose remodelling with lower risk of discomfort or side effects. The submental fat compartment, in particular, benefits from MP-mode selective lipolysis, yielding a more defined cervicomental angle with preserved overlying structure2,6,7
Safety and tolerability
All procedures were well tolerated in the absence of anaesthesia, with adverse effects limited to mild, self-limiting oedema. This underscores the safety profile of MFU when
anatomical planning and appropriate parameters are applied. Pain scores remained below 5/10, and adverse events were limited to mild in severity1,8,9
High patient satisfaction
Satisfaction score was between 9 and 10 out of 10. The patient perceived visible results after a single session and expressed willingness to undergo annual maintenance2,9,10
Conclusion
This case highlights the effectiveness and reproducibility of an anatomy-based protocol using micro-focused ultrasound with MP mode. The integration of retro-ligamentous targeting, layered energy delivery, and MP pulse density contributes to a multi-dimensional approach that addresses both soft tissue sagging and submental adiposity. By relying on shot count rather
“By layering energy and targeting retroligamentous zones, we achieved lifting, contouring, and collagen stimulation — all in a single, well-tolerated session.”
than high energy, this technique minimises pain and recovery time while maximising results. The outcomes support the use of MFU with MP mode as a clinically structured, patient-tailored, and safe method for facial rejuvenation, particularly in the lower face and neck region.
Reference
1. Kim JS, Lee K, Cho J, Oh Y. Three-dimensional analysis of lifting effects after high-intensity focused ultrasound (MFU with MP mode) across seven facial aesthetic units considering sonoanatomy. Plast Reconstr Surg Glob Open. 2024;12:e6203.
2. Ling J, Zhao H. A systematic review and meta-analysis of the clinical efficacy and patients’ satisfaction of micro-focused ultrasound (MFU) treatment for facial rejuvenation and tightening. Aesthetic Plast Surg. 2023;47(5):1806–23.
3. Alam M, White LE, Martin N, Witherspoon J, Yoo S, West DP. Ultrasound tightening of facial and neck skin: a rater-blinded prospective cohort study. J Am Acad Dermatol. 2010;62(2):262–9.
4. Wood E, Gonzalez A, Fletcher L, Belkin D. Comparing the safety and effectiveness of MFU-V: standard vs targeted tissue protocol in lifting the lower face and upper neck. J Drugs Dermatol. 2024;23(4):249–54.
5. Kerscher M, Reuther T, Buntrock H, Pier A, Bohrmann L. A systematic review of the clinical efficacy of micro-focused ultrasound for skin rejuvenation and
More than just a treatment modality, this protocol represents a scalable and teachable framework for practitioners aiming to achieve consistent, natural-looking results in aesthetic practice.
6. Khan I, Malik A, Abbas S, et al. A systematic review of the clinical efficacy of micro-focused ultrasound therapy for skin rejuvenation: evaluation of 10 full-text articles. J Cosmet Dermatol. 2021;20(3):123–30.
7. Al-Azuelos A, SidAhmed-Mezi M, La Padula S, Aboud C, Meningaud JP, Hersant B. High-intensity focused ultrasound: a satisfactory non-invasive procedure for neck rejuvenation. Aesthet Surg J. 2019;39(8):NP343–51.
8. Campo M, Hollander MHJ, Vissink A, et al. A systematic review of the efficacy of microfocused ultrasound for facial skin tightening. Int J Environ Res Public Health. 2023;20(2):1522.
9. Park H, Kim E, Kim J, Ko J. High-intensity focused ultrasound for the treatment of wrinkles and skin laxity in seven different facial areas. Ann Dermatol. 2015;27(6):723–9.
10. Fabi SG, Goldman MP. Retrospective evaluation of micro-focused ultrasound for lifting and tightening the face and neck. Dermatol Surg. 2014;40(6):569–75.
Figure 1 Patient treated with Ultraformer MPT using a layered protocol combining MP and Normal modes. At 60-day follow-up, visible midface lift and improved jawline definition were observed.
LENISNA: THE TRUSTED CHOICE FOR SAFE AND EFFECTIVE BODY VOLUMISING
As body contouring becomes more nuanced, LENISNA offers a scientifically advanced alternative to traditional fillers. Ernesto Perez, MD, outlines his detailed injection strategy and post-care tips for restoring volume and firmness after weight loss
For body contouring treatments, what factors lead you to select LENISA over other available options? When selecting a product for my patients, both efficacy and safety are paramount. LENISNA (Vaim Co., Ltd, Daejeon, Republic of Korea) has consistently fulfilled my expectations on both counts. I have been using LENISNA since 2018 and, remarkably, I have not experienced a single adverse event during that time. This safety profile gives me complete confidence in recommending it to my patients. In addition, the clinical outcomes are both reliable and effective. Unlike hyaluronic acid fillers, which sometimes require correction, LENISNA delivers consistent improvements without the need for adjustments. Another advantage is that antibiotics are generally unnecessary following treatment.
Could you briefly describe the patient’s condition prior to treatment, and your clinical goals with the chosen protocol?
The patient is a 38-year-old woman who has recently lost 7 kg with a semaglutide-based therapy, although she had not been overweight before. As a result, she experienced a noticeable reduction in fat and muscle mass in the buttock area. Her request was not for significant augmentation, but rather to restore the firmness and contour she had lost. My goal was to improve tone and shape while preserving a natural appearance.
Could you share your protocol in detail?
Injection sites were mapped with the patient both seated and standing. I first divided the buttocks into four quadrants by intersecting a horizontal and vertical line. Then, by asking the patient to perform a half squat, I was able to identify muscular movement and depressions, particularly around the ischium bone, that guided my injection points.
For this procedure, I used four vials of LENISNA. Each vial was reconstituted the day before with 5 cc of sterile water for injection (SWFI). Immediately prior to injection, I added 2 cc of 2%
lidocaine and 13 cc of SWFI, bringing the final volume to 20 cc per vial.
Injection distribution:
■ 20 cc into the upper lateral quadrant of each buttock
■ 12 cc at the point of maximum projection on each buttock
■ Complete phase 1 and phase 2 on one side first, then proceed to the other side in number order
■ 8 cc into areas of depression and cellulite on each buttock
■ All injections were placed in the subcutaneous layer.
Instruments:
■ 22 G, 7 cm cannula for the upper quadrant and projection points
■ 27 G needle for localised depressions and cellulite.
What tips or precautions would you recommend during or after the procedure?
Immediately after the procedure, we apply a plastic spray bandage and perform a light massage, demonstrating how the patient should repeat the massage 3 times daily for the next 3 days.
Key post-treatment recommendations include:
■ Avoid high-intensity exercise (e.g., squats) for at least 7 days
■ Use a cushion or float when sitting for long periods
■ Keep the skin well moisturised and manage swelling with cold compresses if necessary.
How did the patient respond to the treatment?
The patient was highly satisfied with the outcome. She understands that a second session may be beneficial, but even after the first procedure, the results were very positive. In a 30-minute session, with minimal discomfort and no social or professional downtime, she achieved a significant improvement toward her desired goals.
How do you foresee the future of LENISNA in the aesthetic field?
The outlook for LENISNA is extremely promising. VAIM, the manufacturer and distributor of both JUVELOOK and LENISNA, is deeply committed to research and development. Several clinical studies are currently underway, with scientific publications in preparation, as well as new product presentations being developed. LENISNA’s unique profile, combining safety, efficacy, and multiple mechanisms of action, is particularly noteworthy. Beyond stimulating collagen and elastin, it also influences stem cell activity and adipocyte modulation. These attributes position LENISNA as a leading product in regenerative aesthetics with a strong role to play in future treatment paradigms.
LENISNA
LENISNA represents the pinnacle of advanced hybridbiostimulators in the next generation of aesthetic medicine. LENISNA, injected subcutaneously, excels in generating a substantial amount of collagen, making it ideal for treating deep wrinkles, scars, nasolabial folds, and facilitating both facial and body contouring, as well as natural volume augmentation.
The key components of this biostimulator include PDLLA (poly-D, L-lactic acid) and hyaluronic acid. The PDLLA particles in LENISNA promote the proliferation and differentiation of ASCs. Mature adipocytes proliferate without increasing in size and stably engraft, thereby thickening the subcutaneous adipose tissue. As a result, LENISNA boosts subcutaneous adipose tissue, dermal collagen and elastin synthesis, improving skin
“I have been using LENISNA since 2018 and, remarkably, I have not experienced a single adverse event during that time.”
elasticity and volume. In addition, hyaluronic acid is a biocompatible gel carrier, providing an immediate hydrating effect at the injection site.
Find out more at: juvelook.com
Figure 2 (A) Before and (B) after treatment on the buttocks with LENISNA.
ANATOMY-BASED FILLER PLACEMENT IN THE TEMPLE USING E.P.T.Q.®: THE ROLE OF ULTRASOUND IMAGING
Edmond Lau, MD, explores how real-time ultrasound guidance and e.p.t.q.®’s tailored HA fillers combine to offer safer, more targeted aesthetic outcomes
Ultrasound anatomy of the temple
Depending on the literature you read, the temple region consists of 11 to 17 distinct anatomical layers2–4 with the most detailed ultrasound model identifying 17 layers3. For clinical purposes, it is sufficient to group these into 11 functional layers, relevant for planning ultrasound-guided filler injections.
These 11 layers are highlighted in Figure 1
Arterial structures in the temple
TEMPLE HOLLOWING IS one of the subtle yet defining signs of facial ageing. As volume diminishes in this area, patients may present with a sunken or gaunt appearance that alters the overall facial harmony. Aesthetic correction of this region requires not just volumisation but a precise understanding of the intricate anatomy, including the multilayered soft tissue structures and critical vascular orientation1. With the advancement of highresolution handheld ultrasound devices, clinicians now have access to real-time visualisation that significantly enhances both the safety and accuracy of temple filler injections.
The temple is a highly vascularised region, making a detailed understanding of its
vascular anatomy essential for safe filler injections. According to recent data, temple injections are the fifth leading cause of ocular complications after the nose, glabella, forehead, and nasolabial fold5
Several critical vascular structures run through the temporal region:
■ Deep temporal artery (branch of the maxillary artery) running near the bone within the temporalis muscle, often connecting with the zygomaticotemporal and middle temporal arteries, linking external and internal carotid circulations6,7
■ Superficial temporal artery and its frontal branch within
the superficial temporal fascia, anastomosing with the supraorbital and supratrochlear arteries
■ Middle temporal artery and vein within the superficial temporal fat compartment. Because the exact course of these vessels varies among individuals, Doppler ultrasound is critical both for pre-injection mapping and real-time guidance to minimise risks such as intravascular injection and hematoma.
Anatomy-based filler placement
Understanding temple anatomy is crucial for selecting the right plane for filler placement,
Figure 1 Ultrasound imaging of the temple region. Annotated image highlighting key layers of the temple, including (from superficial to deep): skin (epidermis and dermis), subcutaneous layer, superficial temporal fascia, innominate fascia - interfascial plane, superficial lamina of deep temporal fascia, superficial temporal fat pad, deep lamina of deep temporal fascia, temporal extension of buccal fat, temporalis muscle and bone.
optimising safety and aesthetics. Among multiple layers, three planes are commonly used: the supraperiosteal, interfascial, and subcutaneous. Each offers unique benefits, and the choice depends on patient anatomy and desired outcome. Selecting appropriate filler rheology is essential. The e.p.t.q.® (JETEMA, Co., Ltd., Republic of Korea) provides tailored formulations for different depths and indications.
e.p.t.q.® dermal fillers
e.p.t.q.® is a premium range of hyaluronic acid (HA) fillers produced under stringent quality standards aligned with the European Pharmacopoeia (EP). Thanks to advanced manufacturing processes,
“e.p.t.q.® is a premium range of hyaluronic acid (HA) fillers produced under stringent quality standards aligned with the European Pharmacopoeia (EP).”
e.p.t.q.® exhibits one of the lowest degrees of modification (MoD) among crosslinked HA fillers, with minimal residual BDDE and endotoxin levels, enhancing biocompatibility and safety8. Its unique rheological profiles are specifically designed to match various anatomical planes:
■ e.p.t.q.® Lidocaine S500: high G', strong cohesivity for deep
“With the advancement of high-resolution handheld ultrasound devices, clinicians now have access to real-time visualisation that significantly enhances both the safety and accuracy of temple filler injections."
structural support
■ e.p.t.q.® Lidocaine S300: balanced properties for both volumisation and subtle lift
■ e.p.t.q.® Lidocaine S100: softer, more elastic gel ideal for superficial contouring. These profiles enable customised, layer-specific
treatments with enhanced safety and precision.
Supraperiosteal plane
This plane lies directly above the bone and is the preferred destination for filler when addressing significant temple hollowing through the restoration
of foundational volume and structural support. e.p.t.q.® Lidocaine S300 or S500 is recommended. Injections should be performed using a needle with bolus placement on the periosteum, guided by an injection point (IP) scan to identify and avoid critical vascular structures.
Figure 2 Illustration of the major arteries in the temple region and the recommended e.p.t.q.® dermal filler for each injection plane.
Figure 3 Workflow for the Injection Point (IP) scan technique, illustrating the step-by-step process of performing the IP scan technique before filler injection.
PROMOTION
“Ultrasound-guided temple filler injection represents a significant advancement in enhancing precision and safety within this high-risk area.”
Interfascial plane
Situated between the superficial and deep temporal fascia, this plane is well-suited for soft volumisation. e.p.t.q.® Lidocaine S100 or S300 may be utilised. A cannula should be gently advanced along the fascial plane, depositing small aliquots in a retrograde fashion to achieve a smooth contour.
Subcutaneous plane
As the most superficial layer, this plane is indicated for minor contour refinement. e.p.t.q.® Lidocaine S100 is advised. A cannula should be introduced at the mid-zygomatic arch and advanced superficially, delivering small linear threads. In patients with very thin skin, this approach should be avoided to reduce the risk of the Tyndall effect and surface irregularities.
The use of ultrasound imaging in temple filler injection
Ultrasound imaging is a critical tool for enhancing the safety and precision of temple filler
Figure 6 Before and after treatment with e.p.t.q.® dermal fillers to the temple and forehead region. The images demonstrate improved contour following the use of e.p.t.q.® Lidocaine S300 in the temples and S100 in the forehead.
Figure 4 Colour Doppler ultrasound image showing the deep temporal artery located deep within the temporalis muscle, close to the bone. This artery may be at risk even when using a needle-on-bone supraperiosteal technique.
Figure 5 (A) Demonstrating the technique for interfascial plane injection. (B) Ultrasound image showing cannula placement within the interfascial plane.
injections. The IP scan involves marking the intended entry site and using ultrasound to confirm the absence of underlying vessels, which is particularly valuable for preventing vascular injury during supraperiosteal injections9.
Although performing a needle-on-bone technique at the Swift point (approximately 1 cm superior and 1 cm lateral to the temporal crest) or the T1/T2 points described in the MD Codes system is generally considered safe10,11, the deep temporal artery and zygomaticotemporal artery— branches of the ophthalmic circulation—may still course close to the periosteum6,7,9, posing a residual risk of intravascular injection.
References
1. Hong G-W, Wan J, Choi W, Yi K-H. An expert guide to anatomy-based filler injection for the temple: techniques and clinical insights. Life. 2025;15(2):266. doi:10.3390/life15020266
2. Kim SB, Hu H, Bae H, Yi KH. Anatomy of the temporal region to guide filler injections. Surg Radiol Anat. 2024;46(5):615–24. doi:10.1007/ s00276-024-03340-x
3. Kim JS. Efficacy, safety, and longevity of hyaluronic acid filler injection in treating temple hollowness by sonographic identifying
For interfascial and subcutaneous injections, real-time ultrasound-guided injection allows for accurate plane identification and filler placement, significantly reducing the risk of vascular compromise and improving treatment outcomes.
Clinical case: Realtime safety and precision
A 37-year-old female presented with moderate bilateral temple hollowing. Doppler ultrasound assessment was performed using the IP scan technique. The deep temporal artery was identified beneath the planned injection point. As a result, an interfascial approach was selected to contour the temple
5. Doyon VC, Liu C, Fitzgerald R, et al. Update on blindness from filler: review of prognostic factors, management approaches, and a century of published cases. Aesthet Surg J.
safely.
e.p.t.q.® Lidocaine S300 dermal filler was used for its balanced viscoelastic properties, ideal for both volume and contour enhancement. A total of 0.55 mL of S300 was injected on each side using a 23 G, 50 mm cannula. Ultrasound imaging was used to confirm cannula placement within the interfascial plane before administering the filler.
In addition, 1.1 mL of S100 was injected into the forehead using a 23G, 50 mm cannula to refine the forehead contour for a more harmonious profile.
The outcome was a smooth and natural-looking contour, and no complications were reported during or after the procedure.
2024;44(10):1091–1104. doi:10.1093/asj/ sjae091
6. Zhou YH, Chen CL, Luo CE, et al. Deep temporal artery anatomy: implications for improving the safety of deep temporal injections. Aesth Plast Surg. 2023;47:2045–50. doi:10.1007/s00266-023-03341-y
7. Bae H, Choi YJ, Lee KL, Gil YC, Hu KS, Kim HJ. The deep temporal arteries: anatomical study with application to augmentation procedures of the temple. Clin Anat. 2023;36(3):386–92.
Conclusion
Ultrasound-guided temple filler injection represents a significant advancement in enhancing precision and safety within this high-risk area. Real-time vascular visualisation allows for tailored injection approaches and optimised filler selection. The diverse rheological properties of e.p.t.q.® fillers support layerspecific outcomes, while techniques such as the injection point scan help avoid critical vessels, reducing complications. This integrated approach ensures natural, symmetrical outcomes with increased safety.
8. Issa MC, Fogaca A, Palermo E, Fontes M, Barud HS, Dametto AC. A new cohesive high-concentrated hyaluronic acid gel filler: correlation between rheologic properties and clinical indications. J Biomed Res Environ Sci. 2023;4(4):614–8. doi:10.37871/jbres1717.
9. Lee W, Moon HJ, Kim MS, Cheon GW, Yang EJ. Pre-injection ultrasound scanning for treating temporal hollowing. J Cosmet Dermatol. 2022;21(6):2420–5. doi:10.1111/jocd.14471
10. Carruthers J, Humphrey S, Beleznay K, Carruthers A. Suggested injection zone for soft tissue fillers in the temple. Dermatol Surg. 2017;43(5):756–7. doi:10.1097/ DSS.0000000000001057
11. de Maio M. MD Codes™: a methodological approach to facial aesthetic treatment with injectable hyaluronic acid fillers. Aesth Plast Surg. 2021;45:690–709. doi:10.1007/ s00266-020-01762-7
Figure 7 An overlapping image volume analysis showing noticeable volume restoration following e.p.t.q.® filler treatment, with S300 used in the temple region and S100 in the forehead.
RESTORING THE FOREHEAD ECM: AN ADVANCED STRATEGY FOR WRINKLE CORRECTION AND MYOMODULATION
Kolmakov Konstantin Sergeevich, MD, outlines a dual strategy combining precise intradermal filler placement with botulinum toxin to achieve natural-looking results, preserve facial expression, and minimise complications
FOREHEAD WRINKLES ARE one of the most common problems that patients seek help for from an aesthetic practitioner. Despite the visual simplicity of the problem, this area has several limitations. Firstly, the difficulty of working with collagen stimulators; secondly, the low response to isolated work with fractional radiofrequency (RF) lifting; and thirdly, the duration of rehabilitation after highintensity laser resurfacing. Using the correct strategy in forehead wrinkle correction allows the practitioner to obtain a pronounced effect in one procedure, while also increasing patient loyalty. The procedure should consist of two aspects:
■ Relaxation of the muscular system
■ Intradermal restoration of the matrisome and direct filling of wrinkles.
The first point is familiar to any specialist, but the second requires a special approach, particularly in the selection of medical devices and injection techniques. The ideal method utilises stabilised hyaluronic, which offers a triple benefit through its prolonged action in the tissues: it corrects wrinkles, restores dermal volume, and stimulates collagen synthesis. Unlike native hyaluronic acid, the modified form has a proven filling and collagen-stimulating effect1
I choose e.p.t.q.® (JETEMA, Co., Ltd., Republic of Korea) products due to their effectiveness and predictability. Manufactured by JETEMA, South Korea, they meet all modern quality standards of aesthetic medicine worldwide. The products achieve optimal crosslinking efficiency with minimised ballast or deactivated BDDE residues, while employing Downing Process technology to produce fine, uniform hyaluronic acid particles with a minimum size of 310 μm4. As a result, maximum effectiveness is achieved with minimal risks of hypercorrection due to the uniform distribution of the product in the dermis. At the same time, the duration of the
effect is maintained, despite the low MOD (modification).
The reinforcement technique using e.p.t.q.® Lidocaine S100 is an ideal option for restoring extracellular matrix (ECM) and improving skin texture. e.p.t.q.® Lidocaine S100 is a soft filler, formulated with 24 mg/mL HA and characterised by a low degree of modification (MoD ≈ 1.18%), a storage modulus G′ of approximately 48 Pa, and a viscosity of approximately 83 Pa·s (measured under manufacturerspecified conditions). This product is specially designed for fast and effective correction of intradermal wrinkles, folds, and relief irregularities.
With the linear-retrograde technique using a 30G × 13 mm needle, the injection vectors are positioned vertically relative to the eyebrows and are applied in a staggered pattern. The step
between vectors is 1 cm. The volume of the preparation on the forehead area is 0.4–0.6 ml. The procedure is shown in Figure 1. In the same session, intradermal microinjections of botulinum toxin type A (total 8–10 U; for example, 100 U reconstituted and administered fractionally) may be performed in combination with e.p.t.q.® Lidocaine S100 (0.4–0.6 mL).
Advantages of the vertical linear technique include a minimal number of intersections of large arteries and veins, and no risk of accumulation of the filler due to muscle activity with subsequent hypercorrection. It is critically important to maintain an intradermal injection depth and to release pressure on the syringe approximately 1 mm before withdrawing the needle. This practice helps prevent hypercorrection and reduces the
KOLMAKOV KONSTANTIN SERGEEVICH, MD, Cosmetologist, dermatologist deputy chief physician at COSMOPRO, Moscow, Russia
Figure 1 Injection of e.p.t.q.® Lidocaine S100 in the reinforcement technique.
“Using the correct strategy in forehead wrinkle correction allows the practitioner to obtain a pronounced effect in one procedure, while also increasing patient loyalty."
risk of compression-related ischemic complications.
After two weeks, we achieved the most pronounced results following a single procedure. Results of a clinical case are presented in Figure 2.
It is interesting to note that this procedure conserves the most natural pattern of facial emotions. Preservation of facial expressions is especially important for patients prone to swelling, as well as those with a decompensated excess skin flap in the upper eyelid area. A monoprocedure using botulinum toxin type A can lead to uncontrolled drooping of the eyebrows, which is negatively perceived by patients. At the same time, after the reinforcement procedure with a minimum intradermal dosage of botulinum toxin type A, facial
expressions remain preserved, as shown in Figure 3. In this case, the so-called myomodulation effect is formed with superficial injection of a soft filler, which is a 'shock absorber' for the muscle component3.
It is important to understand that in the forehead area, there is a huge number of both types of vessels deep and superficial (Figure 4)2. Therefore, in the case of injection into the subcutaneous fat tissue or a large deposition of the filler, there is a risk of vascular complications and compression-ischemic syndrome (Figure 5).
If you are a beginner, or if your patient has thin skin with a minimum amount of subcutaneous fat, we recommend performing procedures using skinbooster e.p.t.q.® hydro plus.
Figure 2 Relief in the forehead area before (A, C) and 2 weeks after the procedure (B, D).
Figure 3 Patient’s facial expressions before (A, C) and after the e.p.t.q.® Lidocaine S100 procedure with intradermal injection of neuroprotein (B, D).
Figure 4 Topography of vessels in the forehead area2.
PROMOTION
e.p.t.q.® hydro plus is a minimally stabilised hyaluronic acid (HA) skinbooster, containing 1.5% HA with a MoD of approximately 1.11%. The special physical and chemical properties of the filler allow the practitioner to perform forehead wrinkle correction treatments in a multi-papular technique specifically on the wrinkle without the risk of hypercorrection and vascular complications. At the same time, the effective degree of modification guarantees prolonged action and results after just one procedure.
The product is injected using a
30G x 4mm needle to the depth of the needle bevel (1–2 mm), with the injection continued until slight visual hypercorrection and gentle blanching of the skin are observed. Injections are placed without intervals, creating contiguous deposits to achieve uniform filling along each wrinkle. Due to the effective 'pushing' force, the consumption of e.p.t.q.® hydro plus is only 0.3-0.5 ml for all wrinkles in the forehead area. Additionally, the tubercle technique can be performed with small gaps between injections, using the needle bevel down to help restore the skin’s ECM. Injections are
shown in Figure 6.
As we said at the beginning of the article, the combination with muscle relaxation creates a synergistic effect, which creates a quick and long-lasting result. However, choosing the right skinbooster is crucial, as residual static wrinkles are common after botulinum toxin treatment.
The result of the procedure with e.p.t.q.® hydro plus in combination with botulinum therapy is shown in Figure 7. After just one procedure, there is almost a complete absence of wrinkles with smoother skin in the forehead area.
Conclusions
Correction of forehead wrinkles is an effective way for an aesthetic practitioner to make a name for themselves. If you choose the right stabilised hyaluronic acid, the patient gets an extremely fast effect, which is especially visually noticeable to others. This, first of all, increases loyalty to the specialist, and secondly, is an excellent starting point for the subsequent range of rejuvenating procedures. e.p.t.q.® Lidocaine S100 and e.p.t.q.® hydro plus have proven themselves as safe, highly purified, and effective fillers and
skinboosters based on stabilised hyaluronic acid.
If the patient has 'capacity' in the forehead area in the form of subcutaneous fat and a thick dermis, we recommend performing a reinforcement procedure using e.p.t.q.® Lidocaine S100. After the first session, patients note the restoration of skin relief and density, a decrease in the severity of wrinkles and, most importantly, maintaining facial expressions. If the patient has thin skin and a minimal amount of subcutaneous fat, there is a risk of vascular complications when working even with a soft filler. In this case, we use e.p.t.q.® hydro plus, which effectively corrects wrinkles in any skin type without the risk of hypercorrection and ischemia. A modern aesthetic practitioner, thanks to just two medical devices, has an effective arsenal for quickly and accurately eliminating forehead wrinkles.
1. Paliwal S, Fagien S, Sun X, Holt T, Kim T, Hee CK, Van Epps D, Messina DJ. Skin extracellular matrix stimulation following injection of a hyaluronic acid-based dermal filler in a rat model. Plast Reconstr Surg. 2014 Dec;134(6):1224-1233.
2. Cong LY, Phothong W, Lee SH, Wanitphakdeedecha R, Koh I, Tansatit T, Kim HJ. Topographic Analysis of the Supratrochlear Artery and the Supraorbital Artery: Implication for Improving the Safety of Forehead Augmentation. Plast Reconstr Surg. 2017 Mar;139(3):620e-627e.
3. de Maio M. Myomodulation with Injectable Fillers: An Innovative Approach to Addressing Facial Muscle Movement. Aesthetic Plast Surg. 2018 Jun;42(3):798814
4. College of Medicine Chung Ang University, 'Comparative analysis of rheological features of fillers.' 2017. Data on file
Figure 5 Clinical case of compression-ischemic syndrome 2 hours after the procedure (A), 3 days (B) and 10 days (C) with therapy.
Figure 6 e.p.t.q.® hydro plus injections: a combination of multi-papular (Black dots) and tubercle injection techniques (Light purple dots).
Figure 7 Clinical case of a patient before (A, C) and after the e.p.t.q.® hydro plus procedure in combination with botulinum therapy (B, D).
COD-LAGEN: REDEFINING SKIN LONGEVITY
PROMOITALIA AND E-FILLERS IN STRATEGIC COLLABORATION
A new chapter in skin longevity is here. Promoitalia’s COD-LAGEN delivers next-generation skin rejuvenation with unmatched purity and results. Through an exclusive collaboration, e-FILLERS is bringing this innovation to the EU and UK market, redefining how premium aesthetic products reach professionals
IN A MARKET WHERE innovation and clinical proof define the next big breakthrough, Promoitalia has once again raised the bar. The global leader in advanced aesthetic solutions introduced COD-LAGEN earlier this year, a professional-grade collagenbased treatment scientifically designed to promote skin longevity, restore elasticity, and deliver visible rejuvenation. Backed by an in-depth clinical study confirming its effectiveness and safety, COD-LAGEN is set to transform aesthetic protocols and beyond.
This launch carries even greater significance: e-FILLERS, the rapidly growing digital platform for distributing premium aesthetic and medical products to professionals worldwide, will serve as the exclusive distributor of COD-LAGEN across the EU and UK markets. This strategic partnership represents not just the arrival of a groundbreaking product but a reshaping of the dermal aesthetic distribution model.
The Science Behind COD-LAGEN
At the heart of COD-LAGEN is 70 mg of highly purified marine
collagen, meticulously extracted from arctic cod using the high purification chromatographic technique (HPCT). This advanced purification process isolates a highly specific R-polypeptide chain α-1, ensuring a molecular profile that delivers maximum biocompatibility, no need for allergy pre-testing, and extreme safety even for sensitive or reactive skin types.
Marine collagen is already recognised in the scientific community as the most bioavailable form of collagen. COD-LAGEN builds on this advantage by presenting the collagen in ultra-fine 170-micron powder form, which is diluted with sterile water before application. This optimised delivery system facilitates deeper dermal integration, allowing the product to interact efficiently with the skin’s extracellular matrix, stimulating new collagen synthesis and improving structural support.
The result is a product that not only enhances the skin’s appearance in the short term, with visible plumping and hydration after the first treatment, but also triggers long-term dermal regeneration, helping to reset the skin’s biological clock.
Why COD-LAGEN is a must-have for every aesthetic practice
COD-LAGEN’s scientificallybacked benefits translate into tangible, versatile applications for aesthetic medicine professionals:
■ Long-lasting skin rejuvenation that extends and ‘freezes’ the results of other aesthetic treatments
■ Targeted correction of fine lines, wrinkles, and localised imperfections
■ Restoration of subcutaneous tissue volume for improved contour
■ Scar improvement, including post-acne and surgical scars, through collagen restructuring
■ Enhanced firmness, hydration, and elasticity to combat intrinsic and extrinsic ageing signs
■ Year-round safety with suitability for all skin phototypes and no photosensitisation risk. Its versatility and clinical proof make COD-LAGEN a valuable addition to any treatment menu, delivering both immediate and long-term patient satisfaction.
Clinical validation
In a controlled observational
study involving 42 participants aged 25 to 65, COD-LAGEN was applied to the face, neck, and décolleté following the official protocol. The evaluation combined professional assessment, volunteer selfassessment, and sensory perception analysis.
The findings were conclusive:
■ Firming effect: Marked tightening and lifting were visible as early as the first session, with cumulative improvement over the treatment cycle
■ Hydration boost: Immediate increase in skin moisture was noted, with sustained hydration at follow-up 30 days post-protocol
■ Texture and elasticity: Consistent improvement in skin smoothness, resilience, and tactile quality
■ Safety: Zero adverse reactions or downtime; participants resumed normal activities immediately after treatment. Importantly, the study confirmed that the results persisted beyond the treatment period, reflecting the deeper regenerative action of the product. Participants also rated the sensory experience highly, describing the application as ‘extremely pleasant’ both during and after the procedure.
“COD-LAGEN’s
scientifically-backed benefits translate into tangible, versatile applications for aesthetic medicine professionals.”
Why marine collagen?
While collagen has been a cornerstone of anti-ageing science for decades, not all sources are equal. Marine collagen, especially from cod, is considered the gold standard for several reasons:
■ Higher absorption: Its lower molecular weight enables faster, more complete dermal integration
■ Purity and safety: It eliminates the disease transmission risks associated with mammalian collagen sources, such as bovine or porcine
■ Sustainability: Derived from fish by-products, reducing waste and supporting eco-friendly production.
As the Promoitalia scientific team notes, ‘COD-LAGEN is designed to reset the skin’s biological clock, prolonging health and enhancing the effects of other treatments.’
e-FILLERS:
The exclusive distributor for COD-LAGEN in the EU and UK
Founded as a next-generation B2B platform for the aesthetic and medical community, e-FILLERS.com has quickly established itself as a go-to source for premium injectables, regenerative treatments, and medical skincare solutions. Its unique model combines e-commerce convenience with specialist knowledge, ensuring that clinics, doctors, and medical aesthetic partners gain
direct access to cutting-edge products as well as educational support.
This partnership positions e-FILLERS not only as a distribution partner but as a strategic growth enabler of Promoitalia for COD-LAGEN in some of the most competitive markets in the world.
A shift in the dermal aesthetic
distribution landscape
Traditionally, premium injectables like collagen-based products have been distributed through fragmented networks. By aligning with e-FILLERS’ streamlined, digitally-enabled model, Promoitalia ensures that COD-LAGEN reaches the market with unified messaging, robust training support, and consistent quality control.
For clinics, doctors, and medical aesthetic partners, this collaboration means access to an authentic source of supply with all the convenience of direct ordering through the e-FILLERS e-commerce platform. At the same time, they gain access to rich educational resources, including the e-FILLERS Library, which provides product information and clinical materials, as well as interactive webinars hosted through the e-FILLERS Academy, ensuring both correct usage and optimal patient outcomes.
Industry impact
The introduction of CODLAGEN under the exclusive e-FILLERS umbrella is more
than a product launch: it’s a signal to the industry. It demonstrates how scientifically validated innovation and modern distribution strategies can intersect to set new benchmarks for success in the aesthetic market.
As patient demand for non-invasive, regenerative treatments grows, marinecollagen-based solutions like COD-LAGEN are expected to capture a larger share of the dermal rejuvenation market. With e-FILLERS driving awareness and adoption, the product is set to establish itself as a cornerstone in anti-ageing protocols across Europe and the UK.
Looking ahead
For the aesthetic industry, 2025 marks the start of a new era, one where premium science meets premium distribution, and where clinical efficacy and strategic market access combine to deliver extraordinary value to
practitioners and patients alike.
About Promoitalia
Promoitalia is a global leader in medical aesthetics, renowned for developing innovative, clinically-backed treatments that merge beauty with science. With a presence in over 30 countries, the brand is renowned for its commitment to quality, safety, and transformative results.
About e-FILLERS
e-FILLERS.com is a specialised B2B platform connecting the medical and aesthetic community to high-quality products, cutting-edge treatments, and expert training. Through its curated portfolio, streamlined logistics, and educational programs, e-FILLERS empowers clinics, doctors, and medical aesthetic partners to deliver top-notch excellence to their patients.
Find out more at: e-fillers.com/
HEALING MATTERS: THE RISE OF MEDICAL-GRADE AFTERCARE
Advanced treatments demand clinical-grade recovery — epicite® CALM meets the moment with sterile, soothing care
AS THE CONSUMER demand for aesthetic procedures, such as laser resurfacing and microneedling, continues to grow, the focus is shifting to what happens after the treatment. Post-treatment care is no longer a cosmetic afterthought it is a clinical necessity. With innovations such as epicite® CALM, practitioners can now offer medical-grade recovery that enhances outcomes, ensures safety, and meets patient expectations.
Minimally invasive aesthetic procedures were once dominated by hyaluronic acid fillers, which, while effective, often resulted in overfilling and an unnatural appearance. Today, there is a shift towards
treatments that use devices to enhance the body’s own collagen production, such as laser resurfacing, microneedling, and other energy-based technologies. According to the '2024 Plastic Surgery Statistics Report' by the American Society of Plastic Surgeons (ASPS) 1, skin resurfacing is the fastestgrowing segment in the field.
Skin resurfacing which includes dermabrasion, ablative and non-ablative lasers, and microdermabrasion has moved to the forefront of aesthetic medicine, growing by 6% in 2024 compared to the previous year. In fact, the combined number of skin resurfacing and laser-based skin treatments reached approximately 6.8 million procedures last year in the U.S. alone.
Yet, as treatments become more advanced, they also leave the skin more vulnerable. The skin, often left in a fragile, wound-like state, requires more than cosmetic creams or over-the-counter solutions. It demands medical-grade recovery solutions that prioritise safety, efficacy, and patient comfort. As the American Board of Cosmetic Surgery puts it2, the success of a treatment ‘depends not just on the technology used, but also on the provider’s expertise and your post-treatment skin care.’
Fragile skin, powerful treatment
Today’s aesthetic procedures are more advanced and more intense than ever before. Technologies such as CO₂ lasers and radiofrequency (RF) microneedling are transforming
skin rejuvenation by reaching deep into the dermis, sometimes up to 8 mm, to stimulate collagen production and cellular renewal. The results are impressive: improved texture, reduced scarring, and visible anti-ageing effects. However, the intensity of these treatments also introduces new challenges. CO₂ laser treatments, for
“Post-treatment care is no longer a cosmetic afterthought it is a clinical necessity.”
Julia Born is Director Strategic Marketing, Medical Device Solutions, Evonik
Figure 1 epicite® CALM face mask is a professional post-treatment care following laser, light, and energy-based treatments.
instance, can reach temperatures nearing 100°C, vaporising damaged skin layers and triggering a healing response. RF microneedling, while less invasive, still creates micro-wounding combined with energy delivery, making the skin highly sensitive post-procedure. In both cases, the skin is temporarily transformed into a wound-like state, making it more susceptible to infection, prolonged erythema, and unwanted pigmentation if not properly cared for.
When aftercare falls short — a regulatory reality check
Despite the clinical sophistication of today’s aesthetic treatments, many post-care routines still rely on cosmetic products that were never designed for compromised skin. These non-sterile solutions often contain preservatives, fragrances, or active ingredients that can irritate or even damage healing tissue especially when the skin is in a vulnerable, postprocedural state. This disconnect between treatment intensity and aftercare quality is drawing increasing scrutiny from regulators. As safety standards tighten, practitioners who
continue to use cosmetic-grade products risk not only poor patient outcomes but also reputational and legal consequences. The message is clear: post-treatment care must evolve to meet medical standards, with sterile, standardised solutions that align with both clinical needs and regulatory expectations.
Setting a new standard with sterile aftercare
To meet the growing demands for high-quality post-treatment care, the innovative university spin-off JeNaCell developed epicite® CALM currently the only medical-grade dressing made from biosynthetic cellulose specifically designed for post-aesthetic procedures.
“Our goal was to create a product that not only meets the highest safety standards but also enhances the patient experience and reduces downtime after a
treatment.”
This development was a natural extension of JeNaCell’s expertise in wound healing, building on the success of the epicite® product family, which was first introduced in 2017 for the treatment of second-degree burns injuries that are more
severe but clinically comparable to the wounds resulting from many aesthetic treatments. The product line also includes solutions for managing chronic wounds, further reinforcing the clinical foundation behind epicite® CALM.
Figure 2 The MDR-certified product epicite® CALM is available as face and neck mask.
Figure 3 (A) Dermoscopy right after IPL procedure (Intense Pulsed Light); (B) dermoscopy after a 60-minute application of epicite® CALM, following an IPL treatment.
after a 60-minute application of epicite® CALM, following an IPL treatment.
Now part of Evonik, JeNaCell benefits from the company’s extensive experience in supplying bioresorbable materials to the medical device and aesthetics industries, ensuring that epicite® CALM is backed by both scientific innovation and industrial reliability.
‘Our goal was to create a product that not only meets the highest safety standards but also enhances the patient experience and reduces downtime after a treatment,’ explains Julia Born, Director of Strategic Marketing for Medical Devices at Evonik Health Care.
Made from biosynthetic cellulose, epicite® CALM has a non-occlusive structure, which allows the skin to breathe while
delivering a cooling and soothing effect that reduces redness and erythema. Unlike occlusive masks that can trap heat and lead to fatty pustules, epicite® CALM supports natural healing without compromising comfort or safety 3-6 . Its clean formulation, free from active ingredients, alcohol, parabens, and fragrances, makes it ideal for sensitive, irritated, or treatment-prone skin. This is particularly important given the regulatory risks associated with applying cosmetic products to broken skin. With epicite® CALM, practitioners can offer a medical-grade solution that aligns with both clinical needs and patient expectations.
Certified under the European Medical Device Regulation (MDR), epicite® CALM is the
“By integrating epicite® CALM into post-treatment protocols, clinics can reduce downtime, minimise adverse reactions, and improve healing outcomes ultimately increasing the value of the treatment itself.”
outcomes ultimately increasing the value of the treatment itself.
As the global market for laser, light and energy-based procedures continues to grow projected to reach USD 10 billion by 2027 7 the demand for reliable, standardised aftercare will only intensify. Practitioners who adopt forward-thinking solutions, such as epicite ® CALM, position themselves at the forefront of safe, effective, and patient-centred care.
‘It’s about giving professionals the tools they need to deliver the best aesthetic outcomes, safely and consistently,’ Julia Born adds.
Recovery as a central concern
only sterile medical device in its category designed specifically for post-aesthetic procedures.
Better healing leads to happier patients
In aesthetic medicine, patient satisfaction is everything. Comfort, recovery time, and visible results all play a role in how a treatment is perceived, and whether a patient returns. By integrating epicite® CALM into post-treatment protocols, clinics can reduce downtime, minimise adverse reactions, and improve healing
References
1. American Society of Plastic Surgeons (ASPS). 2024 Plastic Surgery Statistics Report. ASPS. 2025. Available from: https://www.plasticsurgery.org/documents/news/ statistics/2024/plastic-surgery-statistics-report-2024.pdf
2. How to Avoid Scarring after Cosmetic Laser Treatment [Internet]. ABCS. 2024 [cited 2025 Aug 28]. Available from: https://www.americanboardcosmeticsurgery.org/ making-safe-choices/avoid-scarring-after-cosmetic-lasertreatment/
3. Holzer, J.C.J., Tiffner, K., Kainz, S., Reisenegger, P., Bernardelli de Mattos, I., Funk, M., Lemarchand, T., Laaff, H., Bal, A., Birngruber, T., Kotzbeck, P., Kamolz, L.-P., 2020. A novel human ex-vivo burn model and the local cooling effect of a bacterial nanocellulose-based wound dressing. Burns 46, 1924–1932. https://doi.org/10.1016/j.burns.2020.06.024
4. Luca-Pozner, V., Nischwitz, S.P., Conti, E., Lipa, G., Ghezal, S., Luze, H., Funk, M., Remy, H., Qassemyar, Q., 2022. The use of a novel burn dressing out of bacterial nanocellulose compared to the French standard of care in
As aesthetic medicine continues to push boundaries, recovery must keep pace. Post-treatment care is no longer a secondary concern it is a critical part of the treatment journey. The success of any aesthetic treatment lies not only in the procedure itself but in the care that follows. With epicite® CALM, Evonik offers a solution that meets the demands of modern procedures, regulatory standards, and patient wellbeing.
Learn more about epicite® CALM: www.epicite.com/en/calm
5. Resch, A., Staud, C., Radtke, C., 2021. Nanocellulose based wound dressing for conservative wound management in children with second-degree burns. International Wound Journal 18, 478–486. https://doi.org/10.1111/iwj.13548
6. Hecker, A., Lumenta, D.B., Brinskelle, P., Sawetz, I., Steiner, A., Michelitsch, B., Friedl, H., Gmainer, D., Kamolz, L.-P., Winter, R., 2022. A Randomized Controlled Trial of Three Advanced Wound Dressings in Split-Thickness Skin Grafting Donor Sites—A Personalized Approach? JPM 12, 1395. https://doi.org/10.3390/jpm12091395
7. BCC Research. Antiaging Products and Services: The Global Market [Internet]. Bccresearch.com. 2023 [cited 2025 Aug 28]. Available from: https://www.bccresearch.com/ market-research/healthcare/anti-aging-productsservices-report.html
Georgian Aesthetic International Association – is the leading professional organization for aesthetic medicine in Georgia, promoting high standards, education, and collaboration among specialists
The GAIA Conference 2025 will bring together leading experts in aesthetic medicine for sessions, offering a unique opportunity to learn the latest techniques and connect with professionals in the field
Discover the AMWC Aesthetics Medicine Awards winners
Commemorating Excellence in Aesthetic and Anti-Aging Medicine!
In collaboration with the Aesthetic Multispecialty Society (AMS) , the 2025 AMWC Awards meticulously evaluated more than 1000 submissions hailing from 39 countries, contending for top accolades in categories across Best Products & Devices and Best Clinical Cases . Following an exhaustive review and shortlisting process, 220 standout entries emerged as finalists, ready for evaluation. The final round was judged by a distinguished panel of physicians specializing in aesthetics and anti-aging medicine, alongside over 22,000 votes from industry peers. The ultimate winners across the 24 categories were unveiled at a prestigious ceremony held at AMWC Monaco on March 27th, 2025.
Discover all finalists and winners on the AMWC website: www.amwc-conference.com
Best Products & Devices Winners
Best Skin Regenerative
Aesthetic Solution
GCell®
GLOBAL BIYOMEDIKAL www.globalbiyomedikal.com
GCell® is an advanced regenerative medicine device with Autologous Micrograft and SVF Technology in a fully closed, sterile system. With a 40-minute rapid processing time, homogenization, and photoactivation, it ensures high cell viability and effectiveness. GCell® is 100% autologous, chemical-free, and requires only local anesthesia.
Best Anti-Aging Supplement
Purasomes Xcell
DERMOAROMA
www.dermoaroma.com
Purasomes XCell supports gut health, immunity, and telomere longevity. With organic bovine colostrum, spirulina, and astragalus, it enhances digestion, reduces inflammation, and slows aging at a cellular level. Designed for radiant skin, stronger hair, and overall well-being.
Best Suspension Thread
Visage Excellence HA - Namica Technology
APTOS
aptos.global
Aptos 4th Generation Threads with NAMICA Technology – Lifting, Contouring, Armoring, Skin quality improvement with the revolutionary P(LA/CL) + HA with NAMICA technology. Unique characteristics as targeted delivery (minimizing loss of HA during threads injection); controlled gradual release of HA making it the first solid, long-lasting biostimulator.
Best Cosmetics
Biojuve®
CROWN AESTHETICS
www.skinpen.com/international
BIOJUVE® is a novel skin biome brand that uses a living Xycrobe™ Technology to optimize the overall skin biome and lead to healthier, younger-looking skin. Clinical studies show significant improvement in the appearance of skin texture, tone, fine lines, wrinkles, and photodamage on all skin types.
Best Aesthetic Device
Dermaviz UV QUANTIFICARE
www.quantificare.com
QuantifiCare revolutionizes clinical photography with standardized 3D imaging and 2D UV systems. Our tools ensure precise, reproducible assessments. Already used in trials, DermaViz UV replaces Wood’s lamps with UV flash, offering sharp visuals for pigmented/depigmented areas. Soon for consultations.
Best Laser Redtouch Pro DEKA
www.dekalaser.com
The exclusive 675 nm wavelength of RedTouch PRO, which is selectively absorbed by collagen, makes it the most revolutionary laser system of the year. With high efficacy, it stimulates collagen production and the formation of new collagen fibers. RedTouch PRO is also effective on dark phototypes and tanned skin.
Best Innovations in Treatment Protocols
Discovery Pico With Variopulse Technology® QUANTA SYSTEM
www.quantasystem.com
PICO celebrates 10 years of innovation with VarioPulse Technology®, offering precision and versatility. Featuring three picosecond pulse ranges and unique handpieces like PlasmaFrax and PhotoFrax, it customizes treatments. PicoFilling stimulates skin regeneration with minimal downtime, perfect for wrinkles, acne scars, and more.
Best Non-Invasive Body Shaping Technology
Wonder Axon
LEXTER MICROELECTRONIC ENGINEERING
SYSTEMS S.L.
www.wonder.clinic
Wonder Axon combines neuromuscular stimulation, electromagnetic emissions, and radiofrequency to enhance muscle tone, strength, and collagen production. This non-invasive treatment sculpts the body, tightens skin, and reduces fat, offering natural, balanced results.
Best Aesthetic Product & Device Integration
Cytocare 640 C Line With C Line
Plasma LABORATOIRE REVITACARE
www.revitacare.net
REVITACARE’s C Line Plasma and CYTOCARE 640 C Line duo combine cutting-edge plasma technology and ultrapure hyaluronic acid to reduce wrinkles, acne scars, and imperfections. In just 2 sessions, skin is intensely hydrated and smoothed for a youthful glow.
Best Injectable Dermal Filler
Restylane Lyft GALDERMA
www.galderma.com
Restylane Lyft is designed to provide lift, projection and structure. Its targeted placement and minimal product migration ensures precise outcomes. It has the highest G’ on the market and the lowest degree of modification, for the closest to skin’s own HA, delivering natural looking results.
Best Integrative Medicine
Dr Ernesto Delgado Cidranes Spain
From Aesthetics to Function: Restorative Action of Cytokines and Autologous Exosomes in Patients With Complex Dermatological Lesions
Best EnergyBased Treatment
Dr Yaryna Turkevych
Ukraine
Erasing the Signs of War
Best Hair Restoration Product
Purasomes HSC50+ DERMOAROMA
www.dermoaroma.com
Purasomes HSC 50+ Hair & Scalp
Complex combats hair loss in men and women by addressing root causes, accelerating cellular repair, and promoting hair follicle function. Clinically proven, it offers immediate and long-lasting results for healthier hair and scalp.
Best Injectable Body Fillers
Lanluma X & Lanluma V SINCLAIR sinclair.com
Lanluma is a PLLA-based implant designed to add volume and correct skin depressions. Injected as a suspension, it stimulates collagen production. Available in two versions—Lanluma V (210 mg) and Lanluma X (630 mg)—it suits various face and body areas, including the buttocks.
Best Intimate Health Solution
Intimate Excellence HA APTOS
aptos.global
Female confidence and health often suffer, and female pleasure is very complex.
Aptos Intimate Excellence Method (HA) was created to improving quality of life by treating urinary incontinence, postpartum defects, aesthetic concerns in gynecology using minimally invasive techniques, with a short recovery period and longlasting effect.
Best Neuromodulator
Relfydess GALDERMA
www.galderma.com
RelfydessTM is the next-generation neuromodulator designed with PEARLTM technology. It delivers an advanced performance with fast and sustained results for GLs and LCLs, giving patients a natural, revitalized look with a well-tolerated, ready-to-use, liquid formulation that is optimized for simple volumetric dosing.
Best Clinical Cases Winners
Best Genital Rejuvenation
Dr Pablo Gonzalez
Isaza
Colombia
In Office Topographic Labiaplasty as a Safe Aproach to Massive Labia Minora Hypertrophy
Best Non-Surgical Body Shaping
Dr Daniella Fakih
Lebanon
Combining CaHA With Micro-Needling RF for Stretch Mark Improvement
Best Hair Restoration
Dr Nuttorn Narupaves
Thailand
Combination of Optimize Methods for Best Hair Restoration in Burn Scar Alopecia Patient
Best Surgical Body Shaping
Dr Jaqueline
Rodrigues
Brazil
Abdominoplasty
Extended to Flanks to Avoid Anchor Scar
Best Threads Treatment
Dr Marion Delbaere
France
Medical Face and Neck
Lift With Permanent Threads (Combined With Neck Liposuccion)
Best Complication Treatment
Dr Thomas Rappl
Austria
Catheter-Assisted Application of Hyaluronidase After Hyaluronic Acid Induced Ischemia of the Upper Extremity
Best Surgical Facial Rejuvenation
Dr Adam Scheiner
United States
Upper and Lower Blepharoplasty and Full Face Resurfacing
Best Injectable for Skin Revitalization
Juvelook
VAIM GLOBAL
juvelook.com
JUVELOOK is a hybrid biostimulator for rejuvenating skin, reducing fine wrinkles, and treating scars, stretch marks, and tear troughs. It combines PDLLA, which stimulates collagen and elastin production, with hyaluronic acid, a biocompatible gel that hydrates instantly while restoring lost volume.
Best Condition Improvement Treatment
Dr Fernando Felice
Argentina
Aesthetic and Reconstructive Facial
Surgery Following a Serious Canine Bite to the Face
Best Non-Surgical Facial Beautification
Dr Iryna Smolanka
Ukraine
Beautification After Facial Nerve Injury
Best Skin Enhancement & Scar Treatment
Dr Dilek Basaran
Turkey
Erasing a Burn Scar
Non-Surgical Facial Rejuvenation
Ms Moonika Sibul
Estonia
Non-Surgical Facelift With Combination Treatment
Events
EUROPE
2–3 OCTOBER 2025
BAAPS 2025 London, UK baaps.org.uk
23–25 OCTOBER 2025
International Society of Hair Restoration World Congress Berlin, Germany 33rdannual.org
13–14 MARCH 2026
ACE London, UK www.aestheticsconference.com
20 MARCH 2026
Congress of Dermatology and Anti-Aging Medicine Warsaw, Poland kongres.dermatologia-estetyczna.pl
NORTH AMERICA
REST OF WORLD
26–28 MARCH 2026
AMWC Monaco Monte Carlo, Monaco www.amwc-conference.com
16–19 APRIL 2026
International Dermatology and Cosmetology Congress İstanbul, TÜRKİYE www.indercos.org
28–30 MAY 2026
European Association of Plastic Surgeons Annual Meeting Vienna, Austria www.euraps.org/meetings
26–27 JUNE 2026
The Aesthetic Show London, UK www.im-aesthetics.com
9–12 OCTOBER 2025
Plastic Surgery The Meeting New Orleans, Louisiana www.plasticsurgerythemeeting.com
