[Interview] The one-to-one ratio dilution is the most popular... the procedure technique isn't too demanding yet yields significant effects.

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[MedigateNews] Recently, there has been increasing interest in the field of regenerative aesthetics. Regenerative aesthetics is a new subfield based on the principles of regenerative medicine. While regenerative medicine focuses on repairing tissue damage caused by diseases, regenerative aesthetics aims to restore body tissues affected by aging. Particularly, the market for bio-stimulators leading the way in regenerative aesthetics is projected to grow by over threefold by 2026.

Bio-stimulators directly regenerate the extracellular matrix (ECM), which is the supporting structure within the skin. Among these, calcium hydroxylapatite (CaHA) components specifically help fill in the core of damaged skin by directly stimulating the activity of fibroblasts, cells responsible for synthesizing ECM and collagen within the skin.

Radiesse, a leading product among CaHA formulations, has been used as an aesthetic product for over 20 years. Its safety and effectiveness have been proven, and it's currently sold in more than 80 countries worldwide. Clinical data from over 200 studies involving more than 5,000 participants have confirmed its effects on the creation of collagen types 1 and 3, elastin, proteoglycans, and angiogenesis.

Medigate News interviewed Dr. Katherine Goldie from Clinic 77 in London, UK, who conducted research on the trends in regenerative aesthetics and the characteristics of CaHA components. They explored why bio-stimulators are gaining attention and investigated the trends in the use of CaHA formulations in the international medical field.

The ultimate goal of regeneration is to create an environment where skin cells can thrive and proliferate effectively.

Q.  Last year, there was a publication on ‘Evolution of Regenerative Aesthetics.’ What is the thesis about?

This paper focuses on 'Regenerative Aesthetics,' delving into its concept, significance, and supporting evidence, while also introducing prominent products and components associated with this field. It discusses phenomena that can be termed as regeneration and those that do not fit the criteria, aiming to scientifically define when the term 'regeneration' is appropriately used. By providing a comprehensive overview of the field of regenerative aesthetics, I believe it can effectively contribute to improving and rejuvenating skin tissues through relevant treatments and procedures.
 
Q. What does Bio Stimulator do in Regenerative Aesthetics?

The term bio-stimulation refers to the stimulation of tissues to promote their regeneration. However, not all bio-stimulators operate on the same principle. There are two pathways through which our body responds to external stimuli.

The first involves perceiving incoming foreign substances as threatening, triggering an inflammatory response. Consequently, tissue cells work rapidly in an emergency-like manner. Without the time to produce various elements, they quickly generate a large amount of collagen to form a barrier against the incoming substances within the tissue. This process is known as fibrosis.

The second method involves our immune system not perceiving the foreign substance within the tissue as threatening. It stimulates the cells in the skin to generate various components adequately while maintaining normal cellular activity. For instance, when fibroblasts are stimulated while in a normal state, they can evenly produce components of the extracellular matrix such as collagen, elastin, proteoglycans, and others.

When comparing the outcomes of these two pathways, a well-balanced production of various substances creates an environment conducive for skin cells to thrive. However, when fibroblasts rapidly generate excess collagen leading to fibrotic barriers, cells struggle to survive in an environment with excessive, disordered collagen.

In the past, bio-stimulation was thought to involve solely the abundant production of collagen. Yet, the actual environment for our skin cells is far more complex. The ultimate goal of regeneration is to create an ecosystem where skin tissues and cells can prosper. Regenerative bio-stimulation differs from conventional bio-stimulation in this aspect.

Q. What are the most prominent ingredients of bio stimulator and the products? What are their characteristics?

All bio-stimulation provides directives on how it interacts with our body and immune system. Radiesse, primarily composed of CaHA, enables the regeneration of connective tissues in the field of regenerative aesthetics. Radiesse's CaHA microspheres are small, uniformly sized, and have a smooth surface, possessing the most suitable characteristics for aiding skin regeneration. The smooth surface and appropriate size of CaHA microspheres provide a biomechanical scaffold conducive for fibroblast adherence, allowing these cells to perform their necessary functions.

Conversely, PLLA exhibits a pointed and rough surface that makes it challenging for fibroblasts to adhere and receive biomechanical support. PLLA also triggers an inflammatory response. Research suggests that PLLA promotes skin regeneration through stimulation of macrophages (phagocytic cells) and secretion of inflammatory cytokines.

The comparison between PLLA and CaHA isn't about one being better or worse; rather, it highlights the different pathways induced by these substances. One (CaHA) operates along a regenerative pathway, while the other (PLLA) tends toward fibrosis.

Another noteworthy characteristic of the CaHA component in Radiesse is its natural biodegradation process. It can be used regardless of a specific age group... The earlier it's used, the better the results.

Q. CaHA formulations tend to yield high satisfaction among which patient demographics, and under what circumstances might a physician recommend CaHA to patients?

Discussing the use for different patient types involves understanding how the product is utilized.

When diluted with saline solution, it alters the inherent viscosity, allowing the product to spread deeper and more extensively. This can have a widespread positive impact on the entire skin ecosystem, potentially reaching the dermis and underlying tissues. It can be particularly effective for patients concerned about reduced skin elasticity or density due to aging.

Radiesse can be used from patients in their 40s and, if necessary, even in their 30s. As individuals reach their 30s, they start losing collagen and elastin, impacting the skin. Using CaHA-based Radiesse in their 30s results in significantly firmer, smoother skin with improved hydration and tone. The generation of collagen and elastin yields prime-like results. Even if other procedures are undertaken, using Radiesse concurrently enhances the outcomes, making it highly suitable for patients in their 30s.

For patients in their 40s to 50s or older, there's still a considerable priming effect with Radiesse, and in some cases, additional assistance or treatments can be incorporated. Essentially, I believe Radiesse can serve as a foundational treatment across all patients and age groups.
When considering the effects patients across all age groups experience, besides the evident firming, softening of contours, and roundness, the skin itself undergoes a taut, smooth, and robust lifting effect, offering a rejuvenating impact. Regardless of specific age groups, bio-stimulator products tend to yield better results when used at a younger age.

Q. They mentioned that even in their 30s, substantial effects can be observed. If someone starts using it at a young age, will the effects continue as they age?

Radiesse also works towards preparing for future aging. Aging disrupts the skin's homeostasis, triggered by factors like UV rays, pollutants, and the aging process itself. As this homeostasis is disrupted, the extracellular matrix starts deteriorating, hindering the production of substances necessary for skin elasticity by the original cells. Bio-stimulators like Radiesse aid in restoring the compromised homeostasis, facilitating the recovery of deteriorated elements.

It's essential to utilize the product in the appropriate manner and in the right quantities, often through dilution methods. This approach can provide long-term support to skin tissues, creating a favorable environment for cells to thrive, thereby enabling cells to sustain longer lifespans.

Through patients who have undergone Radiesse treatments for several years, we have witnessed a noticeable delay in aging during the treatment period. It's evident that the effects differ significantly from simply injecting hyaluronic acid. It's also crucial not to use excessive amounts. Using appropriate quantities regularly over several years may have the potential to prevent aging in the future.
 
Optimal regenerative effects in skin improvement are achieved through one-to-one dilution, where collagen production is most actively stimulated.

Q. In South Korea, the use of CaHA formulations as bio-stimulators isn't as prevalent yet. What's the trend regarding their usage internationally?

About 8 years ago, significant impacts of Radiesse on actual skin tissues were discovered, leading to substantial changes in its application. As a result, it became one of the most widely used and sold bio-stimulators worldwide. The background for this lies in the exceptional stability and efficacy of the product.

CaHA was already known for its regenerative effects in regenerative medicine, and its use became widespread globally in the field of regenerative aesthetics due to its capacity to bring about improvements in necessary skin tissues. There has been a growing trend of patients seeking Radiesse for enhancing their skin quality.

Through discoveries made by physicians unexpectedly, the product found a renewed vitality. It all began when doctors in actual clinical settings made innovative findings, surpassing the previously known effects and reporting significantly crucial effects to the company. I consider this phenomenon a 'Grassroots Movement.

Doctors discovered and formed evidence for unexpected effects, and companies supported these findings, leading to a revolutionary direction. Additionally, patients played a crucial role. They showed significant interest in the product because they desired natural and healthy tissues rather than unnatural, inflated procedure effects, contributing to the momentum.

Q. What methods are currently widely used, considering there were significant changes in the way it's used?

The product is diluted and used in a one-to-one ratio. This involves mixing Radiesse 1 syringe with an equal volume of another solution. The diluting solution could be normal saline or saline with lidocaine.

The reason this method is most commonly used is due to its ease of application and the effective distribution of CaHA microspheres on the face, resulting in significant skin improvement. The concentration diluted in a one-to-one ratio brings about optimal regenerative effects in skin enhancement. At this concentration, collagen stimulation is most active, considerably enhancing skin texture.

During the procedure, the 'Butterfly Technique' is commonly employed, spreading widely across the cheeks like one wing of a butterfly, distributing it along the jawline to maintain a sleek chin contour. This technique ensures proper contouring and skin firmness, covering a broad area for ample cell interaction with CaHA microspheres, resulting in overall skin tightening and a lifting effect in a three-dimensional manner. Diluting in a one-to-one ratio for treatment focused on skin improvement is the most popular method worldwide.

Q. Lastly, if you were to advise Korean doctors who are considering the use of CaHA formulations, what would they be?

If you haven't tried it yet, I'd recommend starting with the improvement of the central part of the face to witness the skin enhancement effects. It's relatively straightforward to use, despite initial apprehensions, and the effects can be quite substantial. Dilution and application methods or techniques aren't overly complicated.

One important thing to remember is that using too little may make it difficult to see the effects. Regardless of the ratio with other solutions or dilution, generally, you should use Radiesse 1 syringe over an area of around 100 cm² of skin to observe the effects. Also, distributing over a certain area, rather than a very small one, enhances the skin cells' contractile force visibly and improves various skin quality indicators, leading to changes in how the patients' skin aging patterns appear.

This entire process reconstructs the skin's ecosystem, laying the groundwork for creating healthy tissue. I want to advise that setting the right direction for skin regeneration seems most crucial.

By Do-young Park