Biostimulators (Collagen-Stimulating Injections) in Antalya

How does a biostimulator work?

When the substance is placed in the tissue, it starts a mild, controlled reaction in the lower layer of the skin. This reaction stimulates the collagen-producing cells (fibroblasts). Over time, type 1 and type 3 collagen and elastic fibres increase. The substance itself gradually breaks down and leaves the body naturally.

In other words, the aim is not to place a space-filling substance but to have the skin produce its own supporting tissue again.

How does it differ from hyaluronic acid filler?

• Where the volume comes from: Hyaluronic acid filler binds water and gives volume immediately. With biostimulators, the fullness in the first days comes largely from the carrier fluid and from swelling, and it settles within a few days. The real change comes as your own collagen forms.
• Reversibility: Hyaluronic acid filler can be dissolved when needed with an enzyme (hyaluronidase). Biostimulators cannot be dissolved with this enzyme.
• Visibility on X-ray: Calcium hydroxylapatite can be seen on X-rays and CT scans. If you have had this treatment, it is advisable to tell the doctor before any imaging.

For more on the types of filler, see the Dermal Filler page.

Three substances, three different behaviours

These substances are sold under different commercial products; however, the decision is made not by product name but according to the nature of the substance, the area to be treated and the person's skin.

Poly-L-lactic acid (PLLA)

• A synthetic substance from the same group as the raw material of dissolving surgical stitches. It comes as a powder and is prepared by mixing with a liquid before use.
• It does not give volume by itself; fullness forms over weeks through your own collagen.
• Usually 3–5 sessions 4–8 weeks apart are planned.
• The duration of effect reported in the sources is 18–24 months, and up to 3 years according to some sources.
• After treatment a massage programme described by the doctor is needed; the aim is for the substance to spread evenly and to reduce the risk of firm lumps.

Calcium hydroxylapatite (CaHA)

• It contains very small calcium-based spheres in a gel carrier; it comes ready in a syringe.
• It works in two stages: the gel gives volume immediately, and after the carrier is absorbed in 2–3 months the spheres continue to stimulate collagen production.
• Usually a single session is enough.
• The duration of effect reported in the sources is on average 12–18 months.
• Because it contains calcium, it shows up on X-rays.

Polycaprolactone (PCL)

• A long-lasting medical polymer with small spheres in a gel carrier.
• After the carrier is absorbed in 6–8 weeks, the spheres stimulate the tissue.
• Usually a single session is planned.
• The duration of effect reported in the sources ranges from 1 to 4 years.

These durations are averages from the sources; they vary with the person, the area and the amount used.

Which areas is it used on?

• The midface, cheeks and cheekbone area
• The jawline and chin
• Hollows at the temples
• The nose-to-mouth folds and the lines running down from the corners of the mouth
• The neck, décolletage and backs of the hands (depending on the substance)

Who is it considered for?

The sources describe this approach particularly for people who have general facial volume loss and mild laxity, who want a natural change that develops over time, and who are not considering surgery. Where wrinkles rather than volume loss are the main concern, other methods may be more suitable. For expression lines see the Botulinum Toxin page, and for skin quality the Mesotherapy page.

Which substance is suitable is decided at the examination by looking at:

• How widespread the volume loss is and where it is
• The thickness and quality of the skin
• When the result is expected and for how long
• Health history and medicines being taken

How is the procedure done?

The substance is placed deep under the skin or just above the bone. Injection into the surface of the skin or into the muscle is not recommended because of the risk of firm lumps. The sources emphasise the principle "less is more": rather than trying to correct too much in the first session, under-correction is preferred.

Risks and side effects

• Temporary effects: Swelling, bruising, redness and tenderness. Swelling may be more noticeable than with fillers; it usually settles within days.
• Firm lumps (nodules): Lumps that can be felt under the skin may form. Injection too close to the surface, unsuitable technique or insufficient massage increases this risk. Because these substances cannot be dissolved with an enzyme, treatment can take longer.
• Blockage of a blood vessel: A very rare but serious complication. Slow injection and the use of a suitable needle or cannula reduce the risk.
• Late lumps (granulomas): Rarely, months later, lumps caused by an intense reaction of the body to the substance may appear.

Who should not have it?

• People with an active infection or inflammation in the treatment area
• During pregnancy and breastfeeding
• People with a known hypersensitivity to the product's ingredients or to local anaesthetic
• People with an active autoimmune or connective tissue disease, or who take medicines that suppress the immune system
• People with a bleeding disorder or who take blood thinners
• People with unrealistic expectations

After the procedure

• Do not touch the treated area or wear make-up for the first 24 hours
• Avoid hot baths, saunas, steam baths and strenuous exercise in the first days
• Apply cold intermittently for swelling
• Protect yourself from the sun
• Follow the massage programme described by the doctor
• If you notice a firm lump, increasing pain or a change in colour, see the doctor without delay

More detailed articles on this topic: Biostimulators: collagen-stimulating facial injections and Biostimulator types: PLLA, calcium hydroxylapatite, PCL.