Once a year, leading medical experts in aesthetics worldwide convene to examine beauty trends, delve into the medico-scientific contributions that medical aesthetics can offer patients, and articulate their vision for elevating the quality of life. The Merz Aesthetics Expert Summit (MEXS) stands as an annual gathering organized by Merz Aesthetics. This year, the focal point was "Regenerative Aesthetic." In response to the global shift in aesthetic preferences towards "natural beauty," Merz anticipates that regenerative aesthetics will emerge as the industry's new cornerstone, empowering individuals to optimize their natural beauty by enhancing their skin's inherent ability to regenerate. In a forthcoming series of three articles, we will explore the value and prospects of regenerative aesthetics through insights shared by experts we encountered at MEXS 2023 in Barcelona, Spain, held in November. -- Ed.

Australian plastic surgeon Niamh Corduff and British aesthetician Kate Goldie stand as prominent figures in the realm of regenerative aesthetics. With over a decade of exploration, they have actively contributed to establishing a scientific foundation for this field.

During MEXS 2023, both experts delved into the origins, scientific principles, and the latest definition of regenerative aesthetics. The primary objective of regenerative aesthetics is to enhance the skin's overall quality by revitalizing the tissue system, moving beyond conventional collagen production approaches, they said.

The duo underscored the significance of calcium hydroxylapatite (CaHA), traditionally recognized as a filler but now garnering increased attention as a biostimulant and the rediscovery of its regenerative medicine potential.

We asked them about the definition of regenerative aesthetics, the scientific rationale supporting their conviction that aestheticians can facilitate skin regeneration, and the specific reasons behind the growing popularity of CaHA over other biostimulants in the realm of regenerative aesthetics.

Kate Goldie: About eight or nine years ago, when our fascination with regenerative aesthetics began, the terms "aesthetics" and "regeneration" didn't initially seem compatible.

When people mention they're not into fillers, it's often because they picture it as injecting something into the skin for a visible surface improvement. They believe that's the essence of aesthetics. But, they might not realize that aesthetics goes beyond that – it can actually change the underlying skin tissue.

Regeneration is about rebuilding tissue and restoring it to its youthful state. It's a gradual process of rebuilding tissues to bring them back to their original condition. We thought that the power of regeneration could be amplified by judiciously employing aesthetic products. And so, the concept of regenerative aesthetics was born – focusing on tissue building to achieve a more youthful appearance.

Collagen is a buzzword in regenerative aesthetics nowadays. Yet, boosting regenerative capabilities isn't solely about generating collagen. Collagen is merely one element of the skin. Our focus extends beyond that. It's crucial to grasp the process of collagen production, enabling us to employ diverse protocols to rejuvenate an individual's skin effectively. Regeneration aims at the entire tissue, seeking to transform all its components. This holistic approach defines how regenerative aesthetics addresses the quest for youthful skin.

Niamh Corduff: That's a point I consistently highlight when discussing regenerative aesthetics with patients at my clinic. I explain that "It's not about injecting substances into the skin, it's about prompting your body to construct itself.” When I describe it as encouraging their body to generate new tissue and place it where it's most beneficial, they get it. 

Goldie: In regenerative aesthetics, ensuring the skin has all the proper elements is crucial. If skin cells lack the right living conditions, they won't thrive, highlighting the necessity of the correct structure and function. Take collagen, for instance; there isn't just one variety in the skin. It's a blend of various collagen types. The same principle applies to elastin, a pivotal factor in skin elasticity. Without it, even if your skin appears tight, it won't possess the same elasticity and may feel rigid.

When the body experiences tissue damage, it typically responds in two ways. First, there's the rapid repair process, triggered when the body perceives a wound that needs immediate attention, leading to the production of essential substances. The second approach involves taking the time to systematically reconstruct the entire skin structure. Regenerative aesthetics adopts this latter perspective, focusing on the comprehensive rebuilding of the skin's ecosystem.

Corduff: As Dr. Goldie explained, the skin operates as an ecosystem, with tissue consisting of cells and an extracellular matrix (ECM) that serves as a structural scaffold, providing the skin with its elasticity. In normal conditions, fibroblasts play a crucial role in regulating ECM turnover. In damaged tissue, activated fibroblasts secrete ECM proteins, contributing to the healing process. This intricate interdependence defines the skin ecosystem, where each component relies on the others to function effectively.

You may be wondering how an aesthetician can intervene in this process. Normally, when a filler is injected, an inflammatory response occurs at the injection site, leading to various outcomes, including tissue regeneration, fibrosis, and filler encapsulation. Crucially, the nature of the inflammatory pathway can be influenced by the injected biomaterial.

Calcium Hydroxylapatite, commonly known as CaHA, is gaining significant popularity, with practitioners saying, "My skin feels rejuvenated, my complexion is more radiant, and I appear healthier." What sets it apart from other well-known biostimulant ingredients, causing this distinct impact?

In essence, when you administer CaHA, your immune system opts for tissue regeneration instead of triggering a fibrotic reaction. The immune system distinguishes between friend and foe when something enters the body. If it's deemed friendly, the immune system strategically places it and initiates the necessary processes for regeneration. It generates everything essential to reconnect and rejuvenate. Conversely, if it's perceived as an adversary, the immune system not only aims to eliminate it but strives to repair it. The reparative process kicks in, making the immune system a key determinant between regeneration and fibrotic response.

Unlike other biostimulators, which typically induce a fibrotic reaction, meaning they primarily stimulate collagen production, CaHA takes a different route. Since our immune system doesn't perceive biostimulators as allies, it instructs fibroblasts to swiftly address the issue. It signals the need for collagen to envelop and eliminate the material. This is the general mechanism of action for most biostimulators. However, when CaHA is injected, it fosters the creation of new tissue equipped with all the necessary elements—collagen, elastin, basic matrix—forming a complete skin ecosystem. Consequently, the cells initiate the production of new components and structures, embodying the essence of regeneration.

Goldie: When scientists delved into skin regeneration, they realized they needed to understand the whole collagen, elastin, and more ecosystem. Unlike regular products that just make collagen, CaHA is unique because it regenerates the entire ecosystem. We've re-discovered CaHA as a regenerative medicine. When you create the perfect environment, cells live longer. When cells are in the right place, they stay healthy for a long time. We don't want cranky cells that get more aggressive over the years. What we're doing is getting rid of those grumpy cells and creating new ones. That's the basic idea behind regenerative aesthetics. We want to make sure that the healthy cells stick around for a long time, and then your skin will look amazing.

Corduff:  That's the ultimate goal of regenerative aesthetics. People have tried cryotherapy, fillers, and everything else, and now they have a new option. Regenerative aesthetics is about bringing out the best in a patient's own skin tissue, making it look healthy, vibrant, and youthful.