What do the results of treatments using biostimulators depend on?

AUTHOR:

Dr Magdalena Kędzia

anesthesiologist, aesthetic medicine doctor

The hybrid of poly-D,L-lactic acid (PDLLA) and hyaluronic acid (HA) is a highly effective and safe biostimulator with an excellent safety and efficacy profile. Outstanding results in working with this product are achieved by Dr Magdalena Kędzia—an anesthesiologist, aesthetic medicine doctor, and Masterclass trainer at Beautyeurope.eu. Her results were awarded in the competition for the best treatment outcomes using Juvelook and Lenisna during the international JULIA Summit Europe 2024 conference in Warsaw. Dr Magdalena Kędzia shares key insights on what to pay special attention to in order to achieve visible and natural aesthetic improvements using hybrid collagen stimulators.

I have been working with poly-D,L-lactic acid for nearly three years, and I must admit it is one of my favorite methods for improving appearance. It is a very user-friendly product that forgives more errors than other biostimulators. PDLLA features a patented molecule suspended in HA, which helps us avoid adverse effects while additionally enhancing skin hydration. However, it must be used wisely, patiently, and in accordance with its intended purpose and indications. What do I mean by that?

Patient consultation and qualification

In aesthetic medicine, medical consultation is crucial—it involves both visual assessment and palpation of the patient’s skin, allowing us to estimate collagen and elastin levels in the tissues. This enables us to determine what results can realistically be achieved and what cannot be corrected with a biostimulator. We must remember that some patients are better suited for surgical lifting procedures, and even the best and strongest tissue stimulator may not meet their expectations. This often leads to frustration and misunderstandings, which can be avoided through proper consultation.

For this reason, I personally never qualify patients online. Photos sent by patients—usually taken to present themselves in the best possible way—do not reflect the actual condition we need to treat and do not help in setting realistic expectations or possibilities.

When a patient visits my clinic for the first time, I spend half to three-quarters of the appointment on a detailed consultation. I listen to the patient, explain what we will do and why, and describe how the procedure will proceed. It is also very important to thoroughly inform the patient about what to expect after the treatment, so they are not concerned but instead patiently wait for the results—improved skin quality and increased collagen and elastin density as a result of PDLLA action.

Setting realistic expectations

I always listen very carefully to patients who come to me with a specific vision of themselves and certain aesthetic concerns. Often, they notice different issues than I do. Therefore, I first address what bothers the patient most, and then we may plan further steps to enhance the desired effect.

Patients must also be aware of their anatomical conditions. It is important to explain how factors such as malocclusion or significant facial asymmetry can influence both appearance and treatment outcomes. Why? Because most patients carefully examine themselves in the mirror after treatment, and if they are unaware of their anatomical limitations, they may blame the product or the doctor for results that do not fully match their expectations.

We also live in the era of social media, where beauty standards are often distorted by filters and unrealistic. Patients frequently expect such results, but they are not always achievable—and we must be honest about that. Honesty always pays off, because even if the result is not perfect immediately, the patient will return for another treatment. If we promise unrealistic outcomes, we risk losing something invaluable—the patient’s trust.

Patience, patience, and more patience!

This is probably the most important post-treatment recommendation after using Juvelook and Lenisna. Tissue stimulators are an excellent solution, but for patients who are patient and understand that results take time.

Sometimes the effect appears after 3 months, sometimes after 6 months, and in some cases, the best results occur only after 9 months from the first treatment. Immediate improvement should not be expected. However, thanks to the hybrid formula and the addition of hyaluronic acid, skin revitalization—hydration, glow, elasticity, and improved tone—can be observed relatively quickly.

The most spectacular effects—volume restoration, wrinkle and fold reduction, tear trough correction, and facial contour rejuvenation—develop gradually over several months as collagen and elastin production is stimulated. This process requires time.

Lifestyle for better results

Hybrid collagen stimulators contain hyaluronic acid, so after treatment I strongly recommend that patients increase their water intake. I tell them that since they have invested in the treatment, they should maximize its benefits—particularly hydration and skin revitalization. The more water the body receives, the better the results.

In my opinion, lifestyle accounts for up to 50% of the final outcome and its longevity. This means: a healthy diet, proper hydration, sufficient sleep, and avoiding stimulants—especially alcohol and nicotine, which generate free radicals, disrupt the stimulation process, and significantly shorten the duration of results.

Daily sun protection is also essential. According to the latest scientific reports, SPF should be used year-round, as harmful radiation that degrades collagen and elastin is also emitted by phones and computer screens, which we use for many hours daily. Consistent SPF use significantly prolongs the effects of aesthetic treatments.

Patients with autoimmune diseases, such as the increasingly common Hashimoto’s disease, should be aware that their results may be weaker and shorter-lasting. They can still safely undergo treatments with proper qualification, but they should expect more frequent visits and longer waiting times for results. Physicians must exercise greater caution, as these patients have a higher risk of adverse effects.

I always inform patients about the possibility of tenderness and swelling after the procedure. During the first visit, we cannot predict how pronounced these symptoms will be. Therefore, I recommend scheduling the first treatment at a time that allows for at least two days of recovery at home—for example, Friday afternoon.

PDLLA in combination therapies

Poly-D,L-lactic acid is an excellent substance for combining with other treatments and technologies—it is my “magic wand.” Biostimulators primarily improve collagen and elastin quality and provide some volume, but they do not fully correct significant tissue loss.

In patients with volume deficits or very slim faces, I often first rebuild the cheek area using PDLLA and then perform subtle volumization with hyaluronic acid—used sparingly, as a finishing touch. A similar approach applies to smoker’s lines: first stimulation, then delicate correction with HA if needed. This method produces more natural and longer-lasting results compared to using fillers alone, which can sometimes create an unnatural, amorphous appearance above the lip.

When treating the neck—a particularly challenging area—I often prepare the skin with radiofrequency beforehand. For fine wrinkles on the cheeks, another difficult issue, I find that administering Lenisna with a cannula followed by Juvelook mesotherapy after about three months works very well.

It is worth noting that this product—currently the only one on the market—can be combined with radiofrequency using the RF Combo Jector device, and this application has been clinically studied.

A comprehensive eye-area treatment I use for patients with advanced signs of aging includes tear trough correction with hyaluronic acid, revitalization and stimulation with Juvelook in the lower eyelid area, and botulinum toxin for crow’s feet. Experience in combining different methods and products at appropriate intervals is key to achieving optimal results.

Protocols above all

It is important to follow the manufacturer’s protocols for the preparation and administration of Juvelook and Lenisna (for both face and body). Of course, as physicians, we sometimes like to experiment, and I occasionally use higher dilution in patients with atrophic skin—recent studies have shown that greater dilution can enhance collagen stimulation (which is why preparation guidelines for Lenisna were updated).

However, in the lower eyelid and tear trough area—where Juvelook is used—I strongly recommend adhering strictly to the manufacturer’s protocols. The product should be administered relatively deeply and always with a cannula.

This treatment not only beautifully fills the tear trough and reduces under-eye wrinkles but also improves skin density, helping to reduce dark circles caused by thin skin and visible blood vessels.

* Department of Anatomy and Cell Biology, Gachon University College of Medicine, Prof. Kyunghee Byun