Biostimulators: How the body’s own collagen production can rejuvenate the skin
A Comparison of Sculptra, Radiesse, and Profhilo Structura –
and Which Treatment Suits Whom
Aesthetic medicine has changed significantly in recent years. While the focus used to be primarily on correcting individual wrinkles or targeted volume enhancement, many patients today desire the most natural-looking result possible: skin that is firmer, tighter, and fresher, without the face appearing “done” or overcorrected.
This is precisely where so-called biostimulants come into play.
Biostimulatory treatments take a different approach than conventional fillers. Rather than simply replacing lost volume, they aim to support the body’s own regenerative processes. Depending on the specific product and treatment protocol used, this can influence factors such as collagen production, skin firmness, elasticity, tissue structure, and—in some cases—the quality of subcutaneous adipose tissue.
Among the best-known treatments are Sculptra®, Radiesse®, and Profhilo® Structura. Although they are often grouped together under the term “biostimulators,” they differ significantly in terms of active ingredient, mechanism of action, area of application, immediate effect, and treatment goal.
The crucial question, therefore, is not: Which biostimulant is the best?
Rather:
Which biostimulator is suitable for the individual patient’s starting situation, anatomy, and desired outcome?
1. What are biostimulants? 
The term “biostimulation” essentially describes the targeted stimulation of biological processes within tissue.
As the skin ages, the quantity and quality of collagen and elastin, among other things, decline. At the same time, changes occur in the extracellular matrix, skin thickness, tissue tension, and—particularly in the face—the various fat compartments. As a result, the skin increasingly loses firmness and elasticity.
Biostimulatory procedures target various stages of this complex aging process.
It is important to distinguish between classic fillers and biostimulators.
A classic hyaluronic acid filler primarily serves to immediately add volume or structure. In contrast, a biostimulator—depending on the specific product—aims more to influence biological tissue structure and stimulate the body’s own regenerative processes.
In practice, however, the boundaries are not always strict. Some products can have both an immediate structural effect and a delayed biostimulatory effect.
2. The principle of collagen stimulation
Collagen – the structural framework of the skin
Collagen is one of the most important structural proteins in the human body. In the skin, it contributes significantly to firmness, elasticity, and stability.
Collagen metabolism changes with age. New collagen formation decreases, while breakdown processes simultaneously increase. The result is, among other things, skin that is thinner, less elastic, and less resilient.
Treatment with a collagen stimulator therefore aims to specifically influence this process.
In simplified terms, the principle works as follows:
Biostimulator → biological stimulus → activation of fibroblasts → new formation or remodeling of collagen → improvement of tissue structure
The effect does not necessarily occur immediately as a result.
Rather, the improvement can develop over weeks and months.
This is a crucial difference compared to a classic volumizing filler.
Why the result can look more natural
With a classic filler, a specific amount of material is injected to immediately alter a structure.
With a biostimulator, on the other hand—depending on the specific product—the focus is more strongly on the gradual alteration of the body’s own tissue.
As a result, the outcome can often appear more subtle and natural. At the same time, however, this means that patients need patience: the final result cannot always be assessed immediately after the treatment.
With Sculptra, for example, the manufacturer explicitly describes a gradual treatment effect; a re-evaluation should take place no earlier than four weeks after the treatment.
3. Sculptra® – Collagen stimulation with poly-L-lactic acid
The active ingredient: PLLA
Sculptra® is based on poly-L-lactic acid (PLLA). This is a biocompatible and biodegradable synthetic polymer. The product contains poly-L-lactic acid microparticles.
The goal of the treatment is not primarily immediate volumizing, but rather the gradual improvement of tissue structure through the stimulation of the body’s own processes.
Sculptra has been used in aesthetic medicine for many years. In Europe, its application has since been extended to specific areas of the body. As of 2025, European MDR certification covers the buttocks, posterior thighs, décolletage, and upper arms, in addition to the face.
How does Sculptra work?
Following injection, the PLLA particles are gradually biodegraded. The tissue response is crucial to the aesthetic effect.
The treatment is designed to stimulate the body’s own collagen production, thereby contributing to long-term improvements in firmness, structure, and volume. Accordingly, Galderma describes Sculptra as a regenerative biostimulator that supports collagen and elastin production.
Therefore, the effect does not develop immediately, as it does with a classic filler.
For whom is Sculptra particularly interesting?
Sculptra may be of particular interest to patients,
- who desire a general improvement in skin and tissue quality,
- where there is already a certain volume loss,
- who prefer a natural and gradual effect,
- who do not desire a strong, immediate change,
- in which diffuse tissue weakness or skin laxity is the predominant feature.
A particular advantage of Sculptra is that treatment is not limited to a single wrinkle; instead, the treatment approach can be geared towards a more comprehensive improvement of tissue structure.
The downside: patience is required.
Anyone who undergoes treatment in the morning and expects a noticeably altered facial shape by evening is not necessarily the ideal Sculptra patient.
The process relies on the progression over time.
Improvement develops over weeks and months. Therefore, Sculptra is particularly suitable for people who accept a gradual, natural process of change.
4. Radiesse® – Calcium hydroxylapatite for structure and collagen stimulation
The active ingredient: calcium hydroxylapatite
Radiesse® is based on calcium hydroxylapatite (CaHA).
This is how Radiesse differs fundamentally from Sculptra.
While Sculptra uses PLLA, Radiesse contains calcium hydroxylapatite microspheres in a gel carrier.
A key difference lies in the treatment experience: in addition to its biostimulatory effect, Radiesse can also produce an immediate structural or volumizing effect.
This makes it an attractive option for patients seeking not only improved skin quality but also more defined contours or structural support.
How does Radiesse work?
Radiesse can be viewed on two levels.
1. Immediate structural effect
The gel carrier brings about an immediate change in the treated area.
2. Long-term biostimulation
The calcium hydroxylapatite microspheres act as a biostimulatory stimulus and can support the formation of new collagen.
In this way, Radiesse combines the properties of a structural filler with a long-term biostimulatory approach.
When can Radiesse be particularly beneficial?
Radiesse is interesting if, for example,
- a stronger contouring is desired,
- the skin should become firmer at the same time
- A certain immediate effect is important.
- the treatment should be more structurally oriented
- specific anatomical areas are to be targeted for support.
Depending on the dilution and injection technique, the emphasis can be varied.
This makes Radiesse a very versatile tool in aesthetic medicine.
5. Profhilo® Structura – a different approach
Profhilo Structura occupies a special position in this comparison.
For Structura is not a conventional collagen stimulator based on PLLA or CaHA.
The product is based on a combination of high- and low-molecular-weight hyaluronic acid. It is manufactured using the NAHYCO® technology developed by IBSA. The distinctive approach involves looking beyond the skin’s surface to also address deeper tissue structures—specifically, the subcutaneous adipose tissue.
Why is that relevant?
Facial aging does not occur exclusively in the skin.
The subcutaneous adipose tissue also changes:
- Volume can be lost,
- Fat compartments can shift,
- The tissue anchorage changes,
- The overlying skin loses its support.
As a result, a face can appear not only more wrinkled but also “empty,” tired, or sunken.
Profhilo Structura was specifically developed for facial treatment and the restoration of adipose tissue.
For whom might Structura be of interest?
Structura may be particularly interesting in patients
- whose face appears older and more tired due to volume loss,
- where the primary goal is to improve subcutaneous tissue,
- who desire a subtle regeneration,
- where skin quality and tissue structure are to be considered together,
- who do not want a traditional volumizing filler.
It is important to note: Structura should not simply be viewed as a “lighter version” of Sculptra or Radiesse.
Rather, it is a different therapeutic approach.
6. Direct comparison of Sculptra, Radiesse, and Structura
| Sculptra |
|
||
|---|---|---|---|
| Main ingredient PLLA Calcium hydroxylapatite Hyaluronic acid |
|||
| Hauptansatz | Kollagenstimulation | Struktur + Kollagenstimulation | Geweberegeneration / Unterstützung des Fettgewebes |
| Immediate effect | rather slight | significantly stronger effect possible | subtle |
| gradual | partly immediate + long-term | gradual | |
| Skin/tissue firmness and volume | Contour, structure, firmness | Tissue quality and subcutaneous tissue | |
| Typical patient | Diffuse signs of aging | Loss of structure and contour | Volume/tissue changes |
| Character | regenerative | structural + biostimulatory | regenerative/tissue-related |
The three methods should therefore not be evaluated according to the principle of “good – better – best.”
They are different tools for different anatomical and aesthetic issues.
7. Which procedure is suitable for which patient?
The selection should always be based on three questions:
1. What has changed?
Is it mainly about:
- Skin quality?
- Loss of elasticity?
- diffuse volume loss?
- Loss of definition?
- Sagging tissue?
- Changes in the subcutaneous adipose tissue?
2. What does the patient want to achieve?
If the patient wishes:
- A gradual improvement that is as natural as possible?
- more definition?
- a visible immediate effect?
- Better skin quality?
- more firmness?
- A change without the classic “filler feel”?
3. How much change is desired?
A 45-year-old patient with the onset of skin laxity may require a completely different strategy than a 65-year-old patient with pronounced volume loss.
8. Typical patient situations
Patient A: “My skin is becoming thinner and slacker, but I don’t want more volume.”
A collagen-stimulating approach such as Sculptra can be particularly interesting here.
The goal is less about immediate sculpting than the gradual improvement of the tissue structure.
Patient B: “My jawline is less defined, and my tissue looks slack.”
Radiesse can be an interesting option here, particularly if structural support and contouring are desired in addition to improved skin quality.
Patient C: “My face looks blank and tired.”
A classic filler should not be used automatically here.
First, it should be analyzed whether a loss or alteration of subcutaneous adipose tissue plays a significant role.
In such a situation, Profhilo Structura can be an interesting option as a tissue-focused approach.
Patient D: “I want to look as natural as possible, and I don’t want it to be obvious that I’ve had something done.”
In principle, all three methods are conceivable here—but involving different strategies.
The crucial question is what anatomical cause underlies aging.
“Natural” does not automatically mean “little product.”
Rather, a natural look is achieved through precise diagnosis, the correct indication, and restrained treatment.
9. Can I combine the procedures?
Yes, in principle, various regenerative and structural procedures can be combined within an individual treatment plan.
However, the following principle should not apply:
“The more products, the better the result.”
A so-called layer or concept strategy makes more sense.
The various levels of facial aging are first analyzed:
Skin → Connective tissue → Adipose tissue → Contour → Volume
Only then is it decided which structure should actually be treated.
For example, in a patient with skin laxity and concurrent structural volume loss, a combination of different treatment approaches may be more appropriate than the use of a single product alone.
However, the combination should always be planned on an individual basis.
10. The Limits of Biostimulation
Biostimulators are not a substitute for every other aesthetic treatment.
In cases of significant excess skin, for example, a surgical tightening procedure may be far more suitable.
Pronounced individual wrinkles, significant volume deficits, or specific anatomical changes may also require different treatment methods.
A common mistake is trying to treat every aging-related issue with the same product.
The better strategy is:
Diagnosis before product selection.
Only the analysis of the tissue determines the therapy—not the other way around.
11. Safety and realistic expectations
As with any medical injection treatment, side effects may occur. These include, for example, temporary redness, swelling, tenderness, or bruising. Depending on the product and injection technique, specific complications may also arise.
Therefore, biostimulators should be administered exclusively by appropriately qualified medical professionals.
Proper information is equally important.
A biostimulator can improve skin quality and tissue structure, but it cannot stop the natural aging process.
The goal should therefore not be to “turn back” a particular phase of life.
Rather, the aim is to improve the structure, quality, and proportions of the tissue as naturally as possible.
12. Conclusion: Not the best biostimulator – but the right one.
Sculptra, Radiesse, and Profhilo Structura employ different approaches.
Sculptra is primarily known for progressive collagen stimulation based on poly-L-lactic acid. It is particularly suitable for patients seeking long-term improvement in tissue firmness and volume, with results that develop naturally.
Radiesse is based on calcium hydroxylapatite and combines a potential immediate structural effect with biostimulatory properties. This makes it particularly appealing when contour, firmness, and tissue structure need to be addressed simultaneously.
Profhilo Structura takes a different approach. By combining high- and low-molecular-weight hyaluronic acid and focusing on the subcutaneous tissue, the emphasis shifts from classic collagen stimulation to the regeneration or support of deeper tissue structures.
The most important insight, therefore, is:
Not every aging face requires the same biostimulator.
Successful treatment begins with an analysis of the individual anatomy and the question of which tissue layer has changed and what result the patient actually desires.
Only then should the choice be made between Sculptra, Radiesse, Structura, or—where appropriate—a combination of different procedures.
In this way, a product-based treatment becomes an individualized medical treatment concept.
