Liquid Facelift and Biostimulators

A liquid facelift is the general term for injectable treatments that stimulate the skin’s own collagen production. The aim is not to fill the face or change its proportions, but to gradually improve the thickness, firmness and quality of the skin. For this reason the result develops over weeks rather than days.

On this page I explain how biostimulators work, where they differ from dermal fillers, and which product class comes to the fore for which concern.

What is a biostimulator?

Biostimulators are products that, once placed under the skin, do not add volume directly. Instead they stimulate fibroblast cells and trigger the production of new collagen. The injected molecule is gradually metabolised by the body; what remains is the collagen network the skin has built itself ¹.

This is the defining difference from filler. With filler you see the result at the moment of injection; with a biostimulator your own body produces the result. The fullness visible immediately after treatment belongs to the carrier fluid and settles within a few days. This does not mean the effect has disappeared — the actual process has only just begun.

The collagen response usually becomes noticeable between the fourth and sixth week. On the face the final result settles between the third and fourth month. In body areas the tissue response is slower and can continue to develop up to the sixth month.

Biostimulator versus dermal filler

The two are used for different problems. Both can be right for the same patient, but they solve different things.

The second-to-last row explains why patient selection matters so much here. Hyaluronic acid filler can be dissolved if the result is not what you wanted. Biostimulators cannot — they are broken down naturally by the tissue over time. This is not a disadvantage; it is the nature of the material. But it makes planning and patient selection decisive.

You can find detailed information on hyaluronic acid treatments on the dermal fillers page.

Where the lines are with mesotherapy and polynucleotides

Two other treatment groups are often confused with biostimulators under the heading of “skin quality”: HA-based skin mesotherapies and polynucleotide (PN) treatment. All three address skin quality, but they do different things.

HA-based mesotherapies target hydration and surface quality; CaHA- and PLLA-based biostimulators target firmness through collagen stimulation. One does not replace the other; when needed they are planned in sequence. I decide which comes first at the consultation.

When the request is tightening, the degree of sagging decides:

When tightening is the request, the decision depends on the degree of sagging: if mild laxity and loss of skin quality dominate, bioremodelling HA comes forward; if tissue support and marked firmness are needed, a biostimulator comes forward. In advanced sagging neither replaces a surgical assessment. The final choice is made at the consultation.

With polynucleotide products the line is drawn according to what the tissue needs:

When firmness is the request, the decision depends on what the tissue needs: if thinning and loss of skin quality lead, polynucleotide; if the tissue clearly needs structural support, a CaHA- or PLLA-based biostimulator comes to the fore. The final choice is made at consultation.

The three molecule classes

Products described as biostimulators fall into three main classes. All three stimulate collagen, but they behave differently and are used differently.

PLLA — poly-L-lactic acid It has a crystalline structure and is placed in the deeper layers. It was used in the first collagen stimulator and is one of the most extensively studied classes ¹. Its effect builds slowly, it requires more than one session, and it requires adherence to a post-treatment massage protocol. I cover two products in this class, Sculptra and Lanluma, on separate pages.

PDLLA — poly-D,L-lactic acid It has spherical particles and does not require a mandatory massage protocol. In the two products of this class that I cover, PDLLA is formulated together with hyaluronic acid: Juvelook, used in more superficial layers for skin texture and surface quality, and Lenisna, used for deeper tissue support.

CaHA — calcium hydroxylapatite A microsphere-based product. When applied in diluted form its volumising effect recedes and it behaves as a stimulator targeting skin firmness and tissue quality ²³. The product I use with this technique is Radiesse.

There are also hybrid products containing both hyaluronic acid and CaHA. These sit on the border between the two classes: the hyaluronic acid component provides tissue support at the time of treatment, while the CaHA component initiates the collagen response over the following weeks. HarmonyCa belongs to this group.

I decide which class to work with based on what the tissue needs, not on a product name. I work with products from these classes that offer traceability and a certificate of analysis.

My approach on the face and on the body

This is the most important distinction in this treatment group. I do not use the same molecule for the same purpose on the face and on the body.

On the face I use biostimulators for skin quality — not for shaping, volume or contour. In areas requiring millimetric symmetry such as the cheekbones, chin and jawline, I use hyaluronic acid fillers, which are reversible. This is not a matter of taste but of safety: because biostimulators cannot be dissolved with an enzyme, we do not have the same flexibility if a correction becomes necessary in these areas.

Pure CaHA can technically be used for facial shaping, but for the same reason it is not a first-line choice.

On the body the situation is different. In larger areas such as the buttocks, the lateral hip depression, the inner arms, the abdomen and above the knees, the use of biostimulators for contour and tissue support is a well described application in the literature ¹. Here we are not dealing with millimetric symmetry but with a gradual tissue response across a wide area — and that is what this product class does well by nature.

I am not comfortable with excessive treatment requests. If I believe during consultation that the expectation does not match what the treatment can deliver, I say so, and I do not recommend a procedure I do not consider necessary.

Which concern, which class

The table is a general framework; I choose the product at the consultation, according to what the tissue needs.

The process and what to expect

I begin with a consultation. Skin thickness, the degree of laxity, previous treatments and your expectations determine the plan.

Topical anaesthetic cream is standard. Because I am an anaesthesiologist, I treat pain management as a separate part of the procedure.

Facial treatments take around 20–30 minutes and body treatments 45–60 minutes. You can return to daily life the same day.

The number of sessions depends on the product class. With PLLA on the face I usually plan 2–3 sessions at intervals of 4–6 weeks. With PDLLA products a single session may be sufficient, or a short course at four-week intervals may be planned. With diluted CaHA I perform a single session, assess the tissue response at week 12, and we decide together at that appointment whether a second session is needed.

Duration ranges from 12 months to 2 years depending on the class. At the end of that period the result does not disappear suddenly; the natural ageing process simply continues from where it left off.

Aftercare

First 24 hours

• No make-up on the treated area
• No hot showers, sauna, hammam or steam
• Avoid heavy exercise
• No alcohol
• Do not sleep face-down (facial treatments)

First 48 hours

• Avoid direct and prolonged sun exposure
• No facial massage, skincare treatments or energy-based device treatments

First week

• Avoid intensive lower-body training after body treatments

Expected findings Mild swelling, tenderness or bruising lasting a few days is expected. Part of the fullness seen in the first days is due to swelling and the product’s carrier and settles quickly; this does not mean the effect has worn off.

Massage protocol. With PLLA products, post-treatment massage is required so that the particles distribute evenly through the tissue, and the protocol differs by product. I provide the protocol for the product used in writing at the end of your appointment.

Safety and anatomy

The most common findings after biostimulator treatments are temporary swelling, bruising and tenderness.

Small palpable firmness under the skin is uncommon. It is usually not visible from the outside and softens over time. Following the massage protocol reduces this possibility.

This product class cannot be dissolved with hyaluronidase. For this reason the treatment plan, the choice of layer and the choice of cannula are the most decisive parts of the procedure. Distance from vascular structures and the correct anatomical plane are what determine the safety of the treatment.

Because allergic reactions can occur rarely, treatments are carried out under medical supervision.

Who is not suitable

Treatment is not performed, or is postponed, in the following situations:

• Active infection or inflammation in the treatment area
• Autoimmune disease in an active phase
• Pregnancy and breastfeeding
• Known hypersensitivity to the product components
• Uncontrolled chronic illness
• Untreated bleeding disorder or unregulated anticoagulant use

Without being a medical contraindication, I also consider expectation and treatment to be mismatched in these situations:

• People expecting a marked and immediate change from a single session
• People with advanced tissue laxity who require surgical assessment
• People whose actual need is volume and contour

Suitability is determined by consultation in every case.

Pricing

Under the applicable regulations, price information cannot be published on our website. The cost of a treatment depends on the product used, the technique chosen and the extent of the treatment. You can call the clinic for detailed information.

Planning your visit

My clinic is in Nişantaşı, Şişli, on the European side of Istanbul, approximately 45 minutes from Istanbul Airport.

For a biostimulator treatment I suggest planning a stay of two to three days: arrival, consultation and treatment, and departure. Flying is generally appropriate 24 hours after an injectable treatment.

Consultations are conducted in English. Follow-up after you return home is arranged remotely, and I remain reachable for any questions during the period in which the result develops.

Frequently asked questions

What is a biostimulator?

A biostimulator is a product that, once placed under the skin, does not add volume directly but stimulates fibroblast cells to begin producing the body’s own collagen. The injected molecule is gradually metabolised; what remains is the collagen tissue the skin has produced itself.

What is the difference between a biostimulator and a dermal filler?

Filler adds volume directly to shape the tissue, and you see the result immediately. A biostimulator stimulates collagen production, and the result develops gradually over weeks. Filler is for shaping; a biostimulator is for skin quality.

What is the difference between PLLA, PDLLA and CaHA?

PLLA has a crystalline structure, is placed in deeper layers and requires a post-treatment massage protocol. PDLLA has spherical particles and does not require mandatory massage; in Juvelook and Lenisna it is formulated with hyaluronic acid. CaHA has a microsphere structure and, when diluted, behaves as a stimulator targeting skin firmness. All three stimulate collagen, but they work in different layers and at different speeds.

Can biostimulator treatments be dissolved?

No. Hyaluronic acid fillers can be dissolved with hyaluronidase, but PLLA, PDLLA and CaHA cannot; they are metabolised naturally by the tissue over time. This is why the treatment plan and patient selection are decisive.

When will I see the effect?

The collagen response usually becomes noticeable between the fourth and sixth week. On the face the final result settles between the third and fourth month. In body areas the response is slower and can continue developing up to the sixth month. The fullness seen immediately after treatment belongs to the carrier fluid and settles within a few days.

From what age are these treatments performed?

Collagen production declines with age, and these treatments usually come into consideration once that change in skin quality becomes noticeable. Age alone is not decisive, however; skin thickness, degree of laxity and expectations are assessed together during consultation.

Who are biostimulator treatments not suitable for?

Treatment is not performed, or is postponed, in cases of active infection, autoimmune disease in an active phase, pregnancy and breastfeeding, known hypersensitivity to the product components, uncontrolled chronic illness and unregulated anticoagulant use. In addition, expectation and treatment do not match for people expecting an immediate change from a single session or whose actual need is volume and contour.

Do smoking and lifestyle affect the result?

Yes. These treatments depend on your body’s capacity to produce collagen. Smoking reduces tissue oxygenation and can therefore affect the amount and quality of the collagen produced. Reducing smoking during the treatment period supports the result.

Dr. Ömer Fatih Şahin — Specialist in Anaesthesiology and Reanimation Diploma Registration No: 113606

Published: 2026-09-21 · Last updated: 2026-09-28 This content has been medically reviewed by Dr. Ömer Fatih Şahin.

References

1. Christen MO. Collagen Stimulators in Body Applications: A Review Focused on Poly-L-Lactic Acid (PLLA). Clin Cosmet Investig Dermatol. 2022;15:997–1019. https://pubmed.ncbi.nlm.nih.gov/35761856/
2. Goldie K, Peeters W, Alghoul M, et al. Global Consensus Guidelines for the Injection of Diluted and Hyperdiluted Calcium Hydroxylapatite for Skin Tightening. Dermatol Surg. 2018;44(Suppl 1):S32–S41. https://pubmed.ncbi.nlm.nih.gov/30358631/
3. de Almeida AT, Figueredo V, da Cunha ALG, et al. Consensus Recommendations for the Use of Hyperdiluted Calcium Hydroxyapatite (Radiesse) as a Face and Body Biostimulatory Agent. Plast Reconstr Surg Glob Open. 2019;7(3):e2160. https://pubmed.ncbi.nlm.nih.gov/31044123/ — Some of the authors disclosed consulting and speaker relationships with the manufacturer; the work is manufacturer-linked.