Biomodulators: Calcium hydroxylappatite and polylactic acid-based fillers are so effective & tolerable

    • Less invasive aesthetic treatments with biomodulators and new ultrasound treatments are becoming increasingly popular in facial rejuvenation treatments.
    • As an expert in aesthetic medicine, Leila Frohn, MD, educates patients about the use, modes of action, and results of biomodulators and reveals why she relies on HIFU technology alongside fillers.

November 2022. Hyaluronic acid has become a very popular and well-known treatment among fillers in recent years. But watch out: Biomodulators based on calcium hydroxylappatite and polylactic acid are becoming increasingly popular! Leila Frohn, MD, sees the advantages of these fillers primarily in their mode of action: 

«Biomodulators stimulate the skin to form new functional collagen and elastin fibers through the injection. So it is not – as with hyaluronic acid – the filler that smoothes the skin, but the body’s own newly formed tissue. This results in better lifting power and also longer durability. You can more easily achieve a so-called lifting effect and sustainably improve skin quality.»

Leila Frohn, MD, is a specialist in general medicine and an expert in aesthetic medicine. In 2004, she founded her private practice for aesthetic medicine in Grünwald (district of Munich). One of her specialties is Liquid Liftings with biomodulators, hyaluronic acid or combination treatments. During this treatment, the entire face is injected and the results are particularly natural-looking and longer-lasting. As an expert in this field, Leila Frohn, MD, gives an overview of biostimulatory fillers in an interview with 

Expert check: Leila Frohn, MD, explains what’s behind the trend of biostimulating fillers.


 What exactly are fillers such as Radiesse (calcium hydroxylapatite) and Sculptra (polylactic acid /PLLA)?

Both fillers, calcium hydroxylappatite-based and polylactic acid-based fillers, have been used successfully for skin rejuvenation for many years. The best-known filler based on calcium hydroxylappatite is Radiesse. Here, the finest microspheres of calcium hydroxylappatite are incorporated into a water-based carrier gel. Since calcium hydroxylappatite is a natural component of our bone cement, these fillers are particularly well tolerated. In terms of texture, they are very smooth, more like a viscous cream. Polylactic acid, with the best-known representative Sculptra, is a complex sugar whose basic substance is of natural origin. We have been successfully using polylactic acid as a suture material for decades, and as a result its tolerability is very well proven. The risk of granuloma nodule formation from the early years of wrinkle treatment with PLLA has been practically eliminated by today’s use in higher dilution.


• How are the fillers used and to whom do you recommend the treatment?

Both fillers are injected subdermally and stimulate the rebuilding of functional collagen and elastin fibers in the patient’s own tissue. This creates a natural, skin-tightening rejuvenation effect and volume is regained in areas where it has been lost through the aging process. The skin texture and pores are also refined.

Treatment with these biostimulating fillers is suitable for all patients who desire a skin-firming and skin-improving effect in addition to wrinkle smoothing.

• What are the advantages of biostimulating fillers compared to hyaluronic acid?

Hyaluronic acid-based fillers are injected at various depths and act as «placeholders.» They can only achieve an optical correction and bind some water. Both calcium hydroxylappatite and polylactic acid are biomodulators. By injecting them, they stimulate the skin to produce new functional collagen and elastin fibers. Thus, in these treatments, it is not the filler that smoothes the skin, but the body’s own newly formed tissue. This results in better lifting power and also longer durability. A lifting effect is easier to achieve and the skin quality can be improved in the long term.

• What type of treatment is suitable for Radiesse / Sculptra?

For a naturally refreshed looking and regenerated face, I recommend Liquid Lifting. With these treatments, the entire face is injected rather than individual wrinkles. In this way, sagging areas can also be lifted again in the sense of a lifting effect. Especially in the area of the so-called Jawline, very good results can be achieved. If necessary, the neck and hands can also be treated. The complete result of the biostimulation is visible after about 8-10 weeks. Only then is collagen formation complete. Thus, the rejuvenation is gradual and discreet.


Fact check: Calcium hydroxylappatite and polylactic acid at a glance


    • Collagen stimulating treatments

    • Good tolerance, natural look

    • Results visible for up to 18 months 

    • Calcium hydroxylappatite: texture tends to be creamy and has an immediate plumping effect that is enhanced by collagen buildup.

    • Polylactic acid (PLLA) is dissolved as a powder with sterile water and lidocaine and injected as a liquid. Here, the immediate effect recedes after a few days and the result is visible only after a few weeks.

    • Fields of application: Face, neck, hands or also for cellulite, on the décolleté and inner arms. 

    • Can be combined with hyaluronic acid: Calcium hydroxylappatite and polymichic acid must not be applied, for example, in the red of the lips or in the forehead area. For this reason, hyaluronic acid is often combined in everyday use.

Modern treatments: rejuvenation by ultrasound


In addition to injections with fillers, Dr. Frohn also uses HIFU technology for skin tightening and rejuvenation.

 How can patients imagine this treatment?

HIFU stands for high-frequency ultrasound. I work here with Sofwave Superb, a new type of high-frequency ultrasound that uses a «parallel beam» in the middle dermis to stimulate the tightening of existing collagen fibers and also the production of new collagen and elastin fibers through the controlled release of heat. This FDA-approved treatment is suitable for all skin types and can be performed year-round regardless of UV radiation. For the treatment, the skin is prepared with a numbing cream. After about 40 minutes, the procedure is complete and patients can return to their daily routine without any downtime. Immediately after the treatment you will see a certain immediate effect, which will progressively improve over the next 8-12 weeks until the final result. You get a very fresh, firm skin and lifted contours again. Many of my long-time patients, who have also tried and experienced different procedures, are thrilled with the significantly improved quality of their skin. Sofwave Superb allows an uncomplicated «lunchtime» lifting and has already won four important beauty awards.