In the Sea of Biostimulators - Which One to Choose?

Top 10 Biostimulators Chosen by Dr. Nikola Milojević

This year marks my 20th anniversary in aesthetic medicine, and I’ve been reflecting a lot lately on this branch of medicine that continues to grow and bring innovations every day. I’ve also been thinking about how much it has changed since that "long-ago" day in May 2005, when I treated my first patient in London, when I administered Botox for the very first time.

I’ve been invited to give a lecture titled "20 Years of Injectables in Aesthetic Medicine" at an upcoming international aesthetic medicine congress. At the very beginning of this new millennium, I was among the first doctors in Europe to use Botox for wrinkles in the upper part of the face, and dermal fillers (initially only for lips and nasolabial folds). Back then, we were literally what you might call "one-trick ponies"-magicians with just one trick, so to speak. We rejuvenated patients who didn’t want to go under the knife with this innovative method, but we didn’t have many tools in our medical toolbox.

Back then, I missed my legendary father every day - Professor Boško Milojević, a pioneer of European aesthetic plastic surgery. He was my great inspiration and was supposed to be my mentor in aesthetic surgery. But he was no longer with us, and I embarked on the adventure of non-surgical aesthetic medicine when it was still in its infancy. You can watch a documentary about my father, filmed a few years ago, but I will also dedicate a special blog to him - coming soon! If longevity medicine had existed in his time, he would have been celebrating his 100th birthday this year!

But let me go back to 2005 - a year of uncertainty for me... I was constantly looking for ways to develop aesthetic medicine. Soon we started working with dermal fillers for cheeks and jawline, and I was the first in Europe to fill under-eye hollows and straighten noses using that miraculous hyaluronic gel. Collagen stimulators in the form we know them today didn’t exist yet. There were some basic mesotherapy treatments, chemical peels, and the closest thing to a modern skin biostimulator was Restylane Vital Skinbooster, which appeared around 2007. Some doctors, I believe it was in 2008, started presenting evidence that PRP blood plasma rejuvenates the skin, but at the time, I was skeptical.

Hyaluronic dermal fillers and Botox are still the two most important and effective tools when we talk about aesthetic medicine. Talking about aesthetics in general, we can confidently say that they are even more popular than the most common and in-demand aesthetic surgeries, such as rhinoplasty, facelifts, liposuction, or breast augmentation.

Today, in the year 2025, modern aesthetic medicine has access to a "sea" of lasers and devices that rejuvenate the skin and tighten the face, and in the past few years, we've seen a real boom in new skin biostimulators. The range of options is now fantastic, and by combining all these treatments, we can achieve very effective and natural results.

Although Botox is still the best at removing wrinkles, and hyaluronic filler is still the best for filling sunken cheeks, deep lines, under-eye hollows, and the like, combining them with biostimulators gives beautifully radiant skin and even better results. Also, biostimulators offer a rejuvenation option for the face and skin to anyone who doesn’t want Botox or dermal fillers.

The skin covers the entire body and is the largest human organ. It is constantly exposed to external and internal factors that damage it. Although both Botox and dermal fillers stimulate collagen and elastin production in the skin, the new generation of biostimulators does this even better. The options we have now, 20 years later, are incredible. New products hit the market every month, and every aesthetic congress showcases something that further raises the bar for non-surgical facial and/or body rejuvenation.

In short, biostimulation encourages the skin to produce new collagen, elastin, and hyaluronic acid, making the skin firmer, healthier, shinier, and more elastic. All these new products and biostimulators achieve their results by stimulating the fibroblasts in the skin, whose increased activity stimulates the production of collagen, elastin, and hyaluronan (extracellular matrix).

Collagen is the key to firmer skin and is one of the most abundant proteins in the human body, making up about 75% of the skin. It helps maintain the firmness and shape of your skin. Of all types of collagen, type 1 and type 3 are the most prevalent in the skin. Type 1 collagen is the main structural component of the skin, while type 3 collagen plays a role in the healing and renewal processes of the skin. Collagen levels decrease rapidly with age, and throughout life, an adult loses about 1% of collagen each year. By the age of 35, the skin loses up to 15%, by 45 it loses up to 25%, and by the age of 55, it can lose as much as 35% of its collagen.

In an era where patients are seeking the most natural results, all these laser and injectable solutions for facial and skin rejuvenation offer us numerous options, allowing each treatment to be "tailored" to the skin and desires of every individual patient. Biostimulators can be combined with Botox and fillers, but they can also be applied on their own. Biostimulators make the skin look healthy, rejuvenated, and glowing... something that aesthetic surgery simply cannot achieve.

Unfortunately, as good as it is to have more options, it can sometimes be tricky. With so many methods and ways to stimulate and rejuvenate the skin, which one should you choose for yourself? What are the best biostimulators?

To make your choice easier, I’ve put together a list of the best biostimulators on the market. I’ll start with those I use at Poliklinika Milojević, which have been on the market the longest, and then move on to some "new kids on the block."

Skinboosters

Big companies like Merz, Teoxane, Neuvia, and Fillmed have their own versions. Their composition is the same as stabilized dermal fillers, but in lower concentrations. They are not injected like dermal fillers but are applied through mesotherapy with many small injections across the skin or with the help of a cannula.

A major advantage is that this hyaluronic acid stays in the skin for a few months, hydrating the skin and stimulating collagen.
The face does NOT gain volume, but wrinkles, like smile lines on the cheeks, disappear, and the skin becomes younger and more radiant.
3 ampoules of 1 ml are needed per treatment, which is repeated every 6-12 months.

Sculptra

In 2008, I attended the first training session for Sculptra. Sculptra is the original and unique collagen biostimulator that contains Poly-L-Lactic Acid (PLLA), a completely resorbable polymer, and works in deeper layers of the skin, improving its internal structure. Now, there are many versions of PLLA and PDLA, such as Lanluma, Aespella, and Juvelook.

Big advantage: Scientific research shows that Sculptra and similar biostimulators stimulate collagen growth in the skin better than any other product on the market.
This method achieves the so-called "liquid facelift", where the skin becomes firmer, tighter, and more radiant, without a significant increase in volume.
Sculptra can also be used on the body for issues like loose skin and cellulite, especially when combined with devices such as Ultherapy or Morpheus 8.
3-5 treatments are needed every month or two, and massages are required after the treatment to prevent the formation of lumps.

PRP (PRGF) Blood Plasma

I have been using blood plasma as a method of biostimulation and skin treatment for more than 12 years. Many of you are already familiar with it, and some even know it by the charming nickname "vampire treatment", but let me briefly explain what it’s about. We draw your blood and use a special centrifuge to extract your plasma, which is full of growth factors and stem cells. I must point out that 100% of our patients have been satisfied with this treatment.

The advantage of this treatment, for those who find it important, lies in the fact that nothing external is used - you rejuvenate yourself!
Growth factors stimulate skin regeneration, heal the skin, and rejuvenate it.
The treatment is very effective in dealing with pigmentation, acne, scars, and redness.
Three treatments are needed over one month, with a follow-up after a year.
It combines excellently with microneedling, as well as with DermaPen or SkinPen.

Profhilo

We're only on the fourth biostimulator on the list, and we're already in the realm of newer anti-aging products. Profhilo rejuvenates the skin through a mechanism called bioremodelling, which involves a combination of high and low molecular weight hyaluronic acid. This hyaluronic acid is not stabilized like dermal fillers, so it remains in the skin for weeks rather than months and does not increase facial volume. Among biostimulators in the world of aesthetics, it is one of the most sought-after and award-winning treatments.

A major advantage: Profhilo is injected using the BAP technique at only 5 points on each side of the face. The treatment is quick and painless.
Profhilo rejuvenates the skin, tightens it, and improves facial tone.
There is also Profhilo Structura - an advanced injectable solution based on hyaluronic acid, specifically designed to restore adipose tissue.
Profhilo Body is also excellent for loose skin on the body.
Two treatments are recommended for skin renewal. The second treatment is done one month after the first. For optimal results, the treatment is done 1-2 times a year.

Sunekos

A category of biostimulators very similar to Profhilo, but with important differences. It consists of non-crosslinked hyaluronic acid and 6 carefully selected and balanced amino acids. The hyaluronic acid in Sunekos is produced in France.

Advantages: Sunekos is injected using the mesotherapy method and can be used to treat the entire face, forehead, the area around the lips, and even under-eye hollows. Many biostimulators are limited to specific areas of the face - for example, Profhilo is not used on the forehead.
Sunekos rejuvenates the skin, making it firmer by building the "extracellular matrix" and stimulating collagen production.
It's an excellent solution for treating scars, as Sunekos remodels "bad" collagen in scars and transforms it into "good" collagen.
A very similar product on the market with similar effects and great results is called Jalupro.
Three treatments are needed, with 10-day intervals between them.

HArmonyCA

I consider this treatment a small revolution in aesthetic medicine over the past two years due to its excellent results. It is a hybrid biostimulator combining a crosslinked hyaluronic filler with calcium hydroxyapatite crystals (similar to the well-known biostimulator Radiesse, which has a similar effect on the skin as Sculptra, but unlike HArmonyCA, does not contain hyaluronic acid).

Major advantage: Unlike most others, HArmonyCA delivers instant lifting and filling results thanks to the hyaluronic acid, while the calcium hydroxyapatite crystals, which stimulate collagen production, deliver their best results after about 3 months.
It is applied laterally on the face, in the "marionette" lines and "accordion" lines.
It provides incredible skin firmness and excellent lifting of the entire face, especially the lower part.
The treatment is repeated every 12 to 18 months.

Polynucleotides

Right now, there's perhaps the biggest buzz around polynucleotides. Hollywood celebrities and major beauty enthusiasts like Kim Kardashian have popularized this treatment, calling it the "salmon sperm facial." While this might seem like a "new kid on the block" treatment, Plinest (by Mastelli Aesthetic) celebrated its 50th anniversary this year, meaning the science and research behind their products is extensive.

Polynucleotides are of fish origin (trout) and are full of nucleotides, which are essentially the building blocks of DNA and RNA. They help damaged skin regenerate, hydrate, and stimulate new collagen production.

Advantage: This treatment stimulates fibroblast activity and is ideally used as a preparatory step before other treatments like Morpheus8, as it enhances the overall results.
Particularly good results are seen with sagging skin around the eyes and for treating "smoker's lines."
A full treatment includes three applications in selected areas at agreed intervals, and the cycle is best repeated twice a year.

Exosomes

Exosomes have emerged as one of the most advanced and cutting-edge tools in aesthetic medicine today. I often describe exosomes to patients as stem cells. They are tiny vesicles secreted by various cells in the body and play a crucial role as messengers in cell-to-cell communication and tissue regeneration. They deliver valuable substances to target cells, such as genetic material, proteins, and other molecules. At the Milojević Polyclinic, we use exosomes derived from wild rose, from the world’s most well-known brand - ASCE. Human-derived exosomes are banned in the EU.

Major advantage - Exosomes are not injected with a needle but are used in combination with microneedling treatments like SkinPen or DermaPen.
ASCE masks are also applied, and the treatment continues at home with a cream containing exosomes.
Exosomes aid in faster and better healing of injuries and wounds.
An excellent treatment after laser procedures - reduces redness and shortens recovery time.

ABG mesotherapy

Now, this is the real "new kid on the block"! ABG is an American company that produces special serums for fibroblast biostimulation and the production of collagen, elastin, and hyaluronic acid.

ABG serums use various combinations of active ingredients such as peptides, vitamins, amino acids, microelements, and antioxidants, which are selected based on the specific needs and conditions of the skin. At the Milojević Polyclinic, we have MESO-WHARTON P199, MESO-XANTHIN F199®, and MESOEYE C71® ABG serums for mesotherapy.
Advantages: MESOEYE is particularly interesting. It is used around the eyes to treat dark circles and sagging skin, but the best effects are seen with swollen eyes. This serum reduces swelling, even when it is caused by dermal filler injections. I believe these biostimulators have enormous potential.

NCTF

This is the "kid that's just arriving." In the sea of new biostimulators, the boundaries are constantly being pushed, and I've only heard praise for this product, so I believe we'll be adding it to our offerings soon.

NCTF is a mesotherapy serum from the Fillmed company, designed for skin revitalization. It combines 54 active substances, including vitamins, amino acids, nucleotides, oligoelements, and hyaluronic acid.

For fine lines, hydration, radiance, and skin elasticity
It can be used in combination with many other treatments and lasers for even better results
It can be combined with very small doses of Botox (Mesobotox) for treating acne, pores, and facial redness
I must emphasize that I still prefer the biostimulators I mentioned earlier in this list over NCTF serums, but we will definitely keep an eye on this newest one.

I hope I’ve managed to at least somewhat bring closer or gather in one place everything that might interest you about biostimulators, which, as the word itself suggests, aim for biostimulation - stimulating the skin's natural mechanisms to produce collagen, and thereby slowing down, or even reversing, that relentless ticking of the clock, which is at the very core of the philosophy at the Milojević Clinic.