Regenerative aesthetics in New York and Beverly Hills: what is offered and what the evidence says

The new menu: from “filling” to “regenerating”

In 2024, members of the American Society of Plastic Surgeons (ASPS) recorded over 28.5 million minimally invasive procedures; neuromodulators (9,883,711) and hyaluronic acid fillers (5,331,426) stayed on top¹. But the language of leading practices has changed: the buzzword is “regenerative.” Beauty magazines interviewing dermatologists and plastic surgeons in New York and Beverly Hills describe a menu that includes salmon-DNA polynucleotides, exosomes applied after microneedling or into the scalp, PRP and collagen biostimulators³⁴.

A 2025 systematic review of so-called “regenerative aesthetics” (19 studies, 14 of them randomized trials) concluded that the field still lacks the scientific rigor and regulatory compliance to be considered a specialty in its own right, with unclear mechanisms and no long-term safety data¹⁸. So it pays to go modality by modality.

Biostimulators: the best-evidenced part

Poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHA) are among the materials in FDA-approved fillers; the agency describes PLLA as a material whose effect builds over time and may last up to 2 years¹². In a randomized trial with a no-treatment control for cheek wrinkles, PLLA was associated with 71.6% responders vs 26.1% at 12 months, with mostly mild adverse events¹⁰. In the dorsal hand, a multicenter trial of 114 subjects showed that 75% of CaHA-treated subjects improved by at least 1 point on the Merz scale at 3 months¹¹. It is by far the best-supported “regenerative” segment.

Polynucleotides and PDRN: “salmon DNA”

Injectable polynucleotides (brands such as Plinest, Ameela or Rejuran) are not FDA-approved, although they are used in the UK and South Korea; a London plastic surgeon told ELLE that American patients fly over to get them³. Dermatologist Shereene Idriss summed it up in Harper's Bazaar: “In the United States, PDRN is not FDA-approved for injectable use”⁴. Beverly Hills surgeon Catherine Chang added that “there's currently no standardized method for producing or testing PDRN”⁴.

The evidence is promising but small. In a randomized, double-blind, split-face trial in 27 subjects (periocular area), polynucleotides were associated with greater improvements in elasticity, hydration, roughness and pore volume than non-crosslinked hyaluronic acid, with no difference on the global aesthetic improvement scale and no serious adverse events⁸.

Exosomes: strong demand, no approved product

The FDA's position is explicit: “There are currently no FDA-approved exosome products,” and exosome products intended to treat diseases or conditions require agency approval⁵. Even so, ELLE describes dermatologists injecting them into the scalp or applying them after microneedling, and a Beverly Hills surgeon comparing them with PRP for hair loss, with patient reports that are anecdotal³.

In the most cited trial, 28 people received microneedling with an adipose-derived exosome solution on one side of the face and saline on the other; the global aesthetic improvement score was higher on the treated side at 12 weeks (p = 0.005)⁶. A 2026 systematic review of microneedling with exosomes included 8 studies, with samples of 3 to 60 participants, and concluded that more evidence is needed before safety and efficacy can be established⁷.

PRP and peptides after procedures

PRP is autologous and has been in practices for years, but its facial evidence is weak: an overview of 13 systematic reviews found only 28 primary studies (18 uncontrolled), rated confidence low or critically low in 12 of the 13, and concluded that the evidence does not allow firm conclusions⁹.

Topical peptides such as GHK-Cu appear in post-laser recovery protocols. The only randomized trial in CO2 laser-resurfaced skin (13 patients) showed no objective differences in erythema or wrinkles, although satisfaction was higher with GHK-Cu (P = .04)¹³. In the US, the non-injectable form returned to FDA Category 1, and the agency will consult its advisory committee before the end of February 2027¹⁴. We analyzed that literature in GHK-Cu: four decades of papers, few trials. Other peptides studied after laser, microneedling and surgery are reviewed in Peptides and skin healing.

GLP-1s inside the plastic-surgery practice

In 2024, for the first time, ASPS measured weight-loss drug use: over 800,000 aesthetic patients were using them; 20% had already had surgery, 39% were considering a surgical procedure and 41% a nonsurgical one¹. In 2025, 82% of surgeons reported GLP-1-related consultation requests, and facial fat grafting was the fastest-growing cosmetic procedure (39%)². Some surgeons prescribe semaglutide so that patients with a high BMI can reach a safer range before surgery¹⁶.

“Ozempic face” now has its own literature: a systematic review identified 23 articles and found that online searches for the term are linked to searches for “face filler” and “plastic surgeons”¹⁷. According to Fortune, the American Academy of Facial Plastic and Reconstructive Surgery reported a 50% rise in fat grafting in 2024, and the ASPS president described more patients in their 40s and 50s opting for facial rejuvenation¹⁵. The clinical side is covered in The “GLP-1 face”.

What it means for Panama

• Lead with what has trials: biostimulators with regulatory approval have randomized trials with 12-month follow-up¹⁰¹¹¹²; that is the most defensible basis in front of an informed patient.
• Separate trend from evidence: polynucleotides and exosomes have small trials with favorable results, but no FDA approval³⁵⁶⁸. Presenting them that way, in those words, protects the patient relationship.
• Origin and traceability: the surgeons quoted themselves warn about the lack of PDRN standardization⁴. Cell-derived products also carry a sensitive local context, described in Stem cells in Panama.
• The GLP-1 patient has arrived: facial volume loss with rapid weight loss is a frequent consultation in the US²¹⁷; drug history belongs in the aesthetic assessment.
• Who injects matters: the local framework on who may apply filler substances is summarized in Law 491, serums and mycobacteria.