Regenerative aesthetics in New York and Beverly Hills: the evidence

The best-evidenced part of regenerative aesthetics is the oldest: FDA-approved biostimulators with randomized 12-month trials. Polynucleotides and exosomes have small favorable trials and no FDA approval. Facial PRP has weak evidence. That is the order to present them in, to patients and in your marketing.

Key points

• In 2025, 82% of ASPS surgeons received GLP-1-related consultation requests, and facial fat grafting grew 39% [2].
• FDA-approved biostimulators have solid randomized trials: poly-L-lactic acid was associated with 71.6% responders vs 26.1% with no treatment at 12 months [10][12].
• Injectable polynucleotides are not FDA-approved, although a randomized trial associated them with better elasticity and hydration than hyaluronic acid [3][8].
• FDA states there are no approved exosome products. Published trials are small and the latest systematic review calls for more data [5][6][7].
• For facial PRP, an overview of reviews concluded that the evidence does not allow firm conclusions [9].

US status (October 2026): See the peptide status tracker.

The menu moved 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 top [1]. The language of leading practices has changed, and 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 biostimulators [3][4].

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 data [18]. Go modality by modality.

• 82%: of ASPS surgeons received GLP-1-related consultation requests in 2025 [2]
• 0: FDA-approved exosome products [5]
• 71.6%: responders with poly-L-lactic acid vs 26.1% with no treatment at 12 months [10]

Biostimulators have the best evidence

Poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHA) are among the materials in FDA-approved fillers. FDA describes PLLA as a material whose effect builds over time and may last up to 2 years [12]. 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 events [10]. In the dorsal hand, a multicenter trial of 114 participants showed that 75% of CaHA-treated participants improved by at least 1 point on the Merz scale at 3 months [11]. It is by far the best-supported “regenerative” segment.

Polynucleotides and PDRN are not FDA-approved for injection

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 them [3]. 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 and small. In a randomized, double-blind, split-face trial in 27 participants (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 events [8].

> “I’ve seen news reports of med spas ordering salmon-derived DNA products…and injecting them in people. It’s very early.” (Lara Devgan, MD, plastic surgeon in New York, in ELLE [3])

Exosomes have strong demand and no approved product

FDA’s position is explicit: “There are currently no FDA-approved exosome products,” and exosome products intended to treat diseases or conditions require agency approval [5]. 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 anecdotal [3].

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 established [7]. For why this category draws enforcement, see exosomes and stem cell marketing.

PRP and topical peptides have thin evidence

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 conclusions [9].

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 2027 [14]; see the GHK-Cu status page. That literature is analyzed 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-1 patients are already in the aesthetic chair

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 one [1]. 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 surgery [16].

“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 rejuvenation [15]. The clinical side is covered in The GLP-1 face.

The fair case for regenerative aesthetics

Regenerative aesthetics is more than marketing. PLLA was associated with 71.6% vs 26.1% responders at 12 months [10] and CaHA with 75% improvement in hands [11]. Polynucleotides improved elasticity and hydration vs hyaluronic acid in a double-blind trial [8], and exosomes with microneedling improved the global aesthetic improvement score vs saline (p = 0.005) [6]. Stimulating the skin is a sound idea. The weak points are the size of the trials and the lack of approval for some products.

What this means for you

• Lead with what has trials. Biostimulators with regulatory approval have randomized trials with 12-month follow-up [10][11][12]. 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 and no FDA approval [3][5][6][8]. Present them that way, in those words.
• Check origin and traceability. The surgeons quoted warn about the lack of PDRN standardization [4]. For cell-derived products, the international context is in Stem cells in Panama.
• Take a drug history. Facial volume loss with rapid weight loss is a frequent consultation in the US [2][17]. GLP-1 use belongs in the aesthetic assessment.

Our aesthetics and injectables program is built on that order of evidence.

References

1. American Society of Plastic Surgeons. Interest in aesthetic health remained consistent despite economic uncertainty in 2024, according to new report from American Society of Plastic Surgeons (press release). June 25, 2025. Link
2. American Society of Plastic Surgeons. 2025 plastic surgery by the numbers: What are the trends in plastic surgery – and what it means for you. September 2, 2026. Link
3. Hou K, Berohn K. From Exosome Therapy to Salmon-Sperm: Beauty’s New Frontier. ELLE (issue of November 2024; reprinted in AOL, May 21, 2025). Link
4. Segal L. What Is the So-Called “Salmon Sperm” Facial, and Should You Add It to Your Skincare Routine? Harper’s Bazaar (reprinted in AOL, September 23, 2025). Link
5. U.S. Food and Drug Administration. Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes. July 22, 2020 (content current as of April 9, 2024). Link
6. Park GH, et al. Efficacy of combined treatment with human adipose tissue stem cell-derived exosome-containing solution and microneedling for facial skin aging: A 12-week prospective, randomized, split-face study. J Cosmet Dermatol. 2023;22(12):3418-3426. PMID 37377400. Link
7. Dhaliwal NK, et al. The Use of Microneedling With Exosomes in Dermatology: A Systematic Review. J Cosmet Dermatol. 2026;25(4):e70881. PMID 42027180. Link
8. Lee YJ, et al. Comparison of the effects of polynucleotide and hyaluronic acid fillers on periocular rejuvenation: a randomized, double-blind, split-face trial. J Dermatolog Treat. 2022;33(1):254-260. PMID 32248707. Link
9. Cruciani M, et al. Platelet rich plasma for facial rejuvenation: an overview of systematic reviews. Blood Transfus. 2024;22(5):429-439. PMID 38557322. Link
10. Fabi S, et al. Effectiveness and Safety of Sculptra Poly-L-Lactic Acid Injectable Implant in the Correction of Cheek Wrinkles. J Drugs Dermatol. 2024;23(1):1297-1305. PMID 38206151. Link
11. Goldman MP, et al. Calcium Hydroxylapatite Dermal Filler for Treatment of Dorsal Hand Volume Loss: Results From a 12-Month, Multicenter, Randomized, Blinded Trial. Dermatol Surg. 2018;44(1):75-83. PMID 28562435. Link
12. U.S. Food and Drug Administration. FDA-Approved Dermal Fillers (content current as of November 9, 2020). Link
13. Miller TR, et al. Effects of topical copper tripeptide complex on CO2 laser-resurfaced skin. Arch Facial Plast Surg. 2006;8(4):252-9. PMID 16847171. Link
14. U.S. Food and Drug Administration. Interim policy on compounding using bulk drug substances under section 503A: categories (updated 2026). Link
15. Osmonbekov M. How ‘Ozempic face’ is pushing Gen X, already the biggest Botox and filler consumers, to the facelift table a decade early. Fortune. June 24, 2026. Link
16. Brumby D. Why some plastic surgeons are now offering weight loss medications. American Society of Plastic Surgeons. April 1, 2024. Link
17. Daneshgaran G, et al. “Ozempic Face” in Plastic Surgery: A Systematic Review of the Literature on GLP-1 Receptor Agonist Mediated Weight Loss and Analysis of Public Perceptions. Aesthet Surg J Open Forum. 2025;7:ojaf056. PMID 40626110. Link
18. Rahman E, et al. Regenerative Aesthetics: A Genuine Frontier or Just a Facet of Regenerative Medicine: A Systematic Review. Aesthetic Plast Surg. 2025;49(1):341-355. PMID 39198280. Link

This is general information, not medical or legal advice. Rules vary by state and change. Confirm your own facts with counsel.