Assessment of the Possible Impacts of Collagen Biostimulators on Surgical Facelift.

[BACKGROUND] Minimally invasive facial rejuvenation techniques, including collagen biostimulators and energy-based technologies, have gained popularity alongside surgical facelift (rhytidoplasty). While biostimulators present overall tissue remodeling (collagen, elastin, extracellular matrix), their impact on facelift surgery remains controversial due to a lack of robust scientific evidence.

[OBJECTIVE] To assess surgeons' perceptions on the effects of biostimulators use and facelift surgery, including surgical difficulty, complication rates, and modifications in surgical planning.

[METHODS] A survey was conducted with 63 facial surgeons, including plastic surgeons and otolaryngologists, evaluating their experiences with facelift procedures in patients previously treated with biostimulators. Questionnaire included patient history, preoperative assessment, surgical challenges, operative time, complications, and changes in surgical approaches.

[RESULTS] Most respondents (70%) performed both surgical and minimally invasive procedures, while 28% offered biostimulators through other professionals. When asked about surgery: 59% believed biostimulators could delay facelift surgery and 43.8% adjusted their surgical approach, especially in cases presenting fibrosis whereas 50.8% reported longer operative times, and 84.4% noted increased complication rates. Among complications, 91.8% reported difficulty in tissue dissection, 73.3% observed postoperative skin irregularities, and 57.4% noted prolonged inflammation. The type of biostimulator influenced surgical difficulty (97%), and intraoperative recognition was highest for threads (76.6%) and CaHA (57.8%). There was no consensus on the ideal interval between biostimulator application and surgery, but procedures performed within six months were seen as more challenging.

[CONCLUSION] Biostimulators may delay the need for facelift surgery but can increase intraoperative difficulty and complications. As their use expands, both cosmetic and surgical professionals must refine their techniques to ensure optimal outcomes. Also it may be considered that HCP using biostimulators and threads should advise the patients of these difficulties. Further clinical studies are needed to establish clear guidelines.

[LEVEL OF EVIDENCE V] This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors   www.springer.com/00266.