Biostimulants in Aesthetic Medicine: A Systematic Review and Meta-analysis of Efficacy, Safety, and Patient Satisfaction

Biostimulants, including calcium hydroxyapatite, poly-L-lactic acid, and polycaprolactone, have become popular in aesthetic medicine as they lead to long-term tissue rejuvenation. However, their efficacy (eg, dermal, volume, and anatomic outcomes), patient satisfaction, and safety remain unclear. This systematic review and meta-analysis collates and appraises the available data on biostimulants, examining their efficacy, adverse events, and patient satisfaction. A comprehensive search was conducted in PubMed/Medline (National Library of Medicine, Bethesda, MD), Scopus (Elsevier, Amsterdam, the Netherlands), Embase (Elsevier), and Web of Science (Clarivate, Philadelpha, PA), up to January 14, 2025. Studies were included that assessed the effects of biostimulants on efficacy, adverse events, and patient satisfaction in observational studies. Meta-analyses using random-effects models were performed on individual proportions and applied to 7 outcomes (satisfaction, bruising, ecchymosis, edema, erythema, nodule development, pain). A total of 197 articles were screened, and 25 studies were included in the systematic review. The results of meta-analyses indicate that the pooled satisfaction rate of biostimulants was estimated to be 91% (95% CI, 67%-98%; I2 = 87.3%), with the following adverse event rates: bruising, 27% (95% CI, 12%-50%; I2 = 96%); ecchymosis, 22% (95% CI, 11%-40%; I2 = 95.5%); edema, 5% (95% CI, 1%-18%; I2 = 93.6%); erythema, 16% (95% CI, 4%-47%; I2 = 94.3%); nodule development, 5% (95% CI, 2%-10%; I2 = 85.5%); pain, 92% (95% CI, 63%-99%; I2 = 87.7%). Among studies not included in the meta-analysis, all parameters studied showed significant improvements in terms of dermal, volume, anatomic, and satisfaction outcomes. Biostimulants demonstrate clinical promise and a favorable tolerability profile in aesthetic medicine despite the common occurrence of minor adverse events, most notably pain. Level of Evidence: 3.