Sculptra and Juvelook are in the class of biostimulatory fillers that rely on specific formulations of lactic acid to induce a controlled inflammatory wound-healing response in the skin for the purposes of volume restoration and wrinkle correction.

Lactic acid has chirality and occurs in nature as an enantiomer. For mammals, L-lactate is constantly produced during normal metabolism and exercise, while the D-lactate enantiomer is not naturally found. A racemic mixture of the L and D enantiomers of lactic acid will produce an amorphous solid, while L-lactic acid alone will exist as a crystalline solid at room temperature. Scultpra (PLLA) is composed of only the L-lactic acid, while Juvelook (PDLLA) is a racemic mixture of the D and L lactic acids.

As a crystalline, linear, linear polymer of the L-enantiomer of lactic acid, Scupltra takes longer for the body to hydrolyze and metabolize vs the amorphous solid that the racemic mixture of Juvelook is composed of. This is not to say one is superior to the other, but it’s certainly important for the healthcare provider to note the subtleties between the two biostimulators to provide the optimal treatment plan for their patients. Faster metabolism suggests a quicker time to biostimulation and ultimately volume restoration and visible aesthetic results, though it also implies a shorter overall duration of those results.

Both Sculptra and Juvelook work on a histological level to promote a controlled inflammatory response to initiate a foreign body response that recruits macrophages to surround the PLLA and PDLLA microspheres to form giant cells. This incites the wound healing cascade to deposit new collagen and elastic connections in the spaces between these particles and subsequent giant cells. Even, uniform spread of the microspheres within the correct anatomic tissue planes ensures the safest and most precise volume restoration. Improper reconstitution, storage and most importantly injection techniques, will lead to clumps of PLLA/PDLLA deposits within the tissue, with the resultant risk of nodule and granuloma formation.

Particle size then become an important distinction between Sculptra and Juvelook. Juvelook has a distinctly smaller particle size (~10-40 um) compared to Sculptra (~40-63 um) indicating the possibility of greater uniformity in tissue distribution after injection. Add in the fact that Juvelook typically has an amorphous structure of D- and L-lactic acid copolymer versus the crystalline structure L-enantiomer structure of Sculptra, and it may suggest an advantage in ease of injection for the smaller particle size, amorphous biostimulator. Even spacing between microsphere particles ensures even dosing of biostimulatory material and optimizes the uniformity of collagen synthesis and deposition.

Likely a layered approach using PLLA and PDLLA in a complementary fashion will represent the next stage of this group of biostimulators in aesthetic medicine. Due to its chemical composition PDLLA likely allows for safer superficial skin injections to boost the skin volume, while its duration and overall biostimulatory properties likely lag slightly behind PLLA which allows for a greater degree of volume restoration over a longer duration.

References

Sculptra/PLLA:

• Narins et al., Dermatol Surg: Long-term efficacy of PLLA in nasolabial folds
• Goldberg et al., J Drugs Dermatol: Volumetric assessment and collagen response
• Palm et al., JAMA Facial Plast Surg: Imaging-based volumetric gains and safety

Juvelook/PDLLA:

• Kim H et al., J Cosmet Dermatol: Clinical efficacy and histologic effects of PDLLA + HA
• Lee YJ et al., Skin Res Technol, 2023: Elastin synthesis following PDLLA-based dermal boosters
• Lee et al., Ann Dermatol, 2022: Use of PDLLA in periorbital skin rejuvenation

The aesthetics landscape in 2025 is undergoing a thoughtful transformation. Influenced by biotechnology, facial anatomy literacy on social media, and a cultural shift toward authenticity, the modern aesthetic consumer is smarter, younger, and more discerning than ever.

The Rise of “Prejuvenation” Over Anti-Aging

More patients in their 20s and 30s are pursuing subtle procedures aimed not at reversing aging, but at delaying it entirely. This “prejuvenation” philosophy focuses on:

• Botulinum toxin (“baby Botox”) to prevent deep dynamic wrinkles
• Microneedling with exosomes or PRP to stimulate collagen in early adulthood
• Topical retinoids and antioxidants as baseline skin health measures
• Energy-based devices (e.g., RF – OligioX, Xtherma; RF microneedling – SylfrimX, Potenza; ultrasound – Ultherapy Prime) for early laxity prevention

Why it matters: The goal is not correction, but preservation—starting earlier for longer-lasting, more natural results.

Facial Balancing, Not Isolated Features

Patients are increasingly requesting “facial balancing” rather than single-feature changes. This holistic approach focuses on overall harmony—not just bigger cheeks or sharper chins.

Common tools for balance include:

• Chin augmentation (filler or implant)
• Jawline contouring
• Lateral cheek support, not just anterior cheek volume
• Temples and midface volume restoration

Custom Exosome Therapies

Stem-cell-derived exosomes are now being used not just in microneedling but in tailored regenerative therapies, especially those derived from adipose tissue or bone marrow mesenchyme.

Applications include:

• Post-laser recovery acceleration
• Pigmentation regulation
• Enhanced collagen stimulation
• Non-inflammatory acne care

Why it matters: Exosomes offer a cell-free regenerative approach, tapping into the body’s repair signaling without the legal/ethical complexity of stem cell transplantation.

Skin Barrier and Microbiome Health as the New Luxury

Topical trends have shifted from aggressive exfoliation to barrier repair and microbiome support. Leading formulations in 2025 often feature:

• Postbiotics and fermented ingredients
• Ceramide-rich emulsions
• Non-disruptive cleansers
• Blue light and pollution shields

Why it matters: A resilient skin barrier equals better long-term outcomes, especially when undergoing energy devices, injectables, or retinoid use.

Ethnically Sensitive and Gender-Aware Aesthetics

2025 aesthetics is less about “Western ideals” and more about cultural preservation and gender nuance.

• Surgeons and injectors are refining techniques that respect ethnic anatomical norms rather than imposing a standard ideal.
• There is growing interest in gender-neutral or androgynous beauty—seen in the popularity of soft jawlines, flattened nasolabial transitions, and refined nose tips across all gender identities.

Why it matters: Beauty is being redefined as inclusive, individual, and diverse—pushing practitioners to adapt their aesthetic literacy.

The aesthetic trends of 2025 are defined by individualization, subtlety, and science. Whether it’s regenerative medicine, early intervention, or structural harmony, the modern patient is leaning into treatments that enhance what’s already there, not change it entirely.

As the field continues to evolve, the best outcomes will come from clinicians who combine anatomical mastery with emotional intelligence, guiding patients toward natural results that age gracefully over time.

In the world of advanced skin and hair treatments, exosomes are making headlines—and for good reason. They represent the latest frontier in regenerative medicine, helping to restore and rejuvenate the skin and scalp using the body’s own communication system. If you’ve heard of exosomes but aren’t sure what they do or why they matter, this guide is for you.

What Are Exosomes?

Exosomes are tiny particles (much smaller than cells) naturally released by your body’s cells. Think of them as messengers—they carry important signals like growth factors, proteins, and genetic material from one cell to another. These signals tell cells how to behave, helping to repair tissue, reduce inflammation, and stimulate healthy cell growth.

In aesthetic medicine, exosomes used in treatments are usually harvested from stem cells, such as those found in adipose (fat) tissue. These are purified and applied to the skin or scalp to boost healing and rejuvenation.

How Do Exosomes Help in Skin and Hair Treatments?

Exosomes are being used to enhance results in many cosmetic treatments. Here’s how they help:

1. They Boost Collagen and Elastin

Collagen and elastin are the proteins that give your skin its structure and bounce. Exosomes tell your skin cells to make more collagen and elastin, which leads to smoother, firmer, and more youthful-looking skin.

2. They Calm Inflammation and Speed Up Healing

After treatments like microneedling, laser, or radiofrequency, exosomes can help reduce redness and swelling. They calm the skin by lowering inflammatory signals and supporting the body’s natural repair process—so you heal faster and more comfortably.

3. They Improve Blood Flow and Nutrient Delivery

Exosomes help grow new tiny blood vessels (a process called angiogenesis), which increases blood flow to the skin. This brings in more oxygen and nutrients—key to glowing, healthy skin.

4. They Help Regrow Hair

For patients with thinning hair or early hair loss, exosomes stimulate the hair follicles and help shift them back into the growth phase. They do this by activating specific pathways in the scalp that are known to control hair cycling. This can lead to thicker, fuller hair over time.

5. They Even Out Skin Tone

Some studies show that exosomes may reduce pigmentation and dark spots by calming down the cells that produce melanin (the pigment that gives skin its color). This may support treatment for melasma or post-inflammatory hyperpigmentation.

What Is an Exosome Treatment Like?

Exosomes are often combined with other procedures to maximize their benefits. You might receive exosomes:

• Topically, right after microneedling, laser, or RF microneedling (which opens channels in the skin so the exosomes can penetrate deeply);
• Through injections, especially in the scalp for hair restoration.

These treatments are typically comfortable, non-surgical, and require little to no downtime.

Are Exosomes Safe?

Yes. Exosome products used in aesthetic medicine are purified, cell-free, and carefully processed to remove any cellular material. They contain no live cells or DNA, just the beneficial signals. Most patients experience no side effects—though you might see mild redness or sensitivity if the exosomes are applied after a procedure.

When Will I See Results?

Most patients begin to notice benefits such as smoother skin texture, improved hydration, or reduced redness within a few days to weeks. For hair restoration, results may become visible after 2–3 months, with continued improvement over 6–12 months.

Who Is a Good Candidate?

You may benefit from exosome therapy if you are:

• Recovering from laser, microneedling, or other skin procedures;
• Concerned about signs of aging like fine lines, dullness, or skin laxity;
• Experiencing early hair thinning or mild hair loss;
• Interested in boosting your body’s natural healing capacity without surgery or medication.

The Bottom Line

Exosomes represent a powerful, science-backed tool in aesthetic medicine. By enhancing communication between your cells, they help your skin and hair regenerate more effectively, with faster healing, reduced inflammation, and better long-term outcomes.

Whether you’re looking to restore youthful skin, recover more quickly from procedures, or stimulate hair growth, exosome therapy offers an exciting, natural option—one that works with your body, not against it.

If you’re curious whether exosomes are right for you, schedule a consultation with a provider experienced in regenerative aesthetics.

References

1. Wu, P. et al. (2021). Exosomes derived from adipose stem cells promote dermal fibroblast function via TGF-β/Smad signaling. Stem Cell Res Ther, 12, 505. https://doi.org/10.1186/s13287-021-02582-5
2. Li, Y. et al. (2023). Anti-inflammatory properties of MSC-derived exosomes via NF-κB suppression. J Transl Med, 21, 314.
3. Zhang, H. et al. (2022). Exosomes enhance angiogenesis via PI3K/Akt and ERK pathways. Front Cell Dev Biol, 10, 834153.
4. Han, J. et al. (2023). ADSC-exosomes promote hair growth via Wnt/β-catenin activation. Int J Mol Sci, 24(2), 1543.
5. Park, B.S. et al. (2020). Human adipose-derived exosomes suppress melanin synthesis in melanocytes. J Dermatol Sci, 97(1), 53-61.

Letybo (letibotulinumtoxinA) is a newer botulinum toxin type A formulation developed by Hugel, a South Korean biopharmaceutical company. It joins a growing list of botulinum neurotoxin serotype A (BoNT-A) products used in aesthetic and therapeutic medicine. The primary competitors of Letybo include onabotulinumtoxinA (Botox®), abobotulinumtoxinA (Dysport®), incobotulinumtoxinA (Xeomin®), and prabotulinumtoxinA (Jeuveau®). The following is a comparative analysis based on current scientific literature and available clinical data:

1. Molecular Composition & Formulation

Implication: The presence of complexing proteins may affect immunogenicity and diffusion, although clinical relevance is still debated. Letybo is structurally similar to Botox, both being 900 kDa complexes.

2. Potency and Dose Equivalence

Letybo’s units are not bioequivalent to other BoNT-As on a 1:1 basis, but early studies suggest its clinical potency is comparable to Botox when administered at equal unit doses.

3. Clinical Efficacy

Most studies on Letybo focus on glabellar line treatment, with Phase III trials conducted in Asian and, more recently, European populations.

• Efficacy Onset: Similar to Botox (2–3 days).
• Peak Effect: 1–2 weeks post-injection.
• Duration: ~12–16 weeks (comparable to Botox and Jeuveau).

Head-to-head data comparing Letybo with Botox or other agents in diverse populations (especially non-Asian) are currently limited. A Korean Phase III study (Lee et al., Dermatol Ther, 2021) found non-inferiority to Botox for glabellar lines at week 4.

4. Safety and Adverse Event Profile

Letybo has shown a favorable safety profile consistent with other BoNT-As in trials. No unique adverse effects have been reported.

5. Immunogenicity

Theoretically, toxins without complexing proteins (e.g., Xeomin) might have lower antigenicity, but clinically relevant immunogenicity remains low across all BoNT-As when used in aesthetic doses. No long-term data yet confirm differences in neutralizing antibody development for Letybo.

6. Regulatory & Market Access

• Letybo: Approved in South Korea, China, Canada, and EU (2022). FDA approved (2024) in the U.S.
• Botox/Xeomin/Dysport/Jeuveau: All approved in U.S. and globally widespread.

7. Cost and Economic Consideration

Letybo has been marketed as a cost-effective alternative in regions like South Korea and China. Its competitive pricing may drive adoption, particularly in aesthetic markets sensitive to cost margins.

Conclusion

Letybo is a viable alternative to existing BoNT-A products with comparable efficacy, safety, and pharmacologic properties, particularly similar to Botox in terms of molecular weight and clinical onset/duration. However, due to its limited longitudinal data and fewer global head-to-head trials, particularly in diverse patient populations, broader clinical acceptance (especially in Western markets) may depend on further robust, comparative trials and real-world experience.

The optimal choice of facial chemical exfoliants depends on individual skin type, concerns, and tolerance. Chemical exfoliants fall into three primary categories: alpha-hydroxy acids (AHAs), beta-hydroxy acids (BHAs), and polyhydroxy acids (PHAs). Each group possesses distinct physicochemical properties and dermatological indications. Below is an evidence-based overview of the most efficacious and commonly recommended agents.

1. Alpha-Hydroxy Acids (AHAs)

AHAs are water-soluble and primarily act on the stratum corneum by weakening the cohesion of corneocytes. Ideal for dry, photodamaged, or dull skin.

Common AHAs:

• Glycolic Acid
  • Molecular weight: 76 Da (smallest, most penetrative AHA)
  • Effects: Enhances collagen synthesis, reduces hyperpigmentation, improves texture
  • Evidence: Clinical trials show significant improvement in photoaged skin with concentrations of 8–20% (Stiller et al., 1996)
• Lactic Acid
  • Molecular weight: 90 Da (larger, gentler than glycolic)
  • Effects: Hydrates while exfoliating, suitable for sensitive or rosacea-prone skin
• Mandelic Acid
  • Molecular weight: 152 Da (aromatic AHA with slow penetration)
  • Effects: Antibacterial properties, well-tolerated in acne and sensitive skin
  • Evidence: Demonstrated efficacy in treating inflammatory acne and melasma (Fabbrocini et al., 2009)

2. Beta-Hydroxy Acids (BHAs)

BHAs are lipid-soluble, allowing them to penetrate sebaceous follicles, making them particularly effective for acne-prone or oily skin.

Primary BHA:

• Salicylic Acid
  • Mechanism: Keratolytic, comedolytic, and anti-inflammatory
  • Concentration range: 0.5–2% in OTC products
  • Evidence: Reduces comedones and inflammatory acne lesions (Kligman & Mills, 1972)

3. Polyhydroxy Acids (PHAs)

PHAs are larger molecules that exfoliate more superficially, with humectant properties and antioxidant effects. Suitable for very sensitive or compromised skin (e.g., eczema, post-procedural).

Common PHAs:

• Gluconolactone
• Lactobionic Acid

Evidence:

• PHAs demonstrate comparable efficacy to AHAs with less irritation and added barrier support (Roure et al., 2009)

Top Formulations and Brands (as of 2024)

Selection Guidelines by Skin Type

Safety and Usage Considerations

• Frequency: 2–3 times/week for most; daily use requires careful barrier protection.
• Sun protection is mandatory, as exfoliation increases photosensitivity.
• Avoid combining with retinoids or ascorbic acid without dermatological oversight, due to increased irritation risk.

In recent years, GLP-1 receptor agonists like Ozempic® (semaglutide) and Mounjaro® (tirzepatide) have revolutionized the landscape of medical weight loss. Originally developed to manage type 2 diabetes, these medications are now widely prescribed for obesity and cosmetic weight reduction. However, with rapid and often dramatic weight loss, a new aesthetic concern has emerged—commonly known as “Ozempic face” or “Mounjaro face.”

As facial plastic surgeons, we’re seeing a significant uptick in consultations related to this phenomenon, and the demand for restorative facial procedures is rising accordingly.

What Is “Ozempic Face” or “Mounjaro Face”?

The term refers to the volume loss and skin laxity that can result from rapid weight loss, particularly in the midface, temples, and jawline. While GLP-1 medications are medically effective for systemic health, the face is often one of the first areas to show signs of catabolic changes.

Common features include:

• Sunken cheeks and temples
• Hollowed eyes and under-eye bags
• Sagging jowls and nasolabial folds
• Accelerated appearance of aging

This is especially pronounced in individuals over 35, when collagen and facial fat compartments are already naturally declining.

Why Does This Happen?

GLP-1 medications like Ozempic and Mounjaro work by:

• Suppressing appetite
• Slowing gastric emptying
• Regulating insulin and blood sugar

While the systemic benefits are profound, rapid fat loss in facial areas with thin skin and limited structural support often leads to:

• Loss of deep fat pads (malar, buccal, and periorbital)
• Volume deflation without time for skin redraping
• Laxity exacerbated by aging or sun damage

This can result in a gaunt or aged appearance, despite overall improvements in body composition.

Facial Plastic Surgery & Aesthetic Solutions for Ozempic/Mounjaro Face

Fortunately, there are several effective surgical and non-surgical treatments to restore facial harmony after GLP-1-related weight loss.

1. Facial Fat Grafting

One of the most natural and long-lasting solutions, autologous fat transfer replenishes lost volume using the patient’s own fat harvested from other areas. It’s ideal for:

• Midface and cheek augmentation
• Temple hollowing
• Nasolabial folds

2. Mini Facelift or Deep Plane Facelift

For patients experiencing laxity and jowling, especially over age 40, surgical lifting procedures such as a mini facelift or deep plane facelift can re-suspend tissues and tighten skin for a more youthful contour.

3. Dermal Fillers

Hyaluronic acid and collagen-stimulating fillers offer non-surgical volume restoration and contour refinement, particularly for younger patients or those early in their weight loss journey.

4. Skin Tightening Treatments

Devices like Ultherapy®, radiofrequency microneedling, and laser skin tightening can help stimulate collagen and improve mild to moderate laxity.

Mounjaro vs. Ozempic: Are Facial Effects Different?

While both medications act on the GLP-1 pathway, Mounjaro (tirzepatide) is a dual GIP and GLP-1 receptor agonist and may induce more significant weight loss than Ozempic. This can translate to more pronounced facial volume loss, especially in leaner individuals.

That said, individual responses vary based on:

• Duration of use
• Dosage escalation
• Baseline facial fat distribution
• Age and skin elasticity

Should You Start GLP-1 Therapy If You’re Concerned About Your Face?

GLP-1 medications like Ozempic and Mounjaro are powerful tools for metabolic and cardiovascular health, and their aesthetic impact can be proactively managed. If you’re considering or currently using these medications and are concerned about facial changes, a consultation with a board-certified facial plastic surgeon can help you develop a tailored plan for volume preservation and facial support.

Conclusion

The rise of Ozempic face and Mounjaro face highlights an important interplay between systemic health and facial aesthetics. As weight loss medications reshape the future of obesity management, facial plastic surgery continues to evolve in response, offering solutions that restore balance, youthfulness, and confidence.