Multimodal Biostimulation in Dermatology: PDGF-BB, Hyperdilute CaHA, and Microneedling
Clinical Summary
Multimodal Biostimulation in Dermatology: PDGF-BB, Hyperdilute CaHA, and Microneedling
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Mechanism & synergy: Combining PDGF-BB (platelet-derived growth factor), hyperdilute calcium hydroxyapatite (CaHA), and microneedling enhances outcomes through complementary mechanisms: PDGF-BB provides fibroblast chemotactic/mitogenic signaling, CaHA serves as a collagen-stimulating scaffold, and microneedling promotes superficial neocollagenesis
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Patient selection & indications: Best outcomes seen in cellulite with standing-only dimpling, early striae rubra, and mild-to-moderate skin laxity; less dramatic improvement in atrophic striae or significant post–GLP-1 weight-loss laxity, where surgery may be more appropriate.
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Durability & practice impact: Compared with traditional body contouring, this regenerative approach requires lower upfront practice investment, fewer syringes (~2–4 CaHA syringes vs >20 previously), and provides results lasting ~18–24 months with high patient satisfaction and long-term maintenance potential.
Reviewed by Riya Gandhi, MA, Associate Editor of Immunology Group
Dr Sarah Allen discusses the science behind combining PDGF-BB, hyperdilute calcium hydroxylapatite (CaHA), and microneedling to improve cellulite, striae, and skin laxity through regenerative biostimulation. Learn how this multimodal approach enhances neocollagenesis, optimizes patient selection, and delivers durable, cost-effective results compared with traditional body contouring strategies.
Transcript
I'm Dr Sarah Allen, founder and chief medical officer of Skin Clique.
What is the rationale behind combining PDGF-BB, hyperdilute CaHA, and microneedling, and how does this multimodal approach enhance outcomes compared to single-modality treatments?
Dr Allen: We know that a multimodal approach is much more effective than using one method alone. We know from our colleagues in orthopedic and oromaxillofacial surgery that platelet-derived growth factor requires a scaffold to be most productive. In addition to that, it is a strong chemotactic and mitogenic factor for fibroblasts. So when you pair the signal, platelet-derived growth factor, with the scaffold, calcium hydroxyapatite, which leads to fibroblast stretch and therefore more neocollagenesis, we see that the effects compound over time. When you add microneedling on top of that and have superficial neocollagenesis, the results for patients are really impactful.
From a practical standpoint, how can clinicians optimize technique and patient selection when incorporating this combination therapy for concerns like cellulite, striae, and skin laxity?
Dr Allen: With this procedure, patient selection and setting expectations are essential. Patient selection, I like to start with cellulite. This treatment is best for patients who have cellulite dimpling when they stand, but when they lay down, it improves. This tells us that there are fibrotic tethers in the tissue that will respond well to cannulization with calcium hydroxyapatite and platelet-derived growth factor. Patients who have early stretch marks, or striae, or striae rubra tend to do very well with this procedure. If patients have more mature and atrophic striae, they will see improvement. It doesn't tend to be as impactful as those that you intervene on early.
What advantages have you observed in terms of cost-effectiveness, durability, and patient satisfaction with this approach compared to traditional body contouring strategies?
Dr Allen: Traditional body contouring strategies can be a stretch for practices. We know that the upfront investment for many of these technologies is significant for practices. With this procedure in particular, there's very little upfront cost for practices. So that's from the practice standpoint.
From a patient standpoint, we are able to personalize and tailor treatments to what patients need. So whereas patients were receiving over 20 syringes previously for gluteal improvement, we're able to decrease that from anywhere from 2 to 4 calcium hydroxyapatite syringes paired with platelet-derived growth factor treatments. And the cost-effectiveness for patients is significant.
One thing that we're seeing from a durability perspective and particularly a patient-selection perspective is, with the advent of GLP-1 and rapid weight loss, patients are losing weight precipitously. If a patient has significant weight loss and skin laxity, this is not likely the patient for that procedure. They might need to be evaluated for surgical intervention or other treatment methods. But when you're able to catch patients early in their weight loss journey, this procedure can be very significant and impactful for their results. From a durability standpoint, we're seeing that results are lasting upwards of 18 to 24 months. And anecdotally, we are seeing that patients have deepened and extended, and amplified results long term.
Are there any tips or insights you would like to share regarding your session?
Dr Allen: What is most exciting about this is that it really is a regenerative procedure. This changes the conversation with patients from being transactional, from a body contouring standpoint, and really transitions that into a maintenance conversation. These patients are investing, and they're making a biological investment in their future, and that is so exciting. It's one of the reasons that we at our practice are committed to advancing research in this area to improve patient outcomes and to create safe procedures across the board.
