Combination Treatments for Better Results: What the Evidence Says About Pairing Biostimulators With Other Procedures
Why a Single Treatment Isn't Always the Final Answer
Modern aesthetic medicine has increasingly moved toward minimally invasive procedures, and one concept gaining significant attention is combining multiple treatments within a single treatment plan, rather than relying on one procedure to address everything. I want to walk through a systematic review published in Aesthetic Plastic Surgery in 2025 by Tam and colleagues, to see how much scientific evidence actually supports this approach.
What Are Biostimulators, and Why Combine Them With Other Treatments?
Biostimulators such as PLLA, CaHA, and PCL work by stimulating the body's own collagen production through a natural healing response — different from hyaluronic acid fillers, which add volume directly. Because of this mechanistic difference, researchers and physicians have hypothesised that combining biostimulators with other treatments — botulinum toxin to reduce muscle pull, fillers for immediate volume, or energy-based devices that stimulate collagen through yet another mechanism — might enhance results beyond what a single treatment alone can achieve.
How the Study Was Conducted
The research team conducted a systematic literature review following PRISMA guidelines, searching PubMed, MEDLINE, Embase, and Cochrane databases thoroughly. From an initial pool of 1,237 studies, 29 met the inclusion criteria, covering sample sizes ranging from 10 to 350 subjects and various combinations of biostimulators with botulinum toxin, fillers, and energy-based devices. Due to high variability in study designs and methodologies, the team used a narrative synthesis approach rather than pooled statistical analysis. [1]
Notable Findings
Combining CaHA or PLLA with energy-based devices, such as HIFU, fractional lasers, or microneedling, has demonstrated improved outcomes in skin quality and elasticity, particularly in areas with visible wrinkles. [1]
In terms of safety, most reported side effects were mild and commonly seen with general injection procedures — including erythema (redness), bruising, and subcutaneous papules/bumps — occurring in approximately 15-30% of the cases studied. (Note: this is research-reported data only, based on multiple factors, and should not be taken as representative or generalized to every case.) [1] The severity of potential side effects can vary from case to case. In some instances, they may resolve on their own without requiring further treatment, while in others, medical management may be needed. Treatment approaches may include corticosteroids, hyaluronidase injections, or, in some cases, corrective surgery — depending on the individual case and the treating physician's clinical judgment.
Limitations the Study Acknowledges Honestly
This information is based on a review of multiple clinical studies, which suggests promising treatment outcomes. However, the current evidence remains limited, and further controlled studies are needed to confirm its effectiveness more clearly. [1]
What I Want Patients to Understand
Combination treatment holds genuine potential for enhancing aesthetic outcomes, but this doesn't mean everyone should undergo multiple procedures simultaneously without assessment. Inappropriate combinations can unnecessarily increase the risk of side effects. The decision on which treatments to combine should be based on a genuine assessment of your specific concerns by an experienced physician — not simply following trends or pre-packaged treatment bundles.
Final Thoughts
This study offers useful evidence that combining collagen biostimulators with other treatments may produce better outcomes than a single treatment alone in many cases, particularly when paired with energy-based devices. However, higher-quality research is still needed to confirm these findings definitively. I recommend consulting a physician who thoroughly understands the mechanisms of each treatment before deciding to combine them, so your treatment plan genuinely matches your actual needs.