Biostimulators: how much of the market, and when to learn
Biostimulators are a sound next skill once toxin and hyaluronic acid are routine, but not a first one. In the 2025 ISAPS survey, poly-L-lactic acid (PLLA) and calcium hydroxylapatite (CaHA) together make up fewer than one in twenty of the non-surgical procedures counted. Botulinum toxin and hyaluronic acid make up close to seven in ten [1].
The growth has not been one-way. PLLA rose several times over between 2020 and 2024 and then fell by a third in 2025, while poly-D,L-lactic acid (PDLLA) has no figure in the survey at all. When you choose a course, check your own country's figures, ask which material is taught and find out who wrote the comparison you are shown.
PLLA and CaHA are under one procedure in twenty
The ISAPS survey attributes 17.3 million non-surgical procedures to plastic surgeons in 2025. Botulinum toxin accounts for 42.3 per cent of them and hyaluronic acid for 27.4 per cent. Poly-L-lactic acid is 2.5 per cent, at 426,019 procedures, and calcium hydroxylapatite is 1.8 per cent, at 310,525 [1].
The survey counts plastic surgeons only. Whatever dermatologists, aesthetic physicians, dentists and nurses inject is not in these figures.
PLLA rose several times over, then fell by a third
Poly-L-lactic acid has the most dramatic record of any injectable in the survey. The 2024 report put it at 642,566 procedures, 430.7 per cent above its 2020 figure of 121,087 [4]. In 2025 it stood at 426,019, a fall of 33.7 per cent [1].
Calcium hydroxylapatite fell by 25.7 per cent in 2025, though it remains 7.0 per cent above its 2021 level [1]. The rise and the fall are both real, so a growth figure means little until you know which year it describes.
PDLLA is not counted at all
The questionnaire lists ten non-surgical categories, and poly-D,L-lactic acid is not one of them [1]. Nor are several other products marketed under the same heading. A treatment that is not on the form cannot appear in the result, so the missing figure tells you nothing about how much PDLLA is used. It means only that nobody asked.
PLLA and PDLLA are different materials
The names nearly match, which makes them easy to confuse. Poly-L-lactic acid is a synthetic, biodegradable polymer whose microparticles provoke a subclinical inflammatory response that leads to collagen being laid down [2]. Poly-D,L-lactic acid is a related material with a different structure: amorphous, with an irregular chain, where the L-form is partly crystalline and regular. It is described as degrading faster [3].
That comparison comes from a two-page letter rather than a study. It reports no original data, and two of its three authors disclose that they are medical directors of the company that makes the PDLLA product [3]. Read it as the manufacturer's account.
Each country uses a different mix
In Italy the survey puts botulinum toxin at 353,800 procedures and hyaluronic acid at 328,856, close to parity. In Lithuania the same two stand at 18,662 and 10,381. Finland records 1,785 calcium hydroxylapatite procedures and 68 with poly-L-lactic acid, while in Germany the poly-L-lactic acid figure is 7,216 [1].
These national figures are projections from small samples, so treat them as a rough guide. They still show that the mix of products differs from country to country.
What to check before you book biostimulator training
- Start with toxin and hyaluronic acid. Together they are close to seven in ten of the procedures counted, so that is where most of your early work and learning will be.
- Look up your own country. Before you choose between PLLA and CaHA, check how many of each your country records, remembering that only plastic surgeons are counted.
- Ask which material the course teaches. PLLA, PDLLA and CaHA are different products, and the survey counts only two of them.
- Ask who wrote the comparison. When one product is presented as better than its neighbour, find the paper and read the disclosure line before the conclusion.
- Ask what year a growth figure is from. PLLA rose and then fell, so a number without its year shows only half the record.
A good biostimulator course names its material, explains how it differs from its neighbours, and has you treat patients under the supervision of someone who uses the product in their own practice.
Read next
- Regenerative Aesthetics: Separating the Category From the Marketing
- Injectable Procedures in 2025: Is Demand Still Growing?
- Aesthetic Procedures by Country in Europe: Demand and Rules