What “regenerative” means in aesthetic medicine: a narrative literature review attempting to demystify the core essence of regenerative aesthetics

Regenerative aesthetic medicine has rapidly evolved from a primarily corrective discipline into a biologically oriented field focused on restoring tissue function, quality, and homeostasis. This narrative review examines the conceptual foundations of “regeneration” in aesthetic practice and critically discusses the biological rationale and clinical evidence supporting the main injectable modalities currently described as regenerative, including platelet-rich plasma (PRP), polynucleotides, exosomes, stromal vascular fraction (SVF)-based approaches, poly-L-lactic acid (PLLA), and calcium hydroxylapatite (CaHA). These interventions act through distinct yet partially overlapping mechanisms, involving modulation of inflammation, fibroblast activation, extracellular matrix remodeling, angiogenesis, and immunobiological signaling. PRP provides concentrated growth factors with context-dependent effects on tissue repair; polynucleotides enhance fibroblast activity and dermal hydration through nucleotide-mediated pathways; exosomes function as intercellular signaling mediators influencing inflammatory cascades and tissue remodeling; SVF-based therapies combine volumetric support with paracrine and cellular effects; while PLLA and CaHA act as long-term biostimulatory fillers, promoting sustained neocollagenesis and dermal reorganization through controlled inflammatory and macrophage-mediated responses. Although clinical studies report improvements in skin quality parameters, dermal architecture, elasticity, and hair density, the available evidence is heterogeneous and often limited by variability in preparation methods, product characteristics, injection protocols, and outcome measures. Issues related to standardization, reproducibility, and regulatory classification remain particularly relevant for biologically derived products such as PRP, exosomes, and SVF. Overall, regenerative aesthetics represents a paradigm shift from transient correction toward biologically driven tissue renewal; however, consolidation within evidence-based aesthetic medicine will require higher-quality comparative trials, standardized methodologies, and clearer regulatory frameworks.