The five products at a glance
Before the detail, here is the summary table. Each row links to a deeper section below.
| Product | Material | Mechanism | Immediate volume? | Longevity | Best for |
|---|---|---|---|---|---|
| Sculptra | Poly-L-Lactic Acid (PLLA) | Pure biostimulator — collagen induction over months | No | 24–36 months | Diffuse mid-face restoration, temples, skin quality, peri-oral |
| Radiesse | Calcium Hydroxylapatite (CaHA) microspheres in CMC gel | Hybrid — immediate volume + collagen induction | Yes (substantial) | 12–18 months | Jawline, chin, deep folds, hands; hyperdilute for skin tightening |
| Profhilo | High & low molecular-weight HA, thermal hybrid (no chemical crosslinker) | Bioremodeller — skin firmness and hydration | Minimal | 6–9 months per cycle | Skin laxity (neck, lower face, hands); not for shaping |
| Polynucleotides (PN) | Purified salmon-sperm-derived DNA fragments | Nucleotide signalling → fibroblast activation, reduced oxidative stress | None | 6–12 months | Skin quality, under-eye fragility, post-laser/microneedling repair |
| Ellanse | Poly-caprolactone (PCL) microspheres in CMC gel | Long-lasting biostimulator with structural carrier | Yes | 1–4 years (by formulation: M, S, L, E) | Deep structural restoration; not widely offered at La Clinica |
Sculptra (PLLA) — the pure biostimulator
What it is: Poly-L-Lactic Acid — the same biocompatible polymer used in absorbable sutures. The microparticles are roughly 40–63 microns. Supplied as a freeze-dried powder that is reconstituted with sterile water and lidocaine before injection. Reconstitution timing matters — the historical guidance was overnight, modern practice tends toward 24–72 hours before use, well-shaken.
How it works: Once injected, the PLLA microparticles slowly hydrolyse to lactic acid, then to CO2 and water, over 18–24 months. During that time they trigger a sustained low-grade fibroblast response, which lays down a substantial amount of new collagen. The visible improvement is the new collagen — the PLLA itself contributes nothing to volume after the first 72 hours (when the diluent water absorbs).
The right indication: diffuse facial volume loss. Sculptra excels where you need restoration across a broad area — mid-face flattening, temple hollowing, pre-auricular hollowing, peri-oral atrophy. It is the wrong tool for a single deep fold or a defined contour like a lip border.
The wrong indication: tear troughs (high risk of nodule formation in thin skin), lips (definitely no), or any patient who needs to look different in two weeks.
Protocol: typically 2–3 sessions, 4–6 weeks apart. Most patients start with 1–2 vials per side per session. Patients with significant volume loss may need 3 sessions; mild cases sometimes only need one. Touch-up at 18–24 months.
Longevity: typically 2–3 years from completion of the protocol. Some patients sustain results 4+ years.
Cost: moderate per vial; total cost is meaningful because of the multi-vial, multi-session structure. A complete face protocol commonly runs 4–8 vials over 2–3 sessions.
Risks: the main one is nodule formation — small palpable bumps appearing 3–12 months after treatment, usually in superficial or thin-skin areas. Avoidable with deep placement, vigorous post-treatment massage (the “5-5-5” rule: 5 minutes, 5 times a day, for 5 days), and avoiding the wrong anatomical zones.
See the dedicated Sculptra deep dive for protocol detail.
Radiesse (CaHA) — the hybrid
What it is: Calcium Hydroxylapatite microspheres (25–45 microns) suspended in a carboxymethylcellulose (CMC) gel carrier. CaHA is chemically identical to a major component of bone mineral — biocompatible and biodegradable.
How it works (dual action): the CMC gel provides immediate volume on day one — you see a real lift the moment you walk out. Over 3–6 months, the gel resorbs and the CaHA microspheres act as a scaffold for collagen synthesis. New Type I collagen forms around the microspheres. By 12 months, the gel is gone and what remains is the new collagen.
The two ways Radiesse is used:
- Standard (volumising) — full-strength Radiesse placed deeply for jawline definition, chin projection, pre-jowl support, deep nasolabial folds, and hand rejuvenation. This is the “sculpting” use — you want immediate volume and collagen build-up over time.
- Hyperdilute — Radiesse diluted 1:1 or 1:2 with saline/lidocaine and placed in a subdermal plane for skin tightening rather than volume. Used for the neck, décolleté, upper arms, and full-face skin quality. Lower per-treatment effect but excellent for diffuse improvement and skin laxity.
The right indication: jawline structure, chin projection, hand rejuvenation, hyperdilute for skin tightening of large areas.
The wrong indication: lips (no, the texture is wrong), tear trough (no, risk of palpable lumps), or any area where reversibility matters — CaHA cannot be dissolved.
Longevity: 12–18 months typical, longer with biostim contribution.
Risks: nodule formation (especially in mobile or thin-skin areas), and the universal injectable risk of vascular events. Vascular complications with CaHA are particularly concerning because of the inability to dissolve.
See the dedicated Radiesse deep dive for techniques.
Profhilo — the HA biostimulator hybrid
What it is: a hybrid of high molecular-weight (1100–1400 kDa) and low molecular-weight (80–100 kDa) hyaluronic acid, stabilised by a thermal cross-linking process (NAHYCO™) rather than the BDDE chemical cross-linker used in conventional HA fillers. The result is a product that behaves more like a slow-releasing HA than a structural filler.
How it works: the low-MW fraction releases relatively quickly and signals fibroblasts to upregulate collagen and elastin synthesis. The high-MW fraction provides slow hydration and a longer-lasting tissue effect. The net result is improved skin firmness, thickness, and hydration — without the volumising effect of standard HA fillers.
The technique: the classic BAP (Bio Aesthetic Points) protocol uses 5 fixed injection points per side of the face: zygomatic eminence, nasal base, tragus, chin, and angle of mandible. 2 ml of Profhilo is distributed across these 10 points per session.
Protocol: two sessions, 4 weeks apart. Maintenance every 6–9 months.
The right indication: skin laxity without volume loss — lower face, neck, décolleté, hands. The patient who has “crepiness” rather than “hollowness.”
The wrong indication: volume loss (use HA filler or Sculptra), defined contour change (use HA filler), or significant skin redundancy (lasers/surgery).
Note on offerings: Profhilo has a clear evidence base and is widely used. La Clinica does not routinely stock it at present — we’ll discuss honestly when it’s the right tool and refer if needed rather than substitute.
Polynucleotides (PN) — the regenerative outlier
What it is: highly purified fragments of DNA derived from salmon sperm. The molecules are short, biocompatible, and signalling-active.
How it works: through a different mechanism from the other biostimulators. PN engages purinergic receptors on fibroblasts and other cells, upregulating collagen synthesis, scavenging reactive oxygen species, and modulating local inflammation. The effect is regenerative rather than space-occupying.
The right indication: skin quality, especially under-eye fragility, post-laser/microneedling recovery, sensitive skin types, and patients who want a regenerative approach without microparticle implants. PN can be combined safely with most other treatments.
The wrong indication: patients needing volume or structural change — PN doesn’t fill anything. It improves the quality of what’s already there.
Polynucleotides have their own dedicated pillar guide at La Clinica — see Polynucleotides Explained.
Ellanse (PCL) — the long-acting option
What it is: poly-caprolactone microspheres (25–50 microns) in a carboxymethylcellulose gel. PCL is a fully biodegradable polymer with a much longer breakdown timeline than PLLA — which is precisely why Ellanse can claim 2–4 year results in some formulations.
How it works: immediate volume from the gel carrier (similar to Radiesse), followed by sustained collagen induction around the PCL microspheres. Four formulations exist (M, S, L, E) with progressively longer microsphere persistence — from ~12 months for M to ~4 years for E.
The right indication: patients who want long-lasting structural restoration with biostimulator effect, and who accept the trade-off of reduced reversibility.
The wrong indication: any patient who wants “try it and see” flexibility — the longer the formulation persists, the harder any complication is to manage.
Note on offerings: Ellanse is widely used in Europe and Asia, less so in North America. La Clinica does not routinely use it at this time; this guide includes it for completeness.
How to choose — a decision framework
Three questions usually resolve the choice:
- Is the problem volume or quality? Volume → Radiesse or Sculptra (or HA, depending on specificity). Quality → Sculptra, Profhilo, or PN.
- Do you need it visible quickly, or are you willing to wait? Visible quickly → Radiesse or HA. Willing to wait 3 months → Sculptra, Profhilo, PN.
- Is the area diffuse or focal? Diffuse (broad area) → Sculptra, hyperdilute Radiesse, Profhilo, PN. Focal (one fold, one bone area) → standard Radiesse or HA.
Honest framing
The single most common error is using a biostimulator where HA filler is the right tool, because biostimulators are “newer” and feel more sophisticated. Pick the product that fits the problem, not the marketing.
FAQ
Which is best overall?
There is no “best” biostimulator — only best for a specific indication. For diffuse mid-face restoration, Sculptra. For jawline structure, Radiesse. For neck laxity, Profhilo or hyperdilute Radiesse. For under-eye quality, PN. The right answer depends on what you need.
Can different biostimulators be combined?
Yes, and it’s common practice. Sculptra for mid-face restoration + Radiesse for jawline structure + PN for skin quality is a typical multi-product plan over months. They work on different tissues and timelines.
How does cost compare?
Per session: PN < Profhilo ≈ Sculptra (single vial) < Radiesse standard < Ellanse. Per full treatment course: Sculptra and Ellanse tend to be highest because of multi-vial protocols; PN and Profhilo lowest per cycle but require more frequent maintenance.
Which has the strongest evidence base?
Sculptra has the longest clinical history (FDA-approved since 2004) and the most published peer-reviewed evidence. Radiesse and Profhilo have substantial evidence. PN and Ellanse have growing but less extensive datasets.
Which is the most reversible if something goes wrong?
None of them are truly reversible the way HA is (with hyaluronidase). Profhilo, being HA-based, can theoretically be partially dissolved with hyaluronidase though its hybrid structure makes this less efficient. Sculptra, Radiesse, Ellanse, and PN are not reversible — choose carefully.
Are any of them dangerous?
All injectables carry rare but real risks — primarily vascular events (occlusion of small arteries) and infection. Radiesse and Ellanse are of particular concern because they cannot be dissolved if a vascular event occurs. Practitioner experience and anatomical knowledge matter more than product choice for safety.
Want help choosing between them?
We use Sculptra and Radiesse routinely; we’re honest about Profhilo and Ellanse where they fit. A short consultation maps your concern to the right product (if any). No commitment.