Dr Thomas Rappl
Beyond filling: combining hyaluronic acid, polynucleotides and skin longevity strategies for more natural, regenerative aesthetic outcomes.
Aesthetic medicine is changing. After years marked by excessive volumisation and inappropriate filler use, patients are seeking natural results and healthier skin. The challenge is not to replace HA fillers with PN, but to understand how restoration, regeneration and longevity can work together.
WHEN FILLING BECOMES TOO MUCH
For years, injectable aesthetics has been closely associated with facial volumisation. Hyaluronic acid fillers transformed non-surgical rejuvenation by restoring structural support, volume and facial balance. Yet inappropriate indications, excessive quantities, product misplacement and insufficient understanding of anatomy and aesthetic principles have contributed to the “overfilled face”. This has led to growing mistrust of fillers. But the problem is not HA itself. Poor outcomes related to inappropriate product selection, technique or indication should not discredit a valuable therapeutic tool. The lesson is not to stop filling, but to fill better — and only when necessary.
FROM VOLUME TO TISSUE QUALITY
Patient expectations have evolved towards natural results, improved skin quality and prevention, placing regenerative aesthetics and longevity at the centre of modern practice. This has driven growing interest in polynucleotides (PN), which require the same scientific understanding, appropriate indication and clinical expertise as fillers. Facial aging is multidimensional, involving structural changes, fat redistribution and progressive deterioration of the extracellular matrix and skin properties. Not every sign of aging can therefore be addressed with the same injectable.
RESTORE, REGENERATE, PRESERVE: THE PLURYAL® APPROACH
This is where a combined Pluryal® strategy becomes particularly relevant. HA fillers restore with the biostimulator range. When structural support, projection or volume has been lost, carefully selected HA can restore facial architecture without unnecessarily changing the patient’s identity. Polynucleotides regenerate. Pluryal® Salmostim treatments introduce a different approach, focused on tissue quality and biostimulation rather than simply adding volume. Pluryal® Silk can be integrated into strategies for delicate areas such as dark circles, while Pluryal® Densify, combining highly purified polynucleotides with non-crosslinked HA and mannitol to extend the treatment’s overall efficacy, addresses skin redensification and quality. Longevity preserves. The objective is increasingly moving beyond correcting visible aging towards maintaining healthier tissue over time. Skin longevity integrates prevention, photoprotection, lifestyle, skin-barrier health and appropriately selected regenerative and biostimulatory treatments, with Pluryal® products offering highly effective solutions with a strong safety profile to support long-term skin quality and health.
LESS PRODUCT, MORE STRATEGY
Rather than opposing HA and PN, modern aesthetic medicine should determine what each tissue actually requires. A patient may need structural restoration, improvement in skin quality, a preventive strategy — or a carefully sequenced combination of all three. The philosophy becomes simple: Restore what has been lost. Regenerate what can be improved. Preserve what is still healthy. This represents a transition from product-driven to diagnosisdriven aesthetic medicine. The future should not be defined by using more injectables, but by understanding when, where and why to use them.
HA AND PN: TOWARDS A NEW VISION OF LONGEVITY
Correction, regeneration and longevity no longer compete: they work intelligently together. The right treatment, for the right tissue, at the right time can move beyond simply correcting aging to support healthier, more natural and sustainable aging over time.
Dr Thomas Rappl
Certified Plastic, Aesthetic and Reconstructive Surgeon and Senior Physician at the Medical University of Graz. Medical Director of MA-RA and internationally recognised speaker and trainer in aesthetic medicine, with extensive expertise in regenerative treatments, patient safety and natural results.
