Regenerative

Regeneration over replacement: the position, stated plainly

Name: Regeneration over replacement: the position, stated plainly
Creator: Dr Suha Kersh

Dr Suha Kersh

Co-Founder & Lead Aesthetic Doctor

3 May 2026·5 min·Vol. VII · 05

A woman's face beside editorial text illustrating the subject of regenerative aesthetic care at 23MD

Regenerative medicine asks tissue to repair itself. Replacement medicine substitutes material for it. At 23MD we lead with regeneration and use replacement where the problem is structural. Regeneration is slower and asks for more patience, but in our view it is the more durable foundation for a face that keeps changing.

What is the difference between regeneration and replacement?

Replacement adds material to the face. Filler, fat transfer and implants all work this way: they put volume where volume has been lost, or was never there. The effect is immediate and visible, which is part of its appeal.

Regeneration works with the patient's own biology. Rather than adding volume, it aims to support the skin's own repair processes, so that any improvement comes from the tissue rather than from material placed in it. At 23MD this includes polynucleotides, platelet treatments prepared from the patient's own blood (PRP is currently offered at our Dubai clinic), exosomes applied to the skin surface (never injected) and biostimulating treatments. Change is gradual and appears over weeks to months, not on the day.

Neither approach is good or bad in itself. They answer different questions. The clinical skill lies in knowing which question a particular face is asking.

Why does 23MD lead with regeneration?

The reasoning is about time. Tissue that has been supported to repair itself ages biologically, at the same pace as the rest of the face. Material that has been added ages differently: it may persist, soften or be broken down at its own rate, while the tissue around it continues to change.

Imaging illustrates the point. In one published case report, MRI scans followed hyaluronic acid filler for more than two years after treatment. Product in the mid-face was still visible on every scan, while product in the more mobile chin had largely broken down. That is a single patient and cannot be generalised, but it shows that added material does not simply age alongside the face.

Over a decade, the difference between a face that has been supported and one that has been filled tends to become visible to anyone, including the patient. Leading with regeneration is our way of keeping the face coherent over that span, not only at the next appointment.

When is replacement the right answer?

Some changes are mechanical, and mechanical problems need mechanical answers. Facial ageing happens in every layer: the facial skeleton slowly remodels, deep fat compartments shrink and shift, retaining ligaments loosen and the skin loses collagen and elasticity. Regenerative treatments act mainly at the level of the skin. They cannot rebuild bone or restore a deep fat pad.

The situations where we consider replacement appropriate include:

structural loss in the mid-face, where the cheek has lost its underlying support;
bone resorption at the temple, which leaves a hollow that regeneration cannot fill;
volume deficit at the chin or jaw, whether from ageing or from natural proportions.

In each case we use replacement conservatively: the least material that restores support, placed with attention to anatomy and reviewed over time.

The integrated protocol: which comes first?

Most faces benefit from both approaches. The question is the order. Our position is regeneration as the foundation, replacement as the correction.

Improving skin quality first means that any structural correction afterwards sits within healthier tissue, and often less is needed. The reverse order, volume first and skin quality later if at all, is common. It is also, in our view, commercially driven, and it tends to produce faces that do not hold: correction sitting beneath skin that has not been supported.

In practice the sequence is personal. Some patients need no replacement at all. Others have a clear structural deficit that is worth addressing once the skin has been prepared. The plan is set after a consultation, not chosen from a menu.

Who is this approach for, and who is it not for?

A regeneration-first plan tends to suit patients who:

are noticing changes in skin quality, such as texture, laxity or dullness, rather than marked volume loss;
want gradual change that is not obvious to others;
are willing to commit to a course of treatment and wait for results.

It is less suited to patients who want a visible change for a date in the next few weeks, or whose main concern is a structural deficit that only replacement can address. In those cases we say so plainly. Suitability for any treatment, including during pregnancy or breastfeeding or alongside other medical conditions, is always confirmed by a doctor.

What should you expect, and what does the evidence say?

Regenerative treatments usually involve a course of sessions spaced several weeks apart, with results developing gradually. Mild redness, swelling or small bruises at treatment points are common for a few days. Results vary between individuals and cannot be guaranteed.

The evidence deserves honesty. A 2024 review of polynucleotides in aesthetic medicine found that some studies reported better skin elasticity and hydration while others found limited or no benefit, that most studies were small and observational, and that high-quality evidence is limited. The evidence for exosomes in skin is at an earlier stage still. We present these treatments as reasonable options with a sound rationale, not as proven to reverse ageing.

Speak to a doctor

If you would like to understand which approach suits your face, the first step is a consultation with one of our doctors. You can read more about polynucleotides, skin boosters and how we sequence treatments.

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