Optimizing Collagen Biostimulator Choice in LATAM: Expert Consensus on Patient Selection, Ethnic Skin Phenotypes, and Accessibility

Abstract

Background: The diverse ethnic skin phenotypes and socioeconomic landscape of Latin America (LATAM) necessitate tailored approaches to collagen biostimulators, calcium hydroxylapatite (CaHA) and poly-l-lactic acid (PLLA). A region-specific consensus on their optimal use is lacking. Objectives: To establish expert consensus guidelines on patient selection, techniques, and practical application of CaHA and PLLA for collagen biostimulation in LATAM populations. Methods: A modified Delphi process was conducted with 14 LATAM experts. Following a systematic literature review, 58 statements were drafted across key clinical domains. Consensus was defined as ≥ 75% agreement, stratified as strong (≥ 85%) or moderate (75%–84%). Results: Strong consensus was achieved on 51 statements (87.9%), with 4 reaching moderate consensus. Key recommendations include: selecting CaHA for thicker skin and immediate volumization, and PLLA for thinner skin and long-term collagen remodeling; using specific dilution protocols (e.g., CaHA 1:1 for face, 1:4 for body); employing cannulas for safety; and implementing vigorous post-PLLA massage. Initial disagreements on age-based restrictions were resolved through literature review, achieving final consensus. Conclusion: This consensus provides the first LATAM-specific framework for CaHA and PLLA use, integrating ethnic diversity, anatomical considerations, and accessibility to optimize safety and efficacy in regenerative aesthetics.