The FDA-Approved and Non–FDA-Approved Indications for Biostimulatory Fillers off the Face

BACKGROUND: Biostimulatory fillers are increasingly used beyond the face to address age-related dermal thinning, laxity, crepiness, and soft-tissue volume loss through neocollagenesis and tissue remodeling. OBJECTIVE: The aim of this study was to review the use of calcium hydroxylapatite (CaHA) and poly-l-lactic acid (PLLA) for off-face rejuvenation, emphasizing indications, treatment techniques, clinical outcomes, and safety. MATERIALS AND METHODS: Published literature, consensus recommendations, and clinical experience regarding CaHA and PLLA were reviewed across multiple anatomic sites, including the hands, neck, décolletage, arms, forearms, breasts/chest wall, abdomen, buttocks, knees, and genital areas. RESULTS: Both CaHA and PLLA improve skin quality, laxity, and soft-tissue support through collagen stimulation and dermal remodeling. Optimal outcomes depend on anatomic site, appropriate dilution, subdermal or subcutaneous placement, and meticulous injection technique. Combination approaches with energy-based devices and other regenerative treatments may enhance outcomes. Most off-face applications remain off-label, although CaHA is FDA approved for the hands and décolletage. CONCLUSION: CaHA and PLLA provide versatile, minimally invasive options for off-face rejuvenation. Careful patient selection, anatomic knowledge, individualized technique, and realistic expectations are essential for a safe, effective treatment.