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Despite their proven individual efficacy, the combined use of these biomaterials remains underexplored. This study aimed to evaluate the histological and stereological effects of Calcium Hydroxyapatite, Poly\u2010L\u2010Lactic Acid, and their combination on dermal remodeling and connective tissue deposition. A pilot histomorphometric study was conducted in patients undergoing abdominoplasty, allowing access to treated and untreated tissue. Injections of Calcium Hydroxyapatite, Poly\u2010L\u2010Lactic Acid, their combination (Composite), or saline were administered in infraumbilical areas, using intradermal and deep dermal planes according to the material. Tissue samples were collected at D\u201030 (before intervention), and at 60 and 120\u2009days for analysis. Histological assessment included fiber density, organization, and inflammatory infiltrates. Stereological analysis was performed using the point\u2010counting method to quantify extracellular matrix (ECM) content. Results showed that all active treatments induced significant dermal remodeling compared with controls. Calcium Hydroxyapatite and Poly\u2010L\u2010Lactic Acid individually led to increased fiber bundle thickness and reduced interstitial spaces. The Composite group demonstrated the most pronounced effects, with fiber compaction and enhanced ECM remodeling. The ECM content increased up to 1000% by 60\u2009days, with slower gains between 60 and 120\u2009days, suggesting early peak stimulation followed by stabilization. In conclusion, the combination of Calcium Hydroxyapatite and Poly\u2010L\u2010Lactic Acid resulted in superior histological outcomes compared with isolated applications. These findings support the potential of a dual\u2010modality dermis biostimulation as a promising strategy for treating skin laxity.<\/jats:p>","DOI":"10.1002\/jbm.b.70124","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T05:47:18Z","timestamp":1785131238000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Pilot Histomorphometric Study of Combined Use of Poly\u2010L\u2010Lactic Acid and Calcium Hydroxyapatite to Improve Dermis Remodeling"],"prefix":"10.1002","volume":"114","author":[{"given":"Pedro Ivo Romani de Oliveira","family":"Gon\u00e7alves","sequence":"first","affiliation":[{"name":"Faculty of Medical Sciences and Health, Surgery Department, Postgraduate Program in Biomaterials and Regenerative Medicine (PPGBMR) Pontifical Catholic University of S\u00e3o Paulo  Sorocaba Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavia","family":"Pedrini","sequence":"additional","affiliation":[{"name":"Center of Sciences and Technologies for Sustainability, Postgraduate Program in Biotechnology and Environmental Monitoring (PPGBMA) Federal University of S\u00e3o Carlos  Sorocaba Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Isabela Rodrigues de Souza","family":"Barros","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences and Health (FCMS), Laboratory of Biomaterials Pontifical Catholic University of S\u00e3o Paulo (PUC\u2010SP)  Sorocaba Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rog\u00e9rio de Oliveira","family":"Ruiz","sequence":"additional","affiliation":[{"name":"IZ Plastic Surgery Clinic  S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6327-7363","authenticated-orcid":false,"given":"Eliana A. 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