Longevity, Safety, and Innovation: Merz Aesthetics on Natural Results and the Future of Regenerative Aesthetics

Natural results have to be proven, not promised. That was the thread running through a recent episode of the Medical Spa Insider podcast, recorded live at AmSpa headquarters in Chicago.

AmSpa founder and CEO Alex Thiersch sat down with two guests who see the industry from different sides. Patrick Urban, president of Merz Aesthetics North America, brought the manufacturer’s view. Cheryl Haseeb, DNP, FNP-BC, founder of Pura Medical Aesthetics in Houston and the Aesthetic National Institute (now at seven training locations), brought the view from the treatment room.

They covered Merz’s new Belotero approvals, filler fatigue, the merging of regenerative aesthetics and longevity, and what the industry owes patients on safety. Here are the highlights.

A Belotero portfolio twelve years in the making

On September 14, 2026, the FDA approved Belotero Volume and Belotero Intense. Volume is indicated for midface volume and contour; Intense is indicated for lip fullness. They join Belotero Balance to give Merz a full hyaluronic acid (HA) filler line.

When Thiersch congratulated him on the approval, Urban said:

“We have been more than patient waiting for this approval. I think when I joined Merz about twelve years ago, we were two years away from getting this approval. And here we finally are, twelve years later. But hey, it comes at the right time. It really completes our portfolio.”

He explained what the three products mean together:

“By having now three SKUs of Belotero — Belotero Balance, Belotero Volume now for volumization of the cheeks, and then Belotero Intense for lips definition and volume improvement — it sort of rounds out the entirety of the portfolio that you could argue was a missing ingredient for us to some degree, right?” said Urban. “Because outside of toxin use, HA filler is what everybody has been using for a long time, particularly in the US, the largest filler market in the world — probably going to be about a billion-dollar market in the next three to five years in terms of HA filler. So obviously we want to play in that space, and we want to have that available.”

Filler fatigue is a misconception to correct

Urban pushed back on the social media narrative that HA filler itself is the problem:

“We’ve all lived through this filler fatigue cycle, whatever we want to call the panic and neuroses around ‘I don’t want HA anymore because it makes you look this way or that way.’ And to some degree, we as an industry have to counter that, because that’s an untruth. And we can’t let those things stand.”

He said Belotero arrives at the right time because of how it behaves in tissue. He also called on the industry to back up its claims about natural results:

“This is a product that moves naturally with the tissue, moves naturally with expression, sort of lets your skin do what it does without making you look frozen, without making you look artificial,” said Urban. “Everybody wants natural results, right? We know 75% of patients say they want natural-looking results. And therefore everyone in industry says, ‘We deliver natural-looking results.’ Again, another thing that’s not quite true. There’s got to be science behind that statement, or else we shouldn’t be saying it. I’m big on: we’ve got to prove the things we say. And so with this, there’s plenty of proof. You look at Belotero under histology, you will see how seamlessly it integrates into tissue. And when you see that, it will be obvious that’s going to be a more natural-looking result.”

Haseeb agreed that overfilling was a trend, made worse by social media, and that patients now arrive “exposed but not informed.” Her answer is better product selection and technique. “Not all fillers are the same,” she said. “The correct filler in the correct plane with the correct technique is a beautiful result in one year, in two years.”

Regenerative aesthetics is a mindset shift, not a trend

Thiersch asked whether regenerative medicine and aesthetics will merge into one field or stay separate. Urban answered from an industry view:

“I sort of think it’s here to stay, and it continues to blend and overlap, and there’s some oneness that occurs eventually with all of this. And you could add longevity onto that as well. So this regenerative stuff then becomes wellness, regenerative aesthetics, and longevity. Put it all in a box, and then we have to start working through those tools to figure out where and when and how they fit. Because from a business perspective, being all things to all people usually doesn’t work. But at the same time, our customer, our consumer, is demanding that.”

He pointed to consumer data behind that demand:

“Think about it: it’s not been that long that this has all been around as a movement, if you will,” said Urban. “Yet 72% of patients even today are saying, ‘I expect wellness, longevity, and aesthetics to be in the practice I visit. I don’t want to go three places for that. I want to go to one.’ And we see that in our society, so that’s not a surprise. So for me, I think that this regenerative idea really represents a mindset shift in the mind of the patient. And this is a good thing, I think, because it fits with what we’re doing more naturally anyway.”

Urban then described the core promise of regenerative aesthetics:

“Regenerative aesthetics, as a foundational principle, says: can I turn on mechanisms in my body that used to work a certain way once upon a time, stopped working because I happen to get older — but now can I turn them back on and have them do the things they were doing before, produce the things cellularly and otherwise that they were doing before, which then gives me the outward appearance that I want? And in the end, that’s a pretty cool promise. Let’s take that in the natural: I want to look more natural. Well, if I’m adding something that’s artificial, chances are you’re not going to look that natural. But if I’m turning on the body’s mechanism to do something it always did before that made you look younger, chances are we can at least — not freeze your face, but freeze your age where you are as you continue to evolve. So I think that’s the promise of regenerative, and that’s why it makes so much sense. And longevity only adds to that mix, which is why I think it’s here to stay long term.”

Haseeb sees the same shift in her clinic. Patients now come in asking to “age better,” not to fix a single feature. She frames practice growth around three S’s: skill, scalability, and sustainability. Sustaining a practice in this market, she said, means a multimodal, multilayer plan of care. “It’s more of a marathon rather than a sprint.”

Sell a plan of care, and know when to say no

Today’s patients arrive with research from social media and AI tools, and sometimes with a specific product already in mind. Thiersch asked how Haseeb resets those expectations.

Her answer starts with positioning. Some med spas “sell a syringe or sell a vial,” she said; she sells a plan of care. Over her career she has learned to empower herself, and her patients, to say no. “We are in business, we are in sales, but there’s that fine line that’s blurred between medical ethics in a business and selling,” she said. “Saying no sometimes is the right thing to do.”

Urban said Haseeb’s approach is what keeps patients for the long term:

“I think that’s such a good point. I’ve often said at many conferences when I get a chance to speak about this subject that, to me, what you just identified, Cheryl, is the key to retaining patients long term. It’s a relationship that can’t be built by simply saying yes and providing whatever it is they’ve asked for. Although in our minds that’s the path of least resistance, and so sometimes we want to go there because that makes the patient potentially happy today. But this idea of blending education and walking with the patient and occasionally saying no puts the provider in such a higher level of credibility. I love that. And it’s no wonder that you’re so successful at what you do. I think this is a blueprint for people to really follow, because the psychology of that says that the patient’s going to trust you more.”

Safety is a shared responsibility

With bad press, new legislation, and unqualified operators in the headlines, Thiersch asked what role industry, including AmSpa, should play in setting a safe, consistent standard. Urban said it has to be a joint effort:

“We all have to do it together. So industry’s role is to not be myopic about it, to partner with organizations such as AmSpa, right? You guys do a great job on safety, on the business elements, and on training. And we need to support and supplement that, then also do it on our own as well. Make sure that there’s good science and evidence behind everything that we do, behind everything that we bring to market, and behind everything we say. Again, it’s a partnership between all of us: providers, organizations like AmSpa, industry. We’ve got to look at this not as ‘Merz alone does X, and that’s how we stand apart from other competitors.’ This is an area where we need to stop being competitive, because it’s all of us on the line to do this properly versus not, right? Every single time we do it well is 10 more patients that could find their way to us, to our space, of which we all win our percentages. Every time we do it wrong, we risk the whole existence of this thing. And we’ve got to understand those are the stakes.”

He acknowledged that new problems keep coming, and described what industry owes in return:

“It’s a bit whack-a-mole, as you say,” said Urban. “You could go to sleep and worry about 20 different things, and when you wake up, only 10 of them will be legit, but another 10 will come. I think only by looking at it together, sitting in community with each other and figuring out how we do it — and then industry bears its own responsibility. Are we training? Are we educating? Are we doing the good studies to make sure that we know what we’re talking about, rather than just take the easiest possible path? If we all do it together, we can get really far that way. And then we fight against the things that don’t make sense. The legislation that’s going to hurt our industry, we band together and we battle that. The social media that says the overfilled faces are the fault of HA fillers in general, we fight against that, because it’s just dead wrong. And so we have a powerful organization and community if we view that as one. We’re kind of isolated if we view it as each individually.”

Haseeb called this “synergistic success.” When she entered the field, she said, she called it “an ugly industry,” which is ironic for a beauty business, because of its silos and tribalism. The fix, in her view, is giving “authentic, humble, passionate, educated providers a platform” rather than rewarding the “Insta famous.”

The FDA as a gatekeeper

Thiersch noted that FDA approval is hard to get but matters for the industry. Urban agreed:

“You wouldn’t sign up for the alternative. It’s good that they’re in place and do what they do. And we can all get frustrated that they take longer than we’d like, but there’s still a purpose that’s being served there, and a very important one. And in some ways, once you get the products through from an industry perspective that you’ve been waiting for or wanting, it does serve as a barrier to entry so that the market doesn’t become too crowded. Not that there’s anything wrong with these markets, but go to some markets outside the US and there’s forty fillers. What is a provider to do? How do you choose? So at least here, that gateway sort of regulates what comes through and lets us all, providers and industry alike, deal with the landscape we have without it becoming instantly overcrowded.”

What “longevity” should mean in aesthetics

Thiersch noted that Merz is one of the few family-owned companies of its size and asked how longevity shapes its plans. Urban said family ownership lets Merz take a longer view:

“The family ownership part of it allows us to play a little bit more of the long game. It’s not as quarterly focused as some of the Wall Street–based operations. Doesn’t make them good or bad, just makes that true. So you can take a little bit longer perspective on the runway. And I think for us, the first part of this longevity stuff is that while it’s a cool buzzword, we’ve got to let this thing take shape a little bit too. To know exactly where this is going to go tomorrow would be pretty tough to call right now. There’s so many different things, not the least of which is the things that aren’t medical related — sauna and cold plunges and things like that that are part of it, an anti-inflammatory diet. There’s all this stuff that we’re just going to have to let evolve a bit.”

He was careful to define where Merz fits:

“For Merz right now, our look at that is: how do we take the products we currently have, as well as the products in development that we hope to bring forward, and how do we blend that with the other things that are going to evolve as being the useful tenets in the longevity space?” said Urban. “How does that all work together? Because we don’t want to imply that aesthetic products injected prolong life. And longevity has the danger of having multiple meanings to multiple people if not properly defined. So I think therein lies some of the rub: this is now a new buzzword that we all like, but what does it mean? Longevity of skin, longevity of life, quality of life — it’s a whole bunch of different things. So we’re trying to stay, at least for now, in our lane, which is longevity of skin. How do we preserve that? How do we make that operate and work as naturally as it can, for as long as it can, as youthful as it can — or, as Cheryl said earlier, aging the right way for today’s age, rather than looking 20 years younger? We do all that with good research on our products, with looking at more longevity options and seeing how those products blend, and being able to educate on that. That’s how we help providers and how we grow the space together.”

Haseeb sees longevity in her patient mix. Five years ago her typical patient was 40 to 60. Today she treats patients in their late 20s and early 30s who use sunscreen, retinoids, and neurotoxins preventatively. “They’re starting earlier, they’re aging better, they’re more informed,” she said. Providers’ job is to bridge the gap between social media misinformation and evidence-based care.

Urban agreed and explained why earlier care works:

“Great point. And I think we have to remember too that aging is an inside-out process, right? So this is why it works so well when people come in. This is why we know it’s going to work as they access these products earlier and earlier — not too early, but earlier than they had been. That’s a good thing. It’s going to work because it’s an inside-out process. And so if we can keep the inside where it should be, we’re not going to have that expression on the outside that we’re trying to avoid.”

Thiersch noted that AmSpa has focused on educating providers and now plans to do more to educate the public, including which questions patients should ask their providers.

What’s next for Belotero, and beyond the face

Thiersch asked about the plan for bringing Belotero to market. Urban laid out the timeline and Merz’s commitment to training:

“Of course we want to do it immediately and yesterday. And at the same time, clearance often predates supply. So we’re doing some roadshows now, even here at AmSpa, which we appreciate very much, and we’re just trying to get the word out on it. Right now we have it under very early access, limited supply. But as we get into about the middle of October, we look forward to launching Belotero Volume broadly and generally to anyone that wants it. Of course, we’d like them to get trained, because that’s part of our obligation: to make sure that even though injecting a filler is injecting a filler — as Cheryl mentioned earlier, it’s not really, because they don’t all perform exactly the same. And so we want to make sure that everyone’s going to get the right kind of great result that they want. So we’ve got a commitment to make sure there’s plenty of training avenues for people to get trained. And then probably around mid-November to early December is when we would have the equivalent supply on Intense, and be able to then more broadly launch lips with Intense as well.”

Previous releases anticipate commercial availability dates of October 14 and December 1, 2026.

Haseeb, who has used the products overseas for several years, including with Dr. Kate Goldie, noted that they are new to the US but not to the world. She added that the approvals open the door to on-label training. Urban built on her point:

“I think the great point about it being new here in the US, but not necessarily new globally — in fact, it’s been available globally for twenty years, and there are a hundred and seventy peer-reviewed publications on the product. So people should know that it’s been studied for a long, long time and used for a long, long time, just not here.”

Treatments move off the face

Thiersch also asked about Merz’s Ultherapy PRIME clearance for knee skin laxity. Urban explained what the clearance signals:

“It starts to move off the face. You could argue décolleté also sort of moves off the face onto the body. This also moves to another area of the body that people are self-conscious about, evidently. It is the only device that’s got a clearance for knees. So at least there’s something there that says, now we’re migrating not only off the face, but into areas that, at least on label, haven’t been able to be treated before or talked about openly in that capacity. So who knows where it goes next. I won’t speculate.”

Haseeb confirmed that knees are a frequent topic among her female patients.

Key takeaways for med spa owners

• Back up “natural results” with evidence. Patients want natural outcomes, and claims need science behind them.
• Filler isn’t the problem; misuse is. The right product, plane, and technique still deliver lasting, natural results.
• Build plans of care, not transactions. A multimodal, long-term approach fits patients who want to age better.
• Saying no builds trust. Honest consultations improve credibility and retention.
• Safety is everyone’s job. Manufacturers, providers, and AmSpa win or lose together.
• Get trained on new products. Fillers don’t all behave the same, even within the same category.

Listen to the full episode

Hear the whole conversation with Patrick Urban and Cheryl Haseeb on Medical Spa Insider.