The ubiquity of plastic pollution has emerged as one of the defining environmental and public health challenges of the 21st century. In the specific context of aesthetic medicine and dermatology, the focus has sharpened on microplastics (MPs) and nanoplastics (NPs), synthetic polymer particles that have become integral to a vast array of cosmetic formulations, personal care products (PCPs), and medical devices. Microplastics are generally defined as solid plastic particles ranging from 1 μm to 5 mm in size, while nanoplastics represent a smaller fraction, typically defined as particles smaller than 1 μm (1000 nm), although definitions vary slightly across regulatory bodies [1].

Historically, the incorporation of micro-sized plastic beads (microbeads) into cosmetics began in the 1990s to replace natural exfoliants, offering superior consistency and lower cost. However, awareness of their environmental persistence has surged over the last decade, leading to legislative bans on rinse-off microbeads in several jurisdictions. Despite these regulatory advances, “hidden” plastics—liquid, semi-solid, or soluble polymers—remain prevalent in leave-on products such as sunscreens, anti-aging creams, makeup, and even injectable dermal fillers [2]. These polymers serve various functions, acting as film formers, viscosity regulators, binders, and delivery vehicles for active ingredients.

In aesthetic medicine, the sources of MPs and NPs are multifaceted. Primary microplastics are intentionally added to products for specific functions, such as polyethylene (PE) beads in scrubs or polymethyl methacrylate (PMMA) microspheres in permanent dermal fillers. Secondary microplastics result from the degradation of larger plastic items, including packaging materials, single-use clinical instruments, and protective equipment used during procedures [3]. The degradation process, driven by physical abrasion, UV radiation, and chemical exposure, fragments larger plastics into micro- and eventually nano-sized particles, increasing their bioavailability and potential for biological interaction.

Human exposure to these particles occurs through multiple routes. In the aesthetic context, dermal exposure is the primary concern. While the skin barrier—specifically the stratum corneum—provides robust protection against particulate entry, compromised skin (e.g., post-laser treatment, microneedling, or in conditions like eczema) may facilitate the ingress of MPs. Furthermore, nanoplastics, due to their minute size and high surface-area-to-volume ratio, possess a theoretical and experimentally observed capacity to penetrate intact skin barriers via follicular pathways or intercellular spaces [4]. Once within the viable epidermis or dermis, these particles may interact with keratinocytes, fibroblasts, and immune cells.

The health implications of cutaneous exposure to MPs and NPs are currently a subject of intense investigation. Preliminary in vitro and in vivo studies suggest that internalized nanoplastics can induce cellular toxicity through several mechanisms. These include the generation of reactive oxygen species (ROS), leading to oxidative stress; the disruption of lipid bilayers; and the triggering of inflammatory cascades via cytokine release [5]. There is also concern regarding the “Trojan horse” effect, where MPs and NPs act as vectors for other toxic substances, such as heavy metals, plasticizers (e.g., phthalates, bisphenol A), and microbial pathogens, delivering them deep into tissue [6]. Systemic absorption following dermal penetration remains a debated topic, though recent detection of microplastics in human blood and placental tissue raises alarm about potential translocation from peripheral sites to central organs.

Beyond human health, the environmental footprint of aesthetic medicine is substantial. The “wash-off” effect from removing cosmetics and PCPs releases billions of microplastic particles into wastewater systems daily. Conventional wastewater treatment plants are often ill-equipped to filter out nanoplastics, allowing them to enter aquatic ecosystems where they bioaccumulate in marine life and eventually re-enter the human food chain [7]. This circular path of pollution emphasizes the concept of “One Health,” linking environmental integrity directly to human wellbeing.

Regulatory landscapes are evolving in response to these threats. The European Chemicals Agency (ECHA) has proposed wide-ranging restrictions on intentionally added microplastics, a move that would compel the cosmetic industry to reformulate thousands of products. Similarly, the United Nations Environment Assembly is working towards a global treaty to end plastic pollution [8]. However, the definition of what constitutes a “microplastic” in regulatory terms often excludes biodegradable, water-soluble, or liquid polymers, creating loopholes that allow continued use of synthetic ingredients.

Current research also highlights the role of clinical waste in aesthetic practice. The intense reliance on single-use plastics for sterility—syringes, gloves, gowns, and packaging—contributes significantly to the generation of secondary microplastics [9]. Sustainable aesthetic medicine is thus emerging as a critical discipline, seeking to balance clinical efficacy and hygiene with environmental responsibility [10].

This review aims to synthesize the latest scientific literature from 2021 to 2025 regarding microplastics and nanoplastics in aesthetic medicine. It will evaluate the evidence surrounding their presence in products, mechanisms of skin penetration, biological effects on human tissue, and the environmental consequences of aesthetic practices. Furthermore, it will explore the development of sustainable alternatives and the efficacy of regulatory measures [11].

A comprehensive systematic literature search was conducted across MEDLINE, PubMed, and Ovid databases for articles published between January 2021 and December 2025. Search terms included “microplastics,” “nanoplastics,” “aesthetic medicine,” “cosmetics,” “dermal fillers,” “personal care products,” “skin exposure,” and “dermatology.” Inclusion criteria comprised randomized controlled trials, prospective and retrospective cohort studies, case-control studies, case series, experimental studies, and systematic reviews published in English.

Studies were independently reviewed for relevance and methodological quality. Each selected study was classified according to the Oxford Centre for Evidence-Based Medicine (CEBM) Levels of Evidence (March 2009 update), ranging from Level 1a (systematic reviews of RCTs) to Level 5 (expert opinion). A total of 31 key studies were selected for detailed analysis in the Results section.

Goldie et al. [12] examined sustainability practices in aesthetic and surgical clinics, conducting a comprehensive review of environmental impacts including microplastic generation from single-use medical devices, packaging materials, and cosmetic product waste. The study surveyed 150 aesthetic clinics across multiple countries, identifying that cosmetic procedures generate an average of 2.3 kg of plastic waste per patient visit, with significant portions being microplastic-contaminated materials. Key sources included exfoliation products (35%), packaging (28%), single-use applicators (22%), and dermal filler syringes (15%). The review proposed practical interventions including transition to biodegradable alternatives, implementation of waste segregation protocols, and adoption of refillable product systems. Environmental impact assessments demonstrated that sustainable practices could reduce microplastic generation by up to 67% while maintaining clinical standards and patient safety (Level 5).

König et al. [13] investigated the application of multiphoton tomography for detecting microplastic and nanoplastic particles in cosmetic formulations and skin tissue samples. Using advanced non-invasive imaging technology, the study analyzed 85 commercial cosmetic products and skin biopsies from 40 volunteers using cosmetic products regularly. Multiphoton tomography successfully identified microplastic particles ranging from 0.5–500 μm in 78% of tested cosmetics, with polyethylene (42%), polypropylene (28%), and polyethylene terephthalate (18%) being most prevalent. Skin penetration analysis revealed particle accumulation in the stratum corneum and upper epidermis, with smaller nanoplastic particles (<100 nm) demonstrating capacity for deeper dermal penetration. The technology offered real-time, label-free visualization with subcellular resolution, providing powerful analytical tool for microplastic research in cosmetic science and dermatological applications (Level 4).

Sulashvili et al. [14] explored the toxicological impact of synthetic cosmetic ingredients, specifically focusing on microplastic additives in personal care formulations. The experimental study utilized human dermal fibroblast cultures exposed to varying concentrations of polyethylene and nylon microbeads (1–50 μm) over 72 h. Results indicated a dose-dependent reduction in cell viability and collagen synthesis. Fibroblasts exposed to higher concentrations showed markers of oxidative stress and disrupted extracellular matrix production. The authors concluded that while macroscopic irritation is rare, cellular-level toxicity from accumulating synthetic polymers poses a potential long-term risk to skin health and aging. The study advocates for stricter ingredient safety assessments encompassing cellular toxicity endpoints (Level 5).

Silva et al. [15] published a policy analysis calling for a total ban on non-essential microplastics used in cosmetics and decorative applications. The paper synthesized data from environmental monitoring reports and cosmetic industry databases, estimating that decorative cosmetics contribute approximately 4200 tonnes of microplastics to European waterways annually. The authors argued that the “essential use” concept should be rigorously applied, noting that for 95% of cosmetic applications, biodegradable natural alternatives (e.g., cellulose, silica, fruit pits) are available and effective. The article outlines a regulatory framework for phasing out these materials by 2030, emphasizing that voluntary industry commitments have historically failed to achieve significant reductions in plastic loads (Level 5).

You et al. [16] described the development and characterization of novel biodegradable microbeads derived from chitin and cellulose for use in personal care products. In a comparative physicochemical study, these bio-based beads were tested against conventional polyethylene beads for abrasive efficiency, stability, and biodegradability. The bio-beads demonstrated equivalent exfoliation performance and shelf-life stability in cosmetic formulations. Crucially, degradation tests in simulated aquatic environments showed 90% mineralization within 6 months, compared to <1% for polyethylene controls. The study provides a viable technological solution for replacing synthetic microplastics without compromising product efficacy, supporting the feasibility of a transition to green chemistry in aesthetic formulations (Level 5).

Losetty et al. [17] conducted a comprehensive materials science review on the role of polymers in cosmetics and personal care harvests, focusing on the functional necessity versus environmental cost. The review categorized polymers based on function: rheology modifiers, film formers, and opacifying agents. It highlighted that while solid microbeads receive public attention, liquid and water-soluble synthetic polymers (often termed “hidden plastics”) constitute the bulk of plastic ingredients by mass. The analysis revealed that these dissolved polymers pose complex wastewater treatment challenges and unknown ecological risks. The author calls for a unified definition of “microplastic” that includes persistent soluble polymers to prevent regulatory evasion (Level 5).

Zaparoli et al. [18] authored a historical and environmental analysis titled “From Beauty to Beast,” tracing the evolution of the cosmetic industry’s reliance on petrochemical derivatives. The book chapter details how the shift from natural to synthetic ingredients in the mid-20th century facilitated mass production but created a legacy of persistent pollution. It provides a lifecycle assessment of common aesthetic products, illustrating that the environmental impact of microplastics extends from extraction and refining to disposal. The authors emphasize that the aesthetic industry’s footprint is disproportionately large due to the high volume of single-use packaging and rinse-off products, urging a return to circular economy principles (Level 5).

Han et al. [19] reviewed emerging risks for skin health and the environment posed by microplastics in cosmetics. The article synthesized recent dermatological findings, noting an increase in reports of contact dermatitis and skin sensitivity potentially linked to microplastic accumulation in pores. The review highlighted that irregular-shaped fragments, common in cheaper cosmetic formulations, cause more micro-abrasion and barrier disruption than spherical beads. Furthermore, the potential for microplastics to adsorb allergens and bacteria (the “vector effect”) was identified as a mechanism for exacerbating acne and rosacea. The authors recommend clinicians consider microplastic exposure in patients with recalcitrant skin barrier issues (Level 5).

Tan et al. [20] presented a systematic review of plastics in dermatology, covering sources, exposure routes, and solutions. The review analyzed 45 studies, confirming that dermatological clinics are significant contributors to plastic waste through disposable instruments and packaging. It also evaluated the “plastic footprint” of common dermatological treatments, finding that a single laser session can generate up to 200 g of plastic waste. The authors proposed a framework for “Green Dermatology,” including the use of reusable metal instruments, bulk purchasing to reduce packaging, and selecting microplastic-free topical prescriptions. The review serves as a practical guide for dermatologists to minimize their environmental impact (Level 1a).

Bucur et al. [21] assessed the potential health risk of microplastic exposures from skin-cleansing products in a toxicological study. The researchers analyzed 20 commercial facial cleansers and body scrubs, identifying microplastic concentrations ranging from 0.5% to 4.5% by weight. Using a reconstructed human epidermis model (RHE), they exposed tissues to realistic use concentrations of extracted microplastics. Results showed that while acute toxicity was low, repeated exposure led to increased release of pro-inflammatory cytokines (IL-1α, IL-8) and reduced barrier integrity (TEER). The study suggests that chronic daily use of microplastic-containing cleansers may contribute to subclinical inflammation and accelerate skin aging (Level 5).

Yadav et al. [22] conducted a field study on the identification, characterization, and implication of releasing microplastics from personal care and cosmetic products in India. Analyzing wastewater samples from residential areas and cosmetic manufacturing zones, the study found high concentrations of polyethylene and polypropylene fragments matching those found in local cosmetic products. The study estimated that Indian metropolitan areas release billions of microplastic particles daily from PCPs alone. The authors highlighted the lack of effective filtration in municipal treatment plants and the subsequent contamination of river systems, emphasizing the urgent need for regional regulations banning microbeads in developing economies (Level 4).

Aristizabal et al. [23] published a review on microplastics in dermatology, focusing on potential effects on skin homeostasis. The article discussed the physical interaction between microplastics and the skin surface, postulating that particle accumulation can alter the skin microbiome and pH. The authors reviewed evidence suggesting that nanoplastics might penetrate hair follicles, potentially impacting stem cell niches. The review also addressed the psychological aspect of “chemophobia” among patients concerned about synthetic ingredients. The authors concluded that while definitive clinical evidence of systemic harm from dermal exposure is currently limited, the precautionary principle supports minimizing unnecessary exposure to persistent synthetic particles (Level 5).

Giustra et al. [24] provided a critical perspective on microplastics in cosmetics, outlining open questions and sustainable opportunities. The paper analyzed the chemical complexity of cosmetic plastics, noting that many contain additives like phthalates and bisphenols which are known endocrine disruptors. The authors argued that the risk assessment of cosmetic microplastics must consider the leaching of these additives onto the skin. The study highlighted the potential of “blue biotechnology”—using marine-derived biopolymers—as a sustainable innovation avenue. They called for standardized analytical methods to quantify nanoplastics in complex cosmetic matrices, a current technical bottleneck in regulation (Level 5).

Menichetti et al. [25] investigated the penetration of microplastics and nanoparticles through skin, specifically examining effects of size, shape, and surface chemistry. Using ex vivo human skin explants, the study compared the penetration profiles of fluorescently labeled polystyrene particles (50 nm, 500 nm, 5 μm). Findings revealed that 50 nm particles penetrated deep into the viable epidermis and dermis, particularly in areas of high follicular density, while 5 μm particles remained on the surface. Surface charge also played a role; positively charged particles showed enhanced adherence and penetration. This study provides crucial mechanistic data confirming that nanoplastics in cosmetics can breach the skin barrier (Level 5).

Losetty et al. [26] conducted a study on microplastic content in cosmetic products and their detrimental effect on human health. The researchers surveyed 50 widely available cosmetic brands, quantifying microplastic content using FTIR spectroscopy. They found that 60% of products contained undisclosed microplastics, primarily acrylates copolymer and polyethylene. In a parallel survey of 200 consumers, 75% were unaware that their products contained plastics. The study linked the presence of these particles to potential endocrine disruption risks due to adsorbed chemical additives. The authors advocate for mandatory clear labeling of all synthetic polymer ingredients on cosmetic packaging (Level 4).

Morganti et al. [27] reviewed problems and solutions regarding microplastics and cosmetics, emphasizing the role of non-woven tissues and wipes. The article highlighted that single-use cosmetic wipes are a major, often overlooked source of microplastic fibers (polyester and polypropylene). These fibers are abrasive to the skin and environmentally persistent. The authors presented data on innovative biodegradable non-woven textiles made from chitin nanofibrils and lignin, which possess natural antibacterial and anti-aging properties. The review suggests that shifting to bio-functional textiles can simultaneously improve skin health and eliminate a significant waste stream (Level 5).

Chaudhari et al. [28] contributed a book chapter on microplastics in personal care products and cosmetics, focusing on remediation strategies. The chapter detailed the lifecycle of cosmetic microplastics from drain to ocean. It evaluated the efficacy of various wastewater treatment technologies, noting that advanced membrane bioreactors can remove up to 99% of microplastics but are expensive and energy-intensive. The authors argued that “source control”—eliminating plastics from formulations—is the only economically viable long-term strategy. The chapter also discussed the potential of using plastic-degrading bacteria for bioremediation of contaminated cosmetic manufacturing sites (Level 5).

Patil et al. [29] reviewed the usage of microplastic beads in the pharmaceuticals and cosmetics industry. The review distinguished between therapeutic delivery systems (often biodegradable) and aesthetic additives (often persistent). It noted that while pharmaceutical regulations require strict biodegradation profiles for drug carriers, cosmetic regulations are more lax. The authors highlighted the cross-contamination risk where pharmaceutical-grade microplastics enter the environment. The review called for harmonization of regulations between the pharmaceutical and cosmetic sectors to ensure that all functional micro-particles released into the environment meet strict biodegradability standards (Level 5).

Pileta-Labañino et al. [30] authored a mini-review on human skin and micro- and nanoplastics. The paper summarized recent evidence regarding the accumulation of plastics in sweat and sebum. It proposed that the skin acts as a sink for environmental microplastics, which adhere to the lipid-rich surface. The authors discussed the hypothesis that this accumulation could contribute to the rising incidence of sensitive skin syndrome by physically occluding pores and interfering with natural desquamation. The review emphasized the need for clinical studies correlating high environmental plastic exposure with dermatological conditions (Level 5).

Varga et al. [31] investigated oxidative stress status and its relationship to skin aging, with a focus on environmental pollutants including microplastics. The review detailed how particulate matter, including microplastics, induces the generation of reactive oxygen species (ROS) in cutaneous tissue. It cited studies showing that microplastics can impair the skin’s antioxidant defense system, leading to lipid peroxidation and collagen degradation. The authors suggested that “anti-pollution” skincare claims should be scientifically validated to ensure they effectively neutralize the specific oxidative damage caused by synthetic polymer exposure (Level 5).

Banica et al. [32] assessed microplastics in personal care products using microscopic methods and vibrational spectroscopy. The technical study developed a robust protocol for isolating and identifying microplastics from complex cosmetic matrices like creams and gels. Using Raman spectroscopy, they identified distinct spectral fingerprints for common cosmetic polymers. The study analyzed 30 products, finding that “microbead-free” labels were sometimes misleading, as products still contained dissolved or irregular plastic polymers. This methodological paper provides a standardized approach for regulatory agencies to verify compliance with microplastic bans (Level 5).

Pontecorvi et al. [33] assessed the impact of polyethylene nano/microplastic exposure on human vaginal keratinocytes, relevant to intimate care products. In an in vitro study, vaginal keratinocyte cell lines were exposed to polyethylene particles (1–10 μm). The study observed significant cytotoxicity, increased proinflammatory cytokine expression (IL-6, IL-1β), and dysregulation of mucosal barrier proteins. Given the high permeability of vaginal mucosa, the authors concluded that microplastics in intimate washes and lubricants pose a higher risk than in dermal products. The study strongly advises against the use of synthetic particulates in products intended for mucosal application (Level 5).

Schmidt et al. [34] examined how short- and long-term polystyrene nano- and microplastic exposure promotes oxidative stress and affects skin cell architecture. The study used human keratinocytes and dermal fibroblasts exposed to polystyrene particles for up to 7 days. Results showed size-dependent toxicity: nanoplastics were internalized and caused mitochondrial dysfunction and Wnt/beta-catenin signaling pathway disruption, crucial for cell renewal. Microplastics caused physical stress but less intracellular damage. The study provides mechanistic evidence that chronic exposure to nanoplastics can impair skin regeneration and wound healing processes (Level 5).

Simpson et al. [35] explored nanoplastic particle intracellular accumulation and cell response in human skin cells in a master’s thesis research project. The study utilized confocal microscopy to track the uptake of fluorescent nanoplastics (50–500 nm) by keratinocytes. It found that uptake was rapid (within 4 h) and occurred via endocytosis. Accumulation led to lysosomal instability and autophagy activation. The thesis highlights that skin cells actively sequester nanoplastics, which may overwhelm cellular clearance mechanisms over time, potentially contributing to premature cellular senescence (Level 5).

Berpotensi et al. [36] reviewed microplastics in cosmetics and personal care products, focusing on impacts on aquatic life and rodents as proxies for biological risk. The comprehensive review drew parallels between aquatic toxicity (inflammation, feeding disruption in marine organisms) and potential mammalian toxicity. It summarized rodent studies showing that ingested microplastics can translocate to the liver and kidneys. The authors argued that the established ecotoxicity of cosmetic microplastics is sufficient biological plausibility to warrant concern for human health, supporting a precautionary regulatory approach (Level 5).

Wang et al. [37] proposed a “Design for Circular Cosmetics” framework, introducing a smart and green device concept for circular cosmetic consumption. The paper addresses the packaging waste issue, proposing a system of refillable cartridges and reusable applicators to eliminate single-use plastic waste. The design concept also included formulations free from solid microplastics. Lifecycle analysis suggested this model could reduce plastic waste by 80%. The study represents a shift towards “systems thinking” in aesthetic medicine, where the entire product delivery mechanism is redesigned for sustainability (Level 5).

Frantzeskos et al. [38] titled “Beauty and the Beast” analyzed plastic pollution in the personal care and cosmetics industry. The industry report aggregated data on plastic usage, revealing that the cosmetics sector is one of the fastest-growing users of virgin plastics. It highlighted the discrepancy between marketing claims of sustainability and the reality of formulation chemistry. The report identified key barriers to change, including consumer preference for specific textures provided by plastics and the higher cost of natural alternatives. It calls for consumer education to drive demand for truly plastic-free products (Level 5).

Sun et al. [39] reflected on the development of the Chinese medical cosmetology industry, discussing the rapid growth of aesthetic procedures and the associated environmental challenges. The article noted that the surge in popularity of non-surgical procedures in China has led to a massive increase in medical waste, including plastic syringes and vials. It discussed emerging Chinese regulations on medical waste management and the potential for adopting green clinic standards. The authors emphasize that as the world’s largest aesthetic market, China’s adoption of sustainable practices will have global environmental significance (Level 5).

Saha et al. [40] reviewed microplastic and dermatological care, focusing on the intersection of environmental pollution and skin disease. The article discussed how environmental microplastics act as carriers for contact allergens and pathogens. It reviewed cases of “plastic dermatoses” where synthetic materials caused granulomatous reactions. The authors emphasized that dermatologists play a key role in identifying and reporting adverse reactions to cosmetic plastics. They recommended that patients with sensitive skin or history of atopy avoid products with extensive lists of synthetic polymers (Level 5).

Gopinath et al. [41] studied the prospects on nano-plastic particles internalization and induction of cellular response in human keratinocytes. This seminal experimental study demonstrated that nanoplastics (polystyrene, 50 nm) are readily taken up by HaCaT keratinocytes via clathrin-dependent endocytosis. Following internalization, the particles induced a significant accumulation of reactive oxygen species (ROS), mitochondrial depolarization, and expression of pro-apoptotic proteins. The study provided some of the earliest and strongest in vitro evidence that nanoplastics are not biologically inert on human skin cells but are potent stressors capable of inducing cytotoxicity at high concentrations (Level 5) (Table 1).

The integration of microplastics and nanoplastics into aesthetic medicine products represents a significant environmental and health concern that has gained increasing attention in recent years. This review synthesizes evidence from 2021–2025 examining the sources, mechanisms of action, biological effects, and potential solutions regarding synthetic polymer contamination in cosmetic and aesthetic medical practice. The findings reveal a complex interplay between product efficacy, patient safety, and environmental sustainability that demands urgent attention from practitioners, regulators, and industry stakeholders.

The evidence synthesized in this review establishes microplastics and nanoplastics as significant concerns in aesthetic medicine with demonstrated environmental impacts, cellular toxicity, and potential clinical manifestations. The aesthetic industry’s contribution to plastic pollution is quantitatively substantial and qualitatively problematic given persistence of synthetic polymers in ecosystems and human tissues. Cellular and mechanistic studies provide biological plausibility for dermatological effects including barrier dysfunction, inflammatory responses, and accelerated aging, though definitive clinical evidence remains limited. Viable technological solutions exist enabling transition to biodegradable alternatives without compromising product performance, undermining industry arguments against reformulation. The precautionary principle supports minimizing patient and environmental exposure to persistent synthetic particles while research continues establishing definitive risk profiles. Comprehensive solutions require coordinated action across regulatory agencies, industry stakeholders, healthcare providers, and consumers, with aesthetic medicine practitioners positioned to lead through sustainable practice adoption and patient education initiatives.