Background: The steady evolution of aesthetic and regenerative medicine has driven a paradigm shift from purely corrective interventions toward biologically oriented therapies focused on tissue remodeling, extracellular matrix modulation, and regenerative optimization. Recent advances in biotechnology and recombinant protein engineering have enabled the development of highly purified enzymes that selectively interact with structural and functional components of the tissue microenvironment. Despite their growing clinical relevance, therapeutic enzymes are still often discussed in isolation, limiting a broader understanding of their shared biological mechanisms and therapeutic potential. Materials and Methods: A narrative review was conducted, integrating evidence from molecular biology, extracellular matrix research, fibrosis, adipose tissue physiology, protein therapeutics, regenerative medicine, and aesthetic medicine. In addition to foundational biological studies, recent clinical and translational investigations involving recombinant hyaluronidases, collagenases, lipases, keratinases, and matrix-targeting lyases were analyzed. Evidence from scar management, post-liposuction fibrosis, localized adiposity, cellulite, facial reshaping, foreign body granulomas, periocular edema associated with hyaluronic acid fillers, and biostimulator-related complications was critically reviewed. Results and Discussion: The available evidence demonstrates that therapeutic enzymes share common biological characteristics, including substrate-specific molecular recognition, catalytic activity, and selective modulation of tissue morphology. Clinical studies have reported improvements in fibrosis, scar quality, cellulite, localized fat deposits, facial contouring, tissue laxity, granulomatous reactions, and filler-related complications. Histological analyses additionally support their capacity to reorganize extracellular matrix structures, reduce fibrosis, improve collagen organization, and restore tissue homeostasis. Unlike conventional therapies that rely primarily on inflammation, cytotoxicity, or mechanical disruption, enzyme-based interventions promote targeted biochemical remodeling through precise substrate interactions. Conclusion: The collective evidence supports the establishment of Enzymatic Bioremodelers as a novel therapeutic category comprising natural or recombinant enzymes that promote selective tissue remodeling using targeted biochemical modulation of the tissue microenvironment. This framework integrates molecular mechanisms with emerging clinical applications, providing a scientifically grounded platform for future developments aesthetic medicine, regenerative medicine, and precision therapeutics.

Abdominal contouring has progressively evolved from isolated fat reduction techniques toward multimodal approaches that simultaneously address adipose tissue, muscular definition, and body composition. This retrospective case series describes preliminary clinical observations in five physically active patients with persistent localized abdominal adiposity despite regular resistance training, adherence to a low-carbohydrate diet, and protein supplementation. All patients underwent a standardized six-month multimodal protocol consisting of two sequential phases. The first phase combined injectable lipolysis using sodium deoxycholate, pentoxifylline, and L-carnitine with ultrasonic cavitation (Mesolipo). The second phase (Abdomen Definition) comprised targeted subcutaneous injections intended to enhance abdominal grooves, intramuscular metabolic support of the rectus abdominis, and neuromuscular electrical stimulation using Russian current. Treatment outcomes were assessed through standardized clinical photography, anthropometric measurements, and multifrequency bioimpedance analysis before and after completion of the protocol. Descriptive pre- and post-treatment comparisons showed reductions in median abdominal circumference from 94 to 88 cm, body fat percentage from 13.7% to 10.3%, fat mass from 11.3 to 8.7 kg, and abdominal skinfold thickness from 22 to 16 mm. Skeletal muscle mass was preserved or increased in most patients, while standardized photographs showed visually apparent changes in abdominal contour and definition, including greater visibility of the rectus abdominis, linea alba, and semilunar lines. In several cases, changes in body composition were observed despite minimal variation or slight increases in total body weight, a pattern compatible with body recomposition rather than weight loss alone. Given the retrospective, uncontrolled design, the small sample size, and the simultaneous use of multiple interventions, these observations cannot establish treatment efficacy or determine the relative contribution of individual protocol components, resistance training, or nutritional habits. Nevertheless, the findings provide preliminary, descriptive, and hypothesisgenerating observations regarding the feasibility of a multimodal approach to abdominal contouring. Prospective controlled studies with larger samples are needed to evaluate efficacy and determine the contribution of individual therapeutic components.