Abstract
Since its approval for cosmetic use, injectable poly-l-lactic acid (PLLA) has become increasingly the choice for restoring a youthful appearance to the aging face. This minimally invasive procedure involves the creation of long-lasting volume in the region where it is reinjected without treating the wrinkle itself. However, due to the side effects which can ensue from the improper application of the product, it is essential that physicians follow consensus recommendations to obtain optimal patient results. The present article provides an overview of the history and instructions for injecting PLLA and specifically focuses on its use for facial volumization. Based on the large body of medical evidence available and 11 years’ clinical experience, the author also provides details for preparing, injecting, and reinjecting the product, using retrograde linear threading and depot injection techniques as well as a treatment plan with effective results avoiding complications and side effects.
Abstract
Aging is a complex process that takes place through interdependent changes in the tissues of the face. These changes are gradual and can be seen in the skin, muscle, fat compartments, and bone structures that lead to the overall appearance of facial aging (Fitzgerald and Vleggaar 2011).
References
American Society of Plastic Surgeons. Perception of injection: ASPS survey reveals women confused but drawn to facial injectables. A Harris Interactive Survey (press release). Arlington Heights: American Society of Plastic Surgeons; 2006.
ASDS survey: 3 in 10 consumers considering cosmetic procedures. American Society for Dermatologic Surgery. Available at: http://www.asds.net/_Media.asps?id=7204. Accessed 30 Jan 2014a.
ASDS survey: Consumers rate soft-tissues treatments tops: choose dermatologic surgeons most often. American Society for Dermatologic Surgery. Available at: http://www.asds.net/_Media.aspx?id=7304. Accessed 30 Jan 2014b.
Bartus C, Hanke CW, Daro-Kaftan E. A decate of experience with injectable poly-l-lactic acid: a focus on safety. Dermatol Surg. 2013;39(5):698–705.
Brown SA, Rohrich RJ, Baumann L, Brandt FS, Fagien S, Glazer S, Kenkel JM, Lowe NJ, Monheit GD, Narins RS, Rendon MI, Werschler WP. Subject global evaluation and subject satisfaction using injectable poly-l-lactic acid versus human collagen for the correction of nasolabial fold wrinkles. Plast Reconstr Surg. 2011;127(4):1684–92.
Fitzgerald R, Vleggaar D. Facial volume restoration of the aging face with poly-l-lactic acid. Dermatol Therapy. 2011;24:2–27.
Guardiani E, Davison SP. Angioedema after treatment with injectable poly-l-lactic acid (Sculptra). Plast Reconstr Surg. 2012;129(1):187e–9e. https://doi.org/10.1097/PRS.0b013e3182365e58.
Lemperle G, Gauthier-Hazan N, Wolters M. Foreign body granulomas after all injectable dermal fillers: part I. Possible causes. Plast Reconstr Surg. 2009;123(6):1842–63.
Lowe NJ. Dispelling the myth: appropriate use of poly-l-lactic acid and clinical considerations. J Eur Acad Dermatol Venereol. 2006;20(Suppl 1):s2–6.
Mest DR, Humble G. Safety and efficacy of poly-l-lactic acid injections in persons with HIV-associated lipoatrophy: the US experience. Dermatol Surg. 2006;32(11):1336–45.
Moyle GJ, Lysakova L, Brown S, Sibtain N, Healy J, Priest C, Mandalia S, Barton SE. A randomized open-label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection. HIV Med. 2004;5(2):82–4.
Narins SR, Rotunda AD. Poly-l-lactic acid: a new dimension in soft tissue augmentation. Dermatol Ther. 2006;19:151–8.
Sadick NS. Poly-l-lactic acid: a perspective from my practice. J Cosmet Dermatol. 2008;7(1):55–60.
Sculptra. ®Aesthetic (prescribing information). Bridgewater: Dermik Laboratories; 2009.
Valantin MA, Aubron-Olivier C, Ghosn J, et al. Polylactic acid implants (New-Fill) to correct facial lipoatrophy in HIV-infectd patients: result of the open-label study VEGA. AIDS. 2003;17:2471–7.
Van Putten SM, Ploeger DT, Popa ER, Bank RA. Macrophage phenotypes in the collagen-induced body raction in rats. Acta Biomater. 2013;9(5): 6502–6510. https://doi.org/10.1016/j.act-bio.2013.01.022. Epub 2013 Jan 29.
Vleggaar D. Poly-l-lactic acid: consultation on the injection techniques. J Eur Acad Dermatol Venereol. 2006;20(Suppl 1):17–21.
Vleggaar D, Fitzgerald R, Lorenc ZP. Satisfying patient expectations with poly-l-lactic acid soft tissue augmentation. J Drugs Dermatol. 2014a;13(Suppl 4):s40–3.
Vleggaar D, Fitzgerald R, Lorenc ZP. Understanding, avoiding and treating potential adverse events following the use of injectable poly-l-lactic acid for facial and nonfacial volumization. J Drugs Dermatol. 2014b;13(Suppl 4):s35–9.
Vleggaar D, Fitzgerald R, Lorenc ZP, Andrews TJ, Butterwick K, Comstock J, Hanke CW, O’Daniel G, Palm MD, Roberts WE, Sadick N. TellerCF. Consensus Recommendations on the use of injectable poly-l-lactic acid for facial and nonfacial volumization. J Drugs Dermatol. 2014c;13(Suppl 4):s44–51.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Switzerland AG
About this entry
Cite this entry
Sandoval, M.H.L. (2019). Poly-l-Lactic Acid for Facial Treatment. In: Issa, M., Tamura, B. (eds) Botulinum Toxins, Fillers and Related Substances. Clinical Approaches and Procedures in Cosmetic Dermatology. Springer, Cham. https://doi.org/10.1007/978-3-319-20253-2_28-3
Download citation
DOI: https://doi.org/10.1007/978-3-319-20253-2_28-3
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-20253-2
Online ISBN: 978-3-319-20253-2
eBook Packages: Springer Reference MedicineReference Module Medicine
Publish with us
Chapter history
-
Latest
-Lactic Acid for Facial Treatment- Published:
- 31 December 2018
DOI: https://doi.org/10.1007/978-3-319-20253-2_28-3
-
-Lactic Acid for Facial Treatment
- Published:
- 17 May 2017
DOI: https://doi.org/10.1007/978-3-319-20253-2_28-2
-
Original
-Lactic Acid for Facial Volumization- Published:
- 01 February 2017
DOI: https://doi.org/10.1007/978-3-319-20253-2_28-1