Satisfying Patient Expectations With Poly-L-Lactic Acid Soft Tissue Augmentation
April 2014 | Volume 13 | Issue 4 | Supplement | s40 | Copyright © 2014
Danny Vleggaar MD,a Rebecca Fitzgerald MD,b and Z. Paul Lorenc MD FACSc
aHead of Cosmetic Dermatology in Private Practice, Geneva, Switzerland
bDepartment of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA
cLorenc Aesthetic Plastic Surgery Center, New York, NY, USA
Patient interest and physician use of soft tissue augmentation have increased significantly in recent years, especially among
younger patients. A recent consumer survey conducted on behalf of the American Society of Plastic Surgeons found that the
majority of respondents would rather have a facial injectable treatment than a surgical treatment. In another recent survey, consumers
gave the highest overall satisfaction ratings to injectable filler treatments (92%), including poly-L-lactic acid (PLLA), and
injectable wrinkle relaxers (92%), with injectable fillers receiving the highest "extremely satisfied" rating (45%). Long-lasting benefit
is a desirable attribute in soft tissue augmentation, making PLLA a favorable alternative for many patients. When considering
the use of PLLA, clinicians should ensure that their patients understand its benefit profile, and that these benefits are consistent
with the patients’ cosmetic goals. The implementation of the latest recommendations on methodological approaches in the use
of PLLA will minimize the occurrence of adverse events, further enhancing patient satisfaction.
J Drugs Dermatol. 2014;13(suppl 4):s40-s43.
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There has been significant growth in both patient interest and physician use of soft tissue augmentation in recent years, especially among younger patients. Patients’ motivation behind this increased interest is complex. Studies using digitally enhanced photographs1 and those conducted using botulinum toxin type A injections2 have shown that improvement in facial appearance increases overall attractiveness, reduces perceived age by up to 5 years,2,3 and promotes a positive effect on mood4 and self-esteem.5
A 2006 Harris Interactive Survey involving nearly 800 women aged 35 to 69 years, conducted on behalf of the American Society of Plastic Surgeons, found that the reasons women consider cosmetic interventions include: looking younger, improving intimate relationships, and increasing their confidence.6 Sixty- three percent of the respondents reported that they would much rather have a facial injectable treatment than a surgical treatment. The facial signs of aging that women are most likely to be very concerned or extremely concerned about are wrinkles (44%) and sagging skin (41%).6
Recently, the first ever American Society for Dermatologic Surgery (ASDS) Consumer Survey on Cosmetic Dermatologic Procedures solicited feedback from over 6,300 consumers.7 While 6.4% of those surveyed had previously had a cosmetic treatment, 53% said they were considering injectable fillers in the future.7,8 Consumers gave the highest overall satisfaction ratings to injectable filler treatments (92%), including poly-L-lactic acid (PLLA), and injectable wrinkle relaxers (92%),9 with injectable fillers receiving the highest “extremely satisfied” rating (45%).7
Another study conducted by the ASDS found that among women considering using medical anti-aging treatments, 89% and 75% would prefer gradual results lasting 2 years, compared with immediate results lasting 6 months or 1 year, respectively (Figure 1).10 It is interesting to note that long-lasting effects were more important than cost as a factor in treatment decisions, particularly among women who had already used an injectable product.10
To optimize outcomes, cosmetic treatment must be tailored for each patient; communication is thus paramount. Clinicians need to understand their patients’ treatment goals, including areas for correction and the desired timeframe for cosmetic benefit.11 The cosmetic deficits of patients considered for PLLA should match its benefit profile of increased soft tissue volume. If PLLA is agreed upon, patients should be educated on the nature of their underlying deficits (eg, volume depletion), the gradual onset of cosmetic improvement, the need for multiple sessions, and the long-lasting benefits of the approach.11 Clinicians should also take measures to minimize the occurrence of adverse events, such as nodule formation, through the implementation of the latest recommendations on methodological approaches.11,12
There is a growing trend in the use of injectable dermal fillers for soft tissue augmentation in patients 35 to 50 years of age (Figure 2)11; in fact, in 2012, about 75% of respondents receiving