Consensus Recommendations on the Use of Injectable Poly-L-Lactic Acid for Facial and Nonfacial Volumization

April 2014 | Volume 13 | Issue 4 | Supplement Individual Articles | 44 | Copyright © April 2014


Danny Vleggaar MD,a Rebecca Fitzgerald MD,b Z. Paul Lorenc MD FACS,c J. Todd Andrews MD,d Kimberly Butterwick MD,e Jody Comstock MD,f C. William Hanke MD,g T. Gerald O’Daniel MD FACS,h Melanie D. Palm MD MBA,i Wendy E. Roberts MD,j Neil Sadick MD,k and Craig F. Teller MDl

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
dRiver Oaks, 3355 West Alabama, Houston, TX, USA
eDermatology/Cosmetic Laser Associates of La Jolla Inc., La Jolla, CA, USA
fSkin Spectrum, Tucson, AZ, USA
gDepartment of Dermatology, Saint Vincent Carmel Medical Center, Laser & Skin Surgery Center of Indiana, Carmel, IN, USA
h222 S. First Street, Louisville, KY, USA
iArt of Skin MD, Solana Beach, CA, USA
j35-280 Bob Hope Drive, Rancho Mirage, CA, USA
kSadick Dermatology, New York, NY, USA
lBellaire Dermatology Associates, 6565 W. Loop S, Bellaire, TX, USA

  • A uniform distribution of product should be ensured for each treated region (ie, coat the region); injection should not vary by particular focal areas or based on specific cosmetic deficits.
  • The final volumetric correction is determined by the number of treatment sessions.
  • Treatment can continue until the patient is satisfied with the results.
    • Most experts find 3–5 sessions to be optimal.
    • Younger or fuller faces need less product and fewer sessions.
  • An interval of at least 4 weeks between sessions is recommended.
  • Subsequent courses of treatment (ie, “top-up” courses) typically occur 2 years after the initial course.
    • During these courses, less PLLA per session, and a fewer number of sessions, are generally required.
    • Some patients prefer once-a-year, single-session maintenance treatments to keep pace with the aging process.
    • Post-treatment Massage
  • Although data to support post-treatment massage are limited, massaging the injected area for a few minutes after treatment is recommended.
  • Continued self-massage by patients may be left to the discretion of the treating physician.

    • SUMMARY

    These recommendations are consistent with the authors’ perspectives on “best practices” with the use of PLLA for soft tissue augmentation. It is our hope that these recommendations will both increase clinicians’ confidence in the use of this agent and lead to predictable, consistent, and favorable outcomes across the range of patients seeking cosmetic enhancement.

    Facial Volumization With Poly-L-Lactic Acid: Representative Results

    Due to an increasing societal emphasis on the importance of a youthful appearance, as well as the development of new treatment options, there is a rising consumer demand for procedures that can reverse the signs of aging. For many patients with facial volume loss, poly-L-lactic acid (PLLA) is an excellent treatment choice. Its mechanism of action results in cosmetic effects that have a gradual onset and last 2 years or more, which is well-matched with reported patient preference for durable benefits. Refined PLLA methodology, along with a better understanding of the structures in the aging face and how they interrelate, now allows for favorable and predictable results across a range of patient types.31
    In the above consensus recommendations, we detail procedures for the proper administration and aftercare of PLLA including: careful patient selection and education, proper preparation and storage, optimal injection techniques, and after- injection massage. Here, we provide some representative before-and-after photographs of several of our patients, which illustrate how the implementation of these recommendations during PLLA soft tissue augmentation can replace lost facial volume and sustain this restoration.
    Figure 2 shows a 34-year-old patient before and after her PLLA therapy, with injected areas indicated. Figure 3 demonstrates the progression of PLLA enhancement in a 38-year-old female patient at 6 months and 1 year after beginning therapy. In Figure 4, a 30-year-old female patient is shown at baseline, 2 months, and 2 years after PLLA therapy was initiated. In this patient, PLLA was injected in the supraperiosteal space to enhance the jaw line.
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