INTRODUCTION
The aging process is complex, influenced by a dynamic interplay of external (lifestyle and environment) and internal (genetics) factors. Changes such as bone resorption, fat pad depletion, muscle atrophy, and changes in skin tone, color, and texture transform a youthful appearance into one characterized by aging-related changes.1 Notably, volume loss in the temples is an early sign of aging, which contributes to the lowering of the eyelid and eyebrow, skin laxity in the periorbital and cheek areas, and changes to the overall shape of the face.2,3 Currently, the use of injectable soft tissue fillers and neurotoxins for correcting facial changes associated with aging is the cornerstone for restoring soft tissue loss in aesthetic medicine. Together with energy-based devices and a consistent skincare regimen, patients can achieve natural, longlasting facial rejuvenation, reverse the signs of aging without the need for surgery, associated downtime, or significant health risks.4
While some fillers like hyaluronic acid provide instant volumization at the injection site, they gradually degrade over time and require future injections for volume maintenance. In contrast, poly-l-lactic acid (PLLA) fillers are biostimulatory; they activate resident fibroblasts to produce autologous collagen over time, leading to a more natural and long-lasting effect. The mechanism through which PLLA stimulates neocollagenesis is by triggering a foreign body reaction to the injected material, succeeded by a cellular inflammatory response which leads to the formation of vascularized, connective tissue.5,6 PLLA is then hydrolyzed into lactate, converted to pyruvate, and oxidized into carbon dioxide.7,8 While the inflammatory response subsides in 6 months, the extracellular matrix production continues, leading to a gradual increase in dermal thickness that may last up to 2 years in some patients.5,9
PLLA was first approved as Sculptra® in 2004 by the Food and Drug Administration (FDA) for the treatment of HIV-associated lipoatrophy, and later as Sculptra® Aesthetic in 2009 for the correction of shallow to deep nasolabial folds and other facial wrinkles in healthy patients.10,11 It is distinguished as the only FDA-approved PLLA facial injectable that stimulates the skin’s own collagen production to smooth facial wrinkles. Common side effects include localized swelling, tenderness, redness, itching, and bruising, which typically resolve within 1-7 days. Occurrence of nodules and papules several months after injection has also been reported, but can be prevented with appropriate product dilution, injection depth, and post-injection massage.12-15
Given the benefits and low risk associated with Sculptra, the objective of this study was to evaluate the effectiveness of PLLA injections in the temple area for restoring temporal and midface volume through dual plane injections.
While some fillers like hyaluronic acid provide instant volumization at the injection site, they gradually degrade over time and require future injections for volume maintenance. In contrast, poly-l-lactic acid (PLLA) fillers are biostimulatory; they activate resident fibroblasts to produce autologous collagen over time, leading to a more natural and long-lasting effect. The mechanism through which PLLA stimulates neocollagenesis is by triggering a foreign body reaction to the injected material, succeeded by a cellular inflammatory response which leads to the formation of vascularized, connective tissue.5,6 PLLA is then hydrolyzed into lactate, converted to pyruvate, and oxidized into carbon dioxide.7,8 While the inflammatory response subsides in 6 months, the extracellular matrix production continues, leading to a gradual increase in dermal thickness that may last up to 2 years in some patients.5,9
PLLA was first approved as Sculptra® in 2004 by the Food and Drug Administration (FDA) for the treatment of HIV-associated lipoatrophy, and later as Sculptra® Aesthetic in 2009 for the correction of shallow to deep nasolabial folds and other facial wrinkles in healthy patients.10,11 It is distinguished as the only FDA-approved PLLA facial injectable that stimulates the skin’s own collagen production to smooth facial wrinkles. Common side effects include localized swelling, tenderness, redness, itching, and bruising, which typically resolve within 1-7 days. Occurrence of nodules and papules several months after injection has also been reported, but can be prevented with appropriate product dilution, injection depth, and post-injection massage.12-15
Given the benefits and low risk associated with Sculptra, the objective of this study was to evaluate the effectiveness of PLLA injections in the temple area for restoring temporal and midface volume through dual plane injections.
