DGS averaged 7.6 (range, 6.3-8.4 depending on area treated),
with average patient satisfaction scores higher than those of
physicians (Figure 3).15 The most favorable results were achieved
from treatments to the cheekbones and malar areas.15
In a retrospective survey, 130 respondents who received PLLA
for cosmetic enhancement across a 5-year period rated the results
of their treatment.16 Although not stratified by duration
since treatment, 55% of patients overall indicated that they had
“good†or “excellent†correction of their cosmetic issues. Patient
assessment correlated roughly to the number of treatment sessions,
with 75% of patients having 5 or more sessions reporting
at least “good†correction.16 In another retrospective survey with
40 respondents who had been treated with PLLA for facial atrophy,
80% of patients were satisfied with their cosmetic outcome
(P=.0001) in relation to their expectations prior to treatment.17
In a study that included both non-HIV (n=38) and HIV (n=27)
patients, satisfaction with PLLA was assessed on a 5-point
scale.18 Ninety-one percent of patients overall, and 89.5% of the
non-HIV patients seeking cosmetic enhancement, were “very
satisfied†with their treatment at study end. In a 3-year followup
investigation, satisfaction with PLLA proved durable; 86% of
non-HIV patients (n=35) remained “very satisfied†or “somewhat
satisfied†with the results of their treatment.19
A small study investigated the satisfaction of women treated
with PLLA for sunken nasolabial folds.20 Each patient received 1
injection per month for 3 consecutive months. Patient satisfaction
was assessed on a 4-point scale at each application, at 6
months, and 36 months after treatment. After 6 months, 60% of patients initially indicated that they were “satisfied†or “very
satisfied†with the results, but this increased to 80% when
the patients were shown the clinical photographs of their improvement.
Even 3 years after their injections, 60% of patients
remained at least “satisfied.â€20
In a study in which 36 patients with varying degrees of cutaneous
aging in the neck and chest (presternal area) were treated
with PLLA, 92% indicated that they were pleased with the results
and would choose to do it again.21 Those patients treated
in the presternal region reported optimal improvement and
high satisfaction.21
SUMMARY
Patients seek cosmetic enhancement for a number of reasons
and soft tissue augmentation is increasingly viewed as an
attractive option, especially among younger patients. Longlasting
benefit is a desirable attribute, making PLLA a favorable
alternative for many patients. A high level of patient satisfaction
with PLLA has been established in a rigorous series of
clinical studies and surveys.
To improve the likelihood of satisfaction with PLLA treatment
for individual patients, it is important for clinicians to select
patients appropriately, have a firm grasp on their cosmetic
goals, and calibrate their expectations regarding its benefit
profile.12 Clinicians should take every measure to minimize adverse
events, and for those with little prior PLLA experience,
selection of a younger patient with a less complex array of
cosmetic deficits may enhance patient satisfaction, as well as
afford clinicians the opportunity to increase their experience
and comfort level.
DISCLOSURES
Danny Vleggaar MD has been a medical consultant for Sinclair
IS Pharma, France; PharmaSwiss SA, Switzerland; Valeant
Eastern Europe; and Cutanea Life Sciences, Inc. He also has
been a trainer for Valeant Pharmaceuticals International, Inc./
Medicis Corporation.
Rebecca Fitzgerald MD has been a consultant and speaker for
Valeant Pharmaceuticals North America LLC/Medicis Corporation;
Merz Aesthetic, Inc; and Allergan USA, Inc.
Z. Paul Lorenc MD has been a consultant for Johnson & Johnson;
La Lumiere, LLC; Medicis Corporation; Merz Corporation;
and Mentor Corporation. In addition, he holds the following
