Techniques for the Optimization of Facial and Nonfacial Volumization with Injectable Poly-L-lactic Acid

Lorenc Aesthetic Plastic Surgery Center, 983 Park Avenue, New York, NY, 10028, USA, .
Aesthetic Plastic Surgery (Impact Factor: 0.96). 08/2012; 36(5). DOI: 10.1007/s00266-012-9920-3
Source: PubMed


With the recognition of the key role of volume loss in the facial aging process, injectable dermal fillers and volumizers have become increasingly important treatment options for recontouring and rejuvenating the aging face. While replacement fillers effectively correct individual lines and wrinkles, volumizing agents that replace collagen provide a longer-lasting, volume-based alternative. Poly-L-lactic acid (PLLA) has been shown to increase dermal thickness and volume for up to 2 years and beyond. Although early clinical use of this agent in patients with HIV-associated facial lipoatrophy was associated with a significant rate of nodule or papule formation, subsequent experience has helped define the proper reconstitution volumes and injection techniques for optimizing results and minimizing nodule/papule formation. While injectable PLLA has been used successfully for rejuvenation of most facial areas, increasing experience suggests that it is a versatile agent capable of providing aesthetic enhancement in multiple areas of the body, including the dorsum of the hands, the décolleté, the neck, the buttocks, the medial ankles, and acne scars. Although the current published experience in these areas is limited, further studies and clinical use of injectable PLLA will clarify the potential of this agent as a minimally invasive alternative and/or adjunct to surgery for restoring volume loss in multiple anatomic areas.

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    ABSTRACT: Reversal of the visible signs of facial aging with the use of injectable products as an alternative to surgery has become more popular, with nearly 5 million procedures performed in the United States in 2012. Volume augmentation products, such as hyaluronic acid (HA), calcium hydroxylapatite (CaHA), and poly-L-lactic acid (PLLA), are often used in combination with one another and with neurotoxins for facial rejuvenation because of the complementary modes of action. This article presents 2 case reports involving patientspecific combinations of 2 different HA products, injectable PLLA, and CaHA with incobotulinumtoxinA or abobotulinumtoxinA. The combination of HA, CaHA, PLLA, and neurotoxins has resulted in outstanding outcomes for many patients, with no clinical evidence of increased adverse events secondary to combination therapy. J Drugs Dermatol. 2014;13(2):191-195.
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    ABSTRACT: Abstract Background: Poly-L-lactic acid (PLLA) is a biocompatible and biodegradable polymer device indicated for correction of facial contour deficiencies, with a gradual onset of effect that is maintained for up to 25 months. PLLA is currently widely used to correct age- related facial volume deficits in Asians. Objectives: We sought to evaluate the safety and long term efficacy of PLLA on treating age-related sunken cheeks in Asians. Patients and Methods: This was a retrospective, single-center study of 11 subjects with age-related sunken cheeks who were treated with 3 sessions of PLLA, and then followed-up for 24 months. A questionnaire was used to evaluate patient satisfaction and the incidence of adverse reactions. Results: Seven female and four male subjects with mild to moderate age-related sunken cheeks were included in the study. The mean age of the subjects was 41.5 (range 25-50). Overall, 90.9% of patients replied that they were either satisfied or very satisfied with the results at 24 months follow-up; 91% of patients rated the volume correction to be good or excellent. Despite the high incidence of bruising (63.7%) and post-treatment nodules (27.3%), all subjects (100%) were willing to undergo the procedure again. Conclusion: PLLA has shown long-lasting effects in reversing age-related sunken cheeks in Asians, with high patient satisfaction. Special consideration should be made to minimize the side effects.
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    ABSTRACT: Purpose As Botox®/filler use has increased in recent years, a growing number of nonaesthetic health professionals have emerged to perform these procedures. Since studies have shown that patients identify training as the most important factor in considering these procedures, this study seeks to summarize the perspective of plastic surgeons regarding these paradigm shifts. Methods In the summer of 2013, an eight-question survey was sent to members of ISAPS, ASAPS, and ASPS (approximately 26,113 plastic surgeons globally). Two questions assessed practice location and membership affiliation and six questions assessed various healthcare practitioners’ capability to administer Botox, fillers, and vaccines (control). Healthcare practitioners included plastic surgeons and dermatologists, gynecologists, dentists, nurses in plastic surgery and dermatology, or nurses in other fields. Results On three e-mail notifications, 14,184 plastic surgeons opened the survey and 882 responded: 36.6 % from North America, 29.1 % from Europe, 12.9 % from South America, 10.1 % from Asia, 4.5 % from the Middle East, 3.4 % from Australia, 1.9 % from Africa, and 1.6 % from Central America. Seventy-seven percent believed nurses were not as capable as plastic surgeons in administering Botox; 81 % felt the same for fillers. Conversely, 84 % agreed that nurses were as capable as plastic surgeons in administering vaccines. Plastic surgeons ranked nurses in other fields (48 %) as most capable in administering vaccines, then plastic surgeons (42 %), nurses of plastic surgeons (9 %), gynecologists (1 %), and dentists (
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