The Use of Poly-l-Lactic Acid Filler in Facial Aesthetics

ABSTRACT

The use of poly-l-lactic acid in facial aesthetic surgery has been utilized for over a decade. More recently approved by the Food and Drug Administration as a stimulatory filler for the correction of shallow to deep facial lines, it is gaining popularity in the United States. The advantages of its use include its stimulatory action on collagen formation, the longevity of its effect, and the low side effect profile. Despite these advantages, meticulous preparation practices and injection techniques are paramount to achieving a satisfactory outcome. We review poly-l-lactic acid as a filler, along with its associated side effects, indications of use, and techniques of injection.

KEYWORDS

Poly-l-lactic acid - Sculptra - facial aesthetics - review

REFERENCES

• 1 Kulkarni R K, Pani K C, Neuman C, Leonard F. Polylactic acid for surgical implants.  Arch Surg. 1966;  93 839-843
• 2 Heffelfinger R N, Blackwell K E, Rawnsley J, Keller G S. A simplified approach to midface aging.  Arch Facial Plast Surg. 2007;  9 48-55
• 3 Spenlehauer G, Veillard M, Benoît J P. Formation and characterization of cisplatin loaded poly(D,L-lactide) microspheres for chemoembolization.  J Pharm Sci. 1986;  75 750-755
• 4 Vleggaar D, Bauer U. Facial enhancement and the European experience with Sculptra (poly-L-lactic acid).  J Drugs Dermatol. 2004;  3 542-547
• 5 Conley J. Cheiloplasty in the treatment of facial paralysis.  Laryngoscope. 1986;  96 140-145
• 6 Lowe N J. Optimizing poly-l-lactic acid use.  J Cosmet Laser Ther. 2008;  10 43-46
• 7 Gogolewski S, Jovanovic M, Perren S M, Dillon J G, Hughes M K. Tissue response and in vivo degradation of selected polyhydroxyacids: polylactides (PLA), poly(3-hydroxybutyrate) (PHB), and poly(3-hydroxybutyrate-co-3-hydroxyvalerate) (PHB/VA).  J Biomed Mater Res. 1993;  27 1135-1148
• 8 Moyle G J, Lysakova L, Brown S et al.. A randomized open-label study of immediate versus delayed polylactic acid injections for the cosmetic management of facial lipoatrophy in persons with HIV infection.  HIV Med. 2004;  5 82-87
• 9 Engelhard P, Humble G, Mest D. Safety of Sculptra: a review of clinical trial data.  J Cosmet Laser Ther. 2005;  7 201-205
• 10 Bos R R, Rozema F R, Boering G et al.. Degradation of and tissue reaction to biodegradable poly(L-lactide) for use as internal fixation of fractures: a study in rats.  Biomaterials. 1991;  12 32-36
• 11 Brady J M, Cutright D E, Miller R A, Barristone G C. Resorption rate, route, route of elimination, and ultrastructure of the implant site of polylactic acid in the abdominal wall of the rat.  J Biomed Mater Res. 1973;  7 155-166
• 12 Cutright D E, Perez B, Beasley III J D, Larson W J, Posey W R. Degradation rates of polymers and copolymers of polylactic and polyglycolic acids.  Oral Surg Oral Med Oral Pathol. 1974;  37 142-152
• 13 Salles A G, Lotierzo P H, Gimenez R, Camargo C P, Ferreira M C. Evaluation of the poly-L-lactic acid implant for treatment of the nasolabial fold: 3-year follow-up evaluation.  Aesthetic Plast Surg. 2008;  32 753-756
• 14 Vleggaar D. Soft-tissue augmentation and the role of poly-l-lactic acid.  Plast Reconstr Surg. 2006;  118 (3, Suppl) 46S-54S
• 15 Burgess C M. Treatment of facial asymmetry with poly-l-lactic acid: a case study.  Aesthetic Plast Surg. 2008;  32 552-554
• 16 Valantin M A, Aubron-Olivier C, Ghosn J et al.. Polylactic acid implants (New-Fill) to correct facial lipoatrophy in HIV-infected patients: results of the open-label study VEGA.  AIDS. 2003;  17 2471-2477
• 17 Carr A, Emery S, Law M, Puls R, Lundgren J D, Powderly W G. HIV Lipodystrophy Case Definition Study Group . An objective case definition of lipodystrophy in HIV-infected adults: a case-control study.  Lancet. 2003;  361 726-735
• 18 Mest D R, Humble G. Safety and efficacy of intradermal poly-l-lactic acid (Sculptra) injections in patients with HIV-associated facial lipoatrophy.  Antivir Ther. 2004;  9 L36
• 19 Sculptra package insert. Berwyn, PA: Dermik Laboratories;
• 20 Sadick N S, Palmisano L. Case study involving use of injectable poly-l-lactic acid (PLLA) for acne scars.  J Dermatolog Treat. 2009;  20 302-307
• 21 Beer K. A single-center, open-label study on the use of injectable poly-l-lactic acid for the treatment of moderate to severe scarring from acne or varicella.  Dermatol Surg. 2007;  33 (Suppl 2) S159-S167
• 22 Narins R S. Minimizing adverse events associated with poly-l-lactic acid injection.  Dermatol Surg. 2008;  34 (Suppl 1) S100-S104
• 23 Lam S M, Azizzadeh B, Graivier M. Injectable poly-l-lactic acid (Sculptra): technical considerations in soft-tissue contouring.  Plast Reconstr Surg. 2006;  118 (3, Suppl) 55S-63S
• 24 Lacombe V. Sculptra: a stimulatory filler.  Facial Plast Surg. 2009;  25 95-99
• 25 Fitzgerald R, Graivier M H, Kane M et al.. Appropriate selection and application of nonsurgical facial rejuvenation agents and procedures: panel consensus recommendations.  Aesthet Surg J. 2010;  30 (1, Suppl) 36S-45S