Injectable Poly-l-lactic Acid

What is injectable calcium hydroxylapatite?

Injectable poly-l-lactic acid (PLLA) is known commercially as Sculptra and Sculptra Aesthetic. The FDA has approved Sculptra since 2004 to treat lipoatrophy (thinning of the fat pads on the face) associated with the HIV virus. Sculptra Aesthetic received its FDA approval in 2009 for improving the appearance of nasolabial folds contour changes and other facial wrinkles.

As we age, the fat, muscles, bone, and skin in our face begins to thin. This loss of volume leads to either a sunken or sagging appearance of the face. Injectable poly-l-lactic acid is used to create structure, framework, and volume to the face. PLLA is known as a bio-stimulatory dermal filler, this means it stimulates your own skin to produce new collagen. Over time your skin breaks down PLLA into water and carbon dioxide. The effects of PLLA appear gradually over a few months, producing natural results.

Before (left) and after (right) - Sculptra to full face

Photo courtesy of B. Fitzgerald

Before (left) and after (right) - Sculptra to full face

Photo courtesy of B. Fitzgerald

Before and after Sculptra progression

Photo courtesy of C Burgess

Before (left) and after (right)

Photo courtesy of K. Butterwick

What should first be done before considering injectable poly-l-lactic acid?

First, an ASDS dermatologist will review the patient’s medical history and examine the condition to be treated. Areas to be treated should be kept clean. If there is a skin infection, then treatment needs to be postponed until it resolves. Patients who take blood thinners (such as aspirin, ibuprofen, certain herbal medications) should stop them two weeks prior to injection with the approval of their prescribing doctor.

Your doctor will evaluate the areas of your face needing improvement in structure and/or volume. Topical or injection numbing medication may be used for added comfort prior to your procedure. For additional patient comfort lidocaine, an anesthetic, is mixed with PLLA prior to the treatment. Using a syringe, poly-l-lactic acid is injected into the hollow areas of your face and/or areas requiring improved structure. Multiple treatment sessions with PLLA are needed which are often spaced at one month intervals. The effects of PLLA typically last up to 24 months. After that, additional injections are required to maintain the effect.

 

Before (left) and after (right) Sculptra to full face, Botox to glabella, Juvederm to lower lip and chin.

Photo courtesy of B. Fitzgerald

Before (left) and after (right) Sculptra to full face and Botox to masseters

Photo courtesy of B. Fitzgerald

Before (left) and 6 months after (right) 2 sessions of Sculptra.

Photo courtesy of C Burgess

Before (left) and after (right) - 4 months of Sculptra

Photo courtesy of S. Fabi

Before (left) and after (right) Sculptra.

Photo courtesy of C Burgess

Who is not a candidate for poly-l-lactic acid?
PLLA is not recommended for patients who have:

  •     Current oral herpes or a similar infection
  •     Uncontrolled diabetes
  •     Blood-clotting problems
  •     Lupus or other connective tissue disorders
  •     Allergy to any components of Sculptra Aesthetic
  •     Patients whom are pregnant or breast-feeding

Where is injectable poly-l-lactic acid not appropriate?

  •     Lips augmentation
  •     Close to the eyes
  •     Fine lines around the mouth

Is injectable poly-l-lactic acid painful?

Topical numbing agents or anesthetic injections are sometimes applied to ease discomfort. Also, lidocaine is commonly added to PLLA for improved patient comfort. Before and following treatment, ice may be given to ease discomfort and swelling. Patients are encourage to massage the treatment areas for the first 5 days, 5 times a day, for 5 minutes each. We call this the 5-5-5 rule.

 

Uncommon side effects include:

  • Numbness
  • Allergic reactions
  • Infection
  • Blisters and cyst;
  • Inflammatory reactions
  • Migration of filler material to another site
  • Vascular occlusion
  • Scarring
  • Blindness

What are the complications or potential side effects of injectable poly-l-lactic acid?

Common side effects include:

  • Swelling
  • Bruising
  • Bleeding
  • Lumps and bumps
  • Redness 

What can I expect after having had PLLA?

PLLA fillers are temporary, lasting up to two years, depending on the patient. Most patients require maintenance treatments to achieve the best results.