Gary Goldenberg, MD
Dr. Goldenberg is Assistant Professor, Department of Dermatology, Mount Sinai School of Medicine, New York, New York, and Medical Director of the Dermatology Faculty Practice, New York (http://www.goldenbergdermatology.com).
Dr. Goldenberg reports no conflicts of interest in relation to this post.
A review published in the Aesthetic Surgery Journal (2011;31:95-109) highlighted the use of poly-L-lactic acid (PLLA)(Sculptra Aesthetic, Valeant Aesthetics, a division of Valeant Pharmaceuticals North America) for nonsurgical rejuvenation of the aging face and restoration of facial volume. The nonsurgical, or liquid, facelift has become increasingly popular and use of PLLA is one of the cornerstones of this procedure. Poly-L-lactic acid differs from other injectable “fillers” in that instead of simply filling the creases and lines, it stimulates local collagen production, creating a 3-dimensional change. It is hydrolyzed into lactic acid monomers in the skin and produces a localized inflammatory reaction, which in turn results in increased collagen deposition by fibroblasts.
In this study, 106 patients received 1.6 vials of PLLA per session with an average of 2.3 sessions for volume restoration in the tear trough, midface, malar region, nasolabial folds, prejowl area, mandibular border, and mandibular angle. The authors reported 100% follow-up with 99.1% patient satisfaction. The rate of nodule formation was 4.7% at a minimum follow-up of 2 years.
What’s the issue?
Although this study was published more than a year ago, it remains one of the largest studies of PLLA injections for nonsurgical facial rejuvenation and volume corrections. The dilution technique used by the authors was 6 mL of sterile water and 2 to 4 mL of 2% plain lidocaine. Decreased nodule formation was noted, presumably due to increased hydration of the product. What is your dilution technique? The authors recommended subdermal plane injection, though the manufacturer recommends the intradermal injection technique (Sculptra Aesthetic [package insert]. Bridgewater, NJ: Valeant Pharmaceuticals North America; 2012). A combination of the lattice, fanning, tunneling, and depot techniques was used. I prefer tunneling and depot techniques. Which injection technique do you use?