Guidelines for Using Poly-L-Lactic Acid (PLLA) in Medical Procedures
Poly-L-Lactic acid (PLLA) should be used as a biodegradable volumizer for facial and body rejuvenation, with proper reconstitution techniques and appropriate patient selection to minimize adverse events such as nodule formation. 1, 2
Overview of PLLA
PLLA is a biocompatible, biodegradable synthetic polymer that functions as a collagen biostimulator. It works by gradually increasing facial volume through the endogenous production of fibroblasts and collagen, enabling global facial rejuvenation that can be tailored over time 3.
Approved Indications
- FDA-approved for correction of HIV-related facial lipoatrophy in the United States
- Approved for cosmetic purposes in several countries 3
- Used for volume restoration in HIV-negative patients seeking cosmetic treatment 2
Preparation and Administration
Reconstitution
- Traditionally recommended to be reconstituted 72 hours before treatment
- Recent evidence supports immediate reconstitution before use with similar safety profile 4
- Proper reconstitution is critical for optimal outcomes and minimizing adverse events 3
Concentration Guidelines
Based on treatment area 4:
- Face: Mean concentration of 15.30 mg/mL
- Body: Mean concentration of 8.35 mg/mL
- Scars: Mean concentration of 10.53 mg/mL
Administration Techniques
- Most injections are administered with a blunt cannula (87.3% for face, 100% for body) 4
- For acne scars, PLLA can be administered serially into individual scars and depressions 5
- For scar treatment, PLLA may be applied topically after fractional treatment in addition to injection 4
Treatment Areas
PLLA has been successfully used for:
- Facial volumization (cheeks, nasolabial folds, temples) 2, 3
- Hand rejuvenation 2
- Body contouring 4
- Acne scar treatment 5
- General scar improvement 4
Expected Outcomes
- Substantial increases in dermal thickness can last for up to 2 years 3
- Gradual improvement with multiple treatment sessions (optimal results often seen after 5+ treatments) 2
- Patient satisfaction rates: 55% reporting good to excellent correction overall, with 75% satisfaction in patients receiving five or more treatments 2
Adverse Events and Management
Common Adverse Events
- Nodule formation (8.5% overall incidence) 2
- Highest in hands (12.5%)
- Cheeks (7.2%)
- Most nodules are palpable but not visible
- Bruising (6.57% for face, 7.69% for body) 4
- Mild pain (3.07% for face) 4
Management of Complications
- Nodules may resolve with saline injections 4
- Most adverse events are mild and self-limiting, requiring no intervention 4
Patient Selection and Considerations
- Suitable for patients seeking correction of volume loss due to aging 2
- Appropriate for both HIV-positive and HIV-negative patients 2, 3
- Patients should be informed about:
- Gradual nature of results
- Need for multiple treatment sessions
- Possible adverse reactions during treatment course 2
Special Considerations
- When using PLLA for lateral ridge augmentation in dental procedures, it can be combined with tenting screws for space maintenance 1
- For synthetic absorbable membranes in guided bone regeneration, PLLA membranes have shown excellent preservation of bone dimensions 1
Clinical Pearls
- Patient education about the gradual nature of results is essential for satisfaction
- Multiple treatment sessions are typically required for optimal outcomes
- Proper technique and reconstitution significantly reduce the risk of adverse events
- Regular follow-up allows for assessment and adjustment of treatment plans
PLLA represents an effective option for patients seeking gradual, natural-looking volume restoration with long-lasting results when administered with proper technique and patient selection.