Current concepts in the use of poly-L-lactic acid for facial rejuvenation: literature review and practical aspects

Background All the changes the skin goes through, peaking at flaccidity, occur in the dermis and hypodermis, leading to loss of support and a lower capacity to totally accommodate displacements or any loss of subjacent volume, bringing about the onset of furrows and sagging. Improvements in facial sagging may be obtained with the administrations of substances like poly‐L‐lactic acid (PLLA), which triggers a tissue response through a controlled inflammatory reaction. Objectives Compare the tissue distribution of the particles of PLLA of both products available in Brazil (Sculptra® and Rennova Elleva®) during and immediately after their subdermal administrations, with 22G cannulas, through high‐resolution ultrasound imaging. Methods A total of four patients aged between 18 and 64 years had the inner part of the upper arms divided into eight quadrants and treated with 16 ml of each product, reconstituted to correspond to 9.5 mg/ml. The sites where PLLA was injected were analyzed through the high‐resolution ultrasound during (dynamic imaging) and immediately after the procedures (static imaging). Results During Sculptra® injection, high‐resolution ultrasound revealed that its distribution did not follow the trajectory of the cannula homogeneously. It was characterized by a more hyperechogenic central portion and an anechogenic peripheral portion, forming discrete posterior acoustic shadowing at times. Regarding Rennova ELLEVA® injection, the high‐resolution ultrasound analysis showed a homogeneous distribution of the product across the subcutaneous tissue following the trajectory of the cannula without formation of significant interface with the surrounding tissue, maintaining the sonographic aspect of thinly granulated hyperechogenic deposits, with strong posterior acoustic shadowing during and immediately after its administration. Conclusion Static and dynamic high‐resolution ultrasound imaging show a more homogenous distribution of PLLA particles with the use of Rennova ELLEVA® when compared with Sculptra®, which may induce the formation of capsules and a subsequent more dispersed fibroplasia, with larger area of action and a possible better therapeutic result. The interest of this article lies in its originality, highlighting the differences in the tissue distribution of two different brands of PLLA particles, which can impact the clinical response to the two products ‐ which we are researching and seems to interfere with the increase in dermal thickness.

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“…Gradually, progressively and lastingly, it promotes natural and harmonious results with low risks of adverse effects. 6 …”

Section: Discussionmentioning

confidence: 99%

“…Fibroblasts secrete components of the extracellular matrix, initially type I collagen followed by a smaller production of type III collagen. 5 , 6 …”

Section: Discussionmentioning

confidence: 99%

Static and dynamic high‐resolution ultrasound analysis of tissue distribution of poly‐L‐lactic acid particles during subdermal application in two different presentations

Cunha

Sigrist

2022

Skin Health and Disease

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“…Five years later it was authorized for use in aesthetic treatments, and is currently indicated for the improvement of skin flaccidity, volumetric correction, skin depressions, atrophic scars, and changes resulting from lipoatrophy. 75 , 76…”

Section: Scientific Dermatology: Skin Science and Its Discoveriesmentioning

confidence: 99%

History of dermatology: the study of skin diseases over the centuries

Ferreira

Weber

Bonamigo

2021

Anais Brasileiros de Dermatologia

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The study of skin, the science of dermatology, has undergone significant transformations throughout the centuries. From the first descriptions of skin diseases in Egyptian papyri and in Hippocratic writings to the first treatises on dermatology, important individuals and discoveries have marked the specialty. In the 18 th and 19 th centuries, the specialty consolidated itself as a field of medical study based on the first classifications of dermatoses, diagnostic methods, and drug treatments. In the 20 th century, the scientific and technological revolution transformed dermatological practice, incorporating new therapeutic resources, as well as surgical and aesthetic procedures. In the face of such a vigorous process, it is important to provide a historical synthesis for the medical community to recognize and understand the origins that supported one of the most relevant specialties in the current medical scenario.

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“…Esse processo se dá devido a diminuição da capacidade de divisão celular, ação degradante dos radicais livres, mudanças bioquímicas e estruturais das fibras colágenas e elásticas, onde as primeiras se tornam desorganizadas e fragmentadas, enquanto as segundas diminuem em quantidade e diâmetro. Sendo estas consequências do processo fisiológico de redução da síntese de colágeno e aumento dos níveis de colagenase no organismo (Haddad et al, 2017).…”

Section: Introductionunclassified

“…Por meio do uso de bioestimuladores é possível se ter resultados mais naturais e harmônicos, devido ao fato de agirem de forma gradual e progressiva, o que os diferenciam de materiais preenchedores propriamente ditos. As indicações e o número de sessões necessárias para se ter um resultado satisfatório são individuais levando em consideração as particularidades de cada paciente como idade, tempo de exposição solar ao longo da vida, metabolismo, entre outros (Haddad et al, 2017).…”

Section: Introductionunclassified

A utilização de bioestimuladores de colágeno semipermanentes na harmonização orofacial

Costa

Araújo²,

Oliveira³

et al. 2022

RSD

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Os bioestimuladores de colágeno são preenchedores faciais que possuem a capacidade de agir nas porções mais profundas da pele, estimulando a produção de colágeno através de respostas inflamatórias subclínicas localizadas. São considerados materiais seguros por possuírem características como biocompatibilidade, biodegradação, produção de efeitos adversos mínimos e resultados satisfatórios. O objetivo deste artigo é analisar os tipos e propriedades dos estimuladores semipermanentes disponíveis no mercado, assim como seus mecanismos de ação, duração dos efeitos, indicações e contraindicações. Trata-se de uma revisão integrativa da literatura, e foram pesquisados artigos dos últimos 5 anos, relacionados ao assunto nas bases de dados PubMed, LILACS, Scielo e Google Schoolar com os seguintes descritores: (dermal filleres) AND (calcium hydroxyapatite); (dermal filleres) AND (poly l lactico acid); Sculptra; (dermal filleres) AND (policaprolactona). Por proporcionarem o rejuvenescimento facial, tratar linhas de expressão e ainda promover um preenchimento do volume da face, possibilitando que ocorra uma melhora na sustentação e firmeza da pele esses materiais estão sendo preferíveis a procedimentos invasivos como cirurgias plásticas.

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Current concepts in the use of poly-L-lactic acid for facial rejuvenation: literature review and practical aspects

Cited by 13 publications

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Static and dynamic high‐resolution ultrasound analysis of tissue distribution of poly‐L‐lactic acid particles during subdermal application in two different presentations

Static and dynamic high‐resolution ultrasound analysis of tissue distribution of poly‐L‐lactic acid particles during subdermal application in two different presentations

History of dermatology: the study of skin diseases over the centuries

A utilização de bioestimuladores de colágeno semipermanentes na harmonização orofacial

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