Subcutaneous Versus Supraperiosteal Injections of Poly-L-Lactic Acid: A Clinical and Imaging Study

Mazzuco, Rosemarie; DalʼForno, Taciana; Dini, Simone Afonso

doi:10.1097/dss.0000000000002614

Cited by 5 publications

(8 citation statements)

References 3 publications

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“…Despite the proximity to the dermis, no alterations in that layer, regarding inflammation, neocolagenesis or elastogenesis, were found in any specimen. The fact the inflammatory reaction and neocollagenesis were only presented around the particles, with no tissue reaction occurring at a distance, confirms the importance of ensuring the products are injected as evenly as possible 29 and at higher dilutions to facilitate the spread of the particles beyond the injection site.…”

Section: Described Excisingmentioning

confidence: 82%

“…As some studies have demonstrated, PLLA and CaHA should be injected into the superficial subcutaneous layer, 4,9,29,30 as close as possible to the dermis, because this layer contains the largest amount of fibroblasts and inflammatory cells necessary for neocollagenesis, the final consequence of PLLA and CaHA biostimulation. Consequently, the superficial subcutaneous layer was chosen for the injections in this study as can be seen in Figure 8.…”

Section: Described Excisingmentioning

confidence: 99%

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Clinical and histological comparative outcomes after injections of poly‐L‐lactic acid and calcium hydroxyapatite in arms: A split side study

Mazzuco¹,

Evangelista²,

Gobbato³

et al. 2022

J of Cosmetic Dermatology

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Background Although much has been published on the use of poly‐L‐lactic acid (PLLA) and calcium hydroxyapatite (CaHA) for off‐face indications, questions remain regarding their exact mechanisms of action in subcutaneous tissue and their comparative efficacy. Objective To present the clinical and histological results of the PLLA and CaHA injections into the opposing arms of the same patients. Methods Five women received superficial subcutaneous injections of PLLA into the left arm and CaHA into the right arm. After three sessions, the clinical and histological outcomes were analyzed. Results After the first session, three patients showed improvement in the right arm (CaHA), but at the end of study, two patients showed better results in the left arm (PLLA). Histologically, moderate to intense lymphocytic and giant cell infiltrate, as well as collagen and elastic fiber neoformation, were observed equally near the particles of both products. Dermis had no inflammatory or fiber alterations. Conclusion In this study, there were no clinical differences between these two fillers. Despite current thinking and previous histological studies, we found both products produced moderate to intense inflammatory reaction, as well as collagenic/elastogenic fiber neoformation, only in the subcutaneous tissue of the immediate vicinity and surrounding the individual filler particles.

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Section: Described Excisingmentioning

confidence: 82%

Section: Described Excisingmentioning

confidence: 99%

Clinical and histological comparative outcomes after injections of poly‐L‐lactic acid and calcium hydroxyapatite in arms: A split side study

Mazzuco¹,

Evangelista²,

Gobbato³

et al. 2022

J of Cosmetic Dermatology

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“…However, high-frequency ultrasound was only used in 1 clinical trial to detect side effects associated with PLLA injection; the follow-up time was 5 months, which was far from enough. 10 Our study utilized a high-frequency ultrasound for detection, and the follow-up time was 30 months. The results of our study demonstrated that injectable PLLA was a relatively safe filler because it degraded totally, and no papules and nodules occurred in 80% of subjects after a 30-month injection.…”

Section: Discussionmentioning

confidence: 99%

“…Fortunately, multiple noninvasive imaging techniques, such as ultrasound, magnetic resonance imaging, and Vectra 3D imaging, have been valuable for effect evaluation and complication diagnosis of facial filling. [9][10][11][12] High-frequency ultrasound with a probe with a frequency of more than 10 MHz can illustrate more significant details of cutaneous structures in different layers and characters of lesions. Herein, it is proposed that high-frequency ultrasound can be utilized as a quick, convenient, and precise method to assess the long-term safety of PLLA injection in nasolabial folds.…”

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confidence: 99%

High-Frequency Ultrasound for Long-term Safety Assessment of Poly-L-Lactic Acid Facial Filler

Long

Fang

et al. 2022

Dermatol Surg

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BACKGROUNDInjectable poly-l-lactic acid (PLLA) is a new type of biodegradable dermal filler that has been utilized for soft tissue filling. However, there is no convenient and reliable method to assess the long-term safety of PLLA filler.OBJECTIVETo assess the long-term safety of PLLA injection into nasolabial folds by high-frequency ultrasound and to select the ultrasonic probes with the most appropriate frequency.MATERIALS AND METHODSAfter a 30-month PLLA injection into the deep dermis of the nasolabial fold, subjects were examined by high-frequency ultrasound with the 20 MHz and 50 MHz probes.RESULTSTwenty subjects with nasolabial fold contour deficiency were enrolled in this study. After a 30-month PLLA injection in nasolabial folds, PLLA degraded entirely in 16 subjects (16/20, 80%), and abnormal echo in the skin was observed in 4 subjects (4/20, 20%) caused by undegraded PLLA microparticles, PLLA microparticles deposition, fibrous nodules, and granuloma. The 20-MHz probe is more appropriate than the 50-MHz probe for evaluating the adverse effects of PLLA injection.CONCLUSIONHigh-frequency ultrasound is a rapid, reliable, and noninvasive method to monitor the degradation condition of PLLA and the formation of papules and nodules associated with PLLA injection.

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“…This type of placement supports maxillary protrusion, lifts the lip, and provides support to the infraorbital tissues, camouflaging volume loss in this area. Importantly, PLLA should be placed as a thin layer, as injection of large boluses can lead to formation of nodules 49 …”

Section: Discussion Of Patient Typesmentioning

confidence: 99%

Aesthetic considerations for treating the North American multi‐ethnic patient: Thriving in diversity international roundtable series

Fabi

Callender

Lee

et al. 2022

J of Cosmetic Dermatology

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Background The United States is becoming increasingly diverse, and between 2016 and 2019, an increase of 945 832 aesthetic procedures was recorded for Hispanic, African American, and Asian American patients combined. In aesthetics, where outcomes are technique dependent and tied to the clinician's ability to tailor treatment to the needs of individual patients, a knowledge of ethnic differences in anatomy and how aesthetic issues can be safely and effectively addressed in different groups is paramount. Aims To discuss similarities and difference in anatomy and treatment preferences of patients from a variety of ethnic and racial backgrounds and how these differences may influence the products or techniques utilized to achieve natural‐looking results and minimize side effects. Patients/Methods In support of clinicians who wish to serve a diverse patient population, a 6‐part international roundtable series focused on diversity in aesthetics was conducted from August 24, 2021, to May 16, 2022. Results The results of the first roundtable in the series, the North American Multiethnic Patient, are described here. Conclusions A diverse range of patients can benefit from the tailored use of fillers, fat transfer, neuromodulators, lasers, and energy‐based devices, as long as differences in structural support, skin, and aging patterns, are appreciated.

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Subcutaneous Versus Supraperiosteal Injections of Poly-L-Lactic Acid: A Clinical and Imaging Study

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 5 publications

References 3 publications

Clinical and histological comparative outcomes after injections of poly‐L‐lactic acid and calcium hydroxyapatite in arms: A split side study

Clinical and histological comparative outcomes after injections of poly‐L‐lactic acid and calcium hydroxyapatite in arms: A split side study

High-Frequency Ultrasound for Long-term Safety Assessment of Poly-L-Lactic Acid Facial Filler

Aesthetic considerations for treating the North American multi‐ethnic patient: Thriving in diversity international roundtable series

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