PLLA (Poly-1-lactic acid), a.k.a. Sculptra, was approved by the FDA in 2004 for the treatment of AIDS-related facial lipoatrophy. It is inserted by injection into the subcutaneous tissue and stimulates fibroplasia. A number of injections are required, but the aesthetic results for hollow cheek have been impressive. In the European clinical studies, the result remained for 18 to 24 months. Aesthetic use of Poly-1-lactic acid is considered off-label, but has been utilized for pan facial enhancement. It is very important to insert this product in the correct plane. Injection into the dermis could increase the risk of granuloma formation.
Here’s how PLLA works.
Dissolution of fat on the face results in dramatic alteration in looks and may be caused by hereditary syndromes, disease or aging. In natural ageing, it takes place in the form of loss of elasticity, breakdown of collagen and bone reabsorption. This sinking due to loss of volume leads to excess skin.
Various classifications of lipoatrophy depending upon anatomic considerations have been reported. Trying to correct by tightening the skin without addressing volume replacement results in a sunken appearance. Replacing the volume has been attempted by a host of naturally-occurring (fat, collagen, hyaluronic acid) and man-made (acrylates, silicone and other polymers) fillers, both permanent and biodegradable (i.e. the body can break them down). PLLA (Poly-L-lactic acid, marketed in US and Europe as Sculptra, represents a novel family of fibroblastic fillers whose ‘bulking effect’ depends upon the response of the host.
Injectable Poly-L-lactic acid, a.k.a. Sculptra, is a biocompatible, reabsorbable material that results in a purposeful inflammatory response to foreign body, skin cell regeneration and a slow metabolic breakdown of the polymer material. Microsopic and clinical data suggest long-term results, which may last for longer than 2 years. Currently, PLLA is FDA-approved solely for the purpose of AIDS-related lipoatrophy, and esthetic applications are ‘off-label’, even though randomised clinical trials for aesthetic use are at this time almost done. Numerous documentations recapitulate the biological end products and treatment of lipoatrophy with PLLA.