Dispelling the myth: appropriate use of poly-L-lactic acid and clinical considerations.
OBJECTIVE
Injectable poly-L-lactic acid (PLLA; Sculptra) is widely used throughout Europe and the USA to restore volume in depressed areas of the face by stimulating neocollagenesis. Injectable PLLA was previously marketed as New-Fill, which was often injected incorrectly and at too high a concentration, resulting in some physicians losing confidence in this product. Today, Sculptra is still regarded with a degree of scepticism by some physicians, due to direct or indirect experience with New-Fill. Sculptra, both in formulation and use, is vastly superior to New-Fill and clinical experience with this product dispels the myths associated with the earlier types of injectable PLLA.


RESULTS
PLLA is a very safe, biodegradable compound that has been used in a wide range of medical devices for the last 30 years. In injectable form a good safety profile has been proven; however, when the device is overconcentrated, localized overstimulation of the fibroblasts can result in the formation of small lumps (subcutaneous papules), which are non-pathological but nevertheless palpable by the patient. Physicians must also be trained in the injection of this device, as incorrect injection technique can cause device-related adverse events.


CONCLUSIONS
New product guidelines have ensured that problems with PLLA concentration have been countered, and tried and tested injection techniques have been shown to ameliorate device-related adverse events, both of which are dispelling the myths associated with modern injectable PLLA.
Lowe
N J
NJ
Cranley Clinic, London, UK, and UCLA School of Medicine, Los Angeles, CA, USA. cranleyuk@aol.com
D000152:Acne Vulgaris / Q000150:complications; D001673:Biodegradation, Environmental; D002921:Cicatrix / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D019344:Lactic Acid / Q000494:pharmacology / Q000627:therapeutic use*; D011091:Polyesters; D011108:Polymers / Q000494:pharmacology / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D015595:Skin Aging / Q000187:drug effects*
D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)