Soft-tissue augmentation and the role of poly-L-lactic acid.
BACKGROUND
Facial rejuvenation has traditionally centered on the correction of ptosis, lines, and wrinkles, typically achieved by surgical tightening of the skin or by injecting soft-tissue fillers. In recent years, volumetric augmentation and recontouring have been recognized as fundamentally important aspects of facial rejuvenation.


METHODS
An overview of volume restoration and recontouring is presented. A literature search was also conducted to identify the injectable products representing potential treatment options for facial recontouring. The author also presents the results of his extensive experience with poly-L-lactic acid in the treatment of thousands of cosmetic patients in Europe, with special emphasis on the efficacy and tolerability of this product.


RESULTS
Several injectable treatment options can be used to recontour and restore volume, to the face and beyond. All of these products, except calcium hydroxylapatite and poly-L-lactic acid, are nonresorbable, offering permanent volume augmentation, but with the increased risk of severe foreign-body reactions. Poly-L-lactic acid provides semipermanent results and has been documented to offer volume augmentation with a favorable safety profile. Achieving good efficacy and safety is dependent on the appropriate reconstitution of the product and adhering to the correct injection technique.


CONCLUSIONS
Injectable products offer a flexible means of recontouring the face and localized regions beyond the face. The potential of some of these products is supported by a wealth of published results and clinical experience, helping the physician to identify the most appropriate treatment for their patient.
Vleggaar
Danny
D
Nouvelle Clinic Vert Pré. dvleggaar@mediline.nl
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001672:Biocompatible Materials / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002921:Cicatrix / Q000628:therapy; D003357:Cosmetic Techniques / Q000009:adverse effects; D005145:Face; D005260:Female; D005660:Funnel Chest / Q000628:therapy; D039682:HIV-Associated Lipodystrophy Syndrome / Q000628:therapy; D006225:Hand; D006406:Hematoma / Q000209:etiology; D006801:Humans; D007279:Injections, Subcutaneous; D019344:Lactic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009333:Neck; D017060:Patient Satisfaction; D011091:Polyesters; D011108:Polymers / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D011446:Prospective Studies; D012060:Rejuvenation; D015595:Skin Aging; D013909:Thorax; D016896:Treatment Outcome
D001672:Biocompatible Materials; D011091:Polyesters; D011108:Polymers; D019344:Lactic Acid; C033616:poly(lactide)