Changes in Facial Morphology Using Poly-L-lactic Acid Application According to Vector Technique: A Case Series

Abstract

Background: The search for nonsurgical cosmetic procedures has increased considerably in recent years. A new injection technique, using vector direction, has shown good results in improving facial aesthetics but to date has only been performed with hyaluronic acid which can be associated with a risk of vascular complications. Therefore, in clinical practice, it would be interesting to assess this technique with a liquid product already widely used in the facial region, and at the same time bring the same aesthetic benefits, but with greater durability than hyaluronic acid.

Objective: To investigate the improvement of facial morphology in patients with facial flaccidity submitted to the vector technique using poly-L-lactic acid (PLLA) (Sculptra^®; Galderma, Lausanne, Switzerland).

Case series: Here we report the outcomes of three cases of female patients, aged between 41 and 55 years, seeking improvement of facial flaccidity. In each patient, PLLA was applied in the posterior temporal region as a bolus, in three points, with a 2-mL injection in the upper region, 1.5mL in the midpoint, and 1.5mL at the bottom point. Each of the three patients showed an improvement in face morphology, with concomitant improvement in the support and stretching of the face and improvement in skin sagging in the upper, middle, and bottom regions.

Conclusion: The vector technique with PLLA is a viable alternative for the treatment of patients with facial skin flaccidity, providing harmonious and progressive improvement in the face morphology.

Keywords: Facial aging; cosmetic techniques; poly-L-lactic acid; vector technique.

FIGURE 1.

Vector application technique; the arrows represent the entry area and the points represent the product’s injection site.

FIGURE 2.

Front view of the patient before treatment at rest (2A) and smiling (2C) and after treatment (2B and 2D), at rest and smiling, respectively. In this case, poly-L-lactic acid vial was reconstituted 48 hours before the application with 8mL of sterile water for injection. Immediately before the injection, 2mL of lidocaine without epinephrine were added with 10mL in total as the final volume.

FIGURE 3.

Visualization of the patient before at rest (3A) and smiling (3C) and 90 days after completion of treatment at rest (3B) and smiling (3D). In this case, poly-L-lactic acid vial was reconstituted 48 hours before the application with 8mL of sterile water for injection. Immediately before the injection, 2mL of lidocaine without epinephrine were added, with 10mL in total as final volume

FIGURE 4.

Changes in the face contour and minimization of expression lines observed in the comparison between the beginning and 90 days after treatment. In this case, poly-L-lactic acid vial was reconstituted 24 hours before the application with 8mL of sterile water for injection. Immediately before the injection, 2mL of lidocaine without epinephrine were added, with 10mL in total as final volume.