Injectable Poly-L-Lactic Acid for Body Aesthetic Treatments: An International Consensus on Evidence Assessment and Practical Recommendations

Abstract

Non-facial (body) rejuvenation is a treatment of increasing demand, with patients seeking to harmonize the benefits of rejuvenated facial appearance with other areas of the body. Poly-L-lactic acid (PLLA)-SCA (Sculptra®) has been approved for facial aesthetic uses since 1999 in Europe and since 2009 in the USA and more recently evaluated for the treatment of cellulite of the buttocks and thighs and other body indications. The current evidence base consists largely of prospective observational analyses and case series although systematic evaluations for a number of body areas are underway. Current data support a potential benefit for the use of PLLA-SCA for the aesthetic treatment of the neck, knees, abdomen, hands and upper arms. Improvements in aesthetic appearance (e.g. sagging, wrinkling, dimpling, cellulite) that are sustained over time with minimal side effects can be achieved. Standardization of injection protocols for different body areas is now needed along with the validation of clinical tools that can be used to agree on treatment goals and to evaluate aesthetic improvements over time. A group of international experts in the fields of facial and body aesthetics, plastic surgery and dermatology were selected based on their educational, scientific and publication merits together with clinical experience using PLLA-SCA for body rejuvenation. Here, we provide an evidence-based and expert-led consensus (14 years of off-face treatment experience) on recommendations for appropriate injection protocols for different body sites and evaluation tools when using the biostimulator PLLA-SCA for body aesthetic and rejuvenation procedures.Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Biostimulator; Body aesthetics; Body rejuvenation; PLLA-SCA; Poly-l-lactic acid.

Fig. 1

Before and after treatment with PLLA-SCA in the neck region using 1 vial of PLLA-SCA. Pictures courtesy of Dr Walter Loureiro

Fig. 2

Before and after treatment with PLLA-SCA in the décolletage area using 2 vials of PLLA-SCA. Pictures courtesy of Dr Luddi Oliveira

Fig. 3

Suggested target areas and distribution of PLLA-SCA injection for gluteal aesthetic treatments

Fig. 4

Before and after treatment with PLLA-SCA in the knee area using 0.5 vial of PLLA-SCA per side. Pictures courtesy of Dr Luiz Avelar

Fig. 5

Before and after treatment with PLLA-SCA in the abdominal region using 3 vials of PLLA-SCA. Pictures courtesy of Dr Luiz Avelar

Fig. 6

Before and after treatment with PLLA-SCA in the hands using 0.5 vial of PLLA-SCA per side. Pictures courtesy of Dr Walter Loureiro

Fig. 7

Before and after treatment with PLLA-SCA in the upper arm using 3 vials of PLLA-SCA over 3 sessions. Pictures courtesy of Dr Luiz Avelar

Fig. 8

Before and after treatment with PLLA-SCA in the upper arm using 3 vials of PLLA-SCA over 3 sessions. Pictures courtesy of Dr Luiz Avelar