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. 2024 Dec 4:17:2755-2765.
doi: 10.2147/CCID.S497691. eCollection 2024.

Consensus Recommendations for the Reconstitution and Aesthetic Use of Poly-D,L-Lactic Acid Microspheres

Fabiano Nadson Magacho-Vieira  1   2 , Abrahao Osta Vieira  3 , Amarilho Soares Jr  4 , Hellise Christine Lana Alvarenga  5 , Iran Roger Alkimin de Oliveira Junior  6 , João Antonio Correa Daher  7 , João Vitor Moraes Pithon Napoli  8 , Júlia Portocarrero de Almeida Serra  9 , Suellen Costa Provázio  10
Affiliations

Consensus Recommendations for the Reconstitution and Aesthetic Use of Poly-D,L-Lactic Acid Microspheres

Fabiano Nadson Magacho-Vieira et al. Clin Cosmet Investig Dermatol. .

Abstract

Poly-D,L-lactic acid (PDLLA) microspheres, marketed globally as Aesthefill® (Regen Biotech, Seoul, South Korea), are recognized for their biocompatible and biostimulatory properties, positioning them as a preferred option in aesthetic medicine. This article presents consensus recommendations from Brazilian experts on the reconstitution and clinical application of PDLLA for facial and non-facial treatments. Developed using a modified Delphi method with contributions from leading dermatologists and plastic surgeons, the consensus outlines protocols for reconstitution, injection techniques, and patient management. Key recommendations include reconstitution with 7-8 mL of sterile water for injection, the addition of lidocaine to improve patient comfort, and a preference for targeting the superficial subcutaneous layer. Dosing guidelines are specifically tailored to each treatment area and the desired degree of correction, underscoring the importance of personalized treatment plans. Maintenance treatments are advised at biennial intervals or at shorter intervals for patients exhibiting accelerated collagen degradation. The consensus also highlights the need for proper training and patient screening to minimize adverse effects, such as nodules and granulomas. This comprehensive guide aims to standardize the use of PDLLA, prioritizing patient safety and optimizing outcomes. While clinical trials evaluating PDLLA's aesthetic indications remain limited, these evidence-based guidelines bridge the gap by offering practical protocols grounded in clinical expertise. Further research is encouraged to validate these recommendations and explore new applications for PDLLA in aesthetic medicine.

Keywords: collagen stimulator; consensus; expert recommendations; filler; poly-D,L-lactic acid; polylactic acid.

Plain language summary

Poly-D, L-lactic acid (PDLLA) microspheres are small particles used in aesthetic medicine to improve skin appearance by stimulating collagen production. This summary outlines expert recommendations from experts on preparing and using PDLLA for facial and body treatments. Why was the study done? The study aimed to create standardized guidelines to help practitioners achieve the best results and ensure patient safety when using PDLLA for cosmetic purposes. What did the researchers do and find? They used a method called the Delphi approach to gather and refine recommendations on the reconstitution and injection of PDLLA. By consensus, the experts who participated in this study recommend using of sterile water for injection to prepare the PDLLA and adding lidocaine to reduce discomfort during injections. Specific techniques, such as linear retrograde and fanning methods, are advised for different areas of the face and body. The experts have also provided dosing guidelines and emphasize the need for individualized treatment plans. What do these results mean? The recommendations help practitioners use PDLLA more effectively and safely, providing better aesthetic outcomes for patients. Regular maintenance treatments are suggested every two years, with more frequent sessions for those with faster collagen loss. Proper training and careful patient screening are essential to avoid complications such as nodules or granulomas.

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Conflict of interest statement

Dr F.N. Magacho-Vieira is a medical director for Derma Dream Corporation Brazil and was a regular speaker for Galderma, until May, 2024. A. Soares Jr, H.C.L. Alvarenga, I.R.A. Oliveira Jr. J.A.C. Daher, J.V.M.P. Napoli, J.P.A. Serra, and S.C. Provázio are speakers for Derma Dream Corporation Brazil. A. Soares Jr is also a speaker for Medsystem Brazil and Evopharma Brazil. Abrahao Vieira reports being a Speaker for Dermadream Corporation Brazil. João Napoli reports non-financial support from Derma Dream Corporation Brazil, during the conduct of the study; non-financial support from Dream Corporation Brazil, outside the submitted work. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Recommended injection volumes for different facial areas.
Figure 2
Figure 2
A 69-year-old woman is depicted in frontal view, before (A), and 4 months after treatment (B), and in oblique view, before (C), and 4 months after treatment (D). The treatment involved two vials of PDLLA collagen stimulator injected into the anterior temporal, malar, jowl, and masseteric regions. Images were captured using a three-dimensional LifeViz digital imaging system (QuantifiCare S.A., Valbonne, France).
Figure 3
Figure 3
Regions and volumes of poly-D,L-lactic acid (PDLLA) that were injected for the treatment of the patient depicted in Figures 2 and 4.
Figure 4
Figure 4
The previously shown patient (Figures 2 and 3) is depicted before (A), and 15 days post-treatment (B), in frontal view, and before (C), and 15 days post-treatment (D), in oblique view. The red arrows indicate rectification of the nasolabial fold, which was evident as early as 15 days post-treatment. The images were obtained using the LifeViz imaging system (QuantifiCare S.A., Valbonne, France).
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