Clinical and histological comparative outcomes after injections of poly-L-lactic acid and calcium hydroxyapatite in arms: A split side study.

BACKGROUND: Although much has been published on the use of poly-L-lactic acid (PLLA) and calcium hydroxyapatite (CaHA) for off-face indications, questions remain regarding their exact mechanisms of action in subcutaneous tissue and their comparative efficacy. OBJECTIVE: To present the clinical and histological results of the PLLA and CaHA injections into the opposing arms of the same patients. METHODS: Five women received superficial subcutaneous injections of PLLA into the left arm and CaHA into the right arm. After three sessions, the clinical and histological outcomes were analyzed. RESULTS: After the first session, three patients showed improvement in the right arm (CaHA), but at the end of study, two patients showed better results in the left arm (PLLA). Histologically, moderate to intense lymphocytic and giant cell infiltrate, as well as collagen and elastic fiber neoformation, were observed equally near the particles of both products. Dermis had no inflammatory or fiber alterations. CONCLUSION: In this study, there were no clinical differences between these two fillers. Despite current thinking and previous histological studies, we found both products produced moderate to intense inflammatory reaction, as well as collagenic/elastogenic fiber neoformation, only in the subcutaneous tissue of the immediate vicinity and surrounding the individual filler particles.

Subcision™ plus poly-l-lactic acid for the treatment of cellulite associated to flaccidity in the buttocks and thighs.

BACKGROUND: There is a growing demand for procedures to treat cellulite. Subcision™ is widely used for cellulite correction, and injectable poly-L-lactic acid (PLLA) has been shown to be an effective option for various body conditions. AIMS: Present the results of combining Subcision™ plus PLLA, in the same session, in patients with cellulite and flaccidity. PATIENTS/METHODS: Twenty-four women underwent Subcision™ followed by PLLA injections. An expert panel of dermatologists evaluated before and after photographs according to Global Aesthetic Improvement Scale (GAIS). Patients also answered a satisfaction questionnaire. RESULTS: The author describes the results, as well as number of sessions and dose used. The most frequent GAIS score was "great improvement." No nodules or granulomas appeared in the treated areas. CONCLUSION: The combination of Subcision™ plus PLLA, in the same treatment session, promotes safe and desirable results for cellulite associated with flaccidity.

Recommendations on the Use of Injectable Poly-L-Lactic Acid for Skin Laxity in Off-Face Areas

Injectable poly-L-lactic acid (PLLA) is a biodegradable synthetic polymer that stimulates collagen production, leading to gradual volume restoration. The treatment of sagging skin in body areas is still a big challenge, as there are few aesthetic procedures aiming to improve it. This article provides recommendations on the use of PLLA in the treatment of skin laxity in off-face areas, as the neck, décolletage, arms, abdomen, buttocks, and thighs, including the patient selection, product preparation, and injection techniques. The use of PLLA is a promising method for the treatment of skin laxity in corporal areas, improving body contour and appearance. Further investigation is needed to better understand the efficacy and durability of PLLA in non-facial indications and to provide the best evidence for optimal patient outcomes. J Drugs Dermatol. 2019;18(9):929-935.

Gummy smile and botulinum toxin: a new approach based on the gingival exposure area.

BACKGROUND: Gummy smile (GS) is an aesthetic disorder for some patients, which can be corrected by injection of botulinum toxin. OBJECTIVE: We sought to classify GS according to the area of gingival exposure and the respective muscles involved in order to perfect the botulinum toxin injection technique for each patient. METHODS: Sixteen patients with GS were evaluated before receiving botulinum toxin injections. Based on the area of excessive gum displayed and identification of the muscles involved, 4 different types of GS were identified: anterior, posterior, mixed, and asymmetric. AbobotulinumtoxinA (Dysport, Ipsen Biopharm Limited, Wrexham, UK) was injected using a different injection technique for each type of GS, based on the main muscles involved. With the aid of two computer programs, the area of gum exposed was measured before and after the application of abobotulinumtoxinA, to evaluate the level of improvement. RESULTS: There was a decrease in the degree of gum display in all patients. The general average improvement achieved was 75.09%. Two patients showed slight adverse effects that were easily corrected with additional doses of abobotulinumtoxinA. LIMITATIONS: For this study, there was no sample size calculation and no statistical analysis of the cases. CONCLUSION: The authors conclude that it is important to identify the type of GS and therefore the main muscles involved, so that the correct injection technique can be used. AbobotulinumtoxinA was shown to be effective and safe for use in all types of GS in the present sample.

Poly-L-lactic acid for neck and chest rejuvenation.

BACKGROUND: Poly-L-lactic acid (PLLA) has been widely used in the enhancement of facial contours, but its use in nonfacial areas is rarely cited. OBJECTIVES: To demonstrate the efficacy and safety of PLLA for neck and chest rejuvenation. METHODS: Thirty-six patients with different degrees of cutaneous flaccidity, atrophy, and wrinkles in the neck and chest were treated with PLLA. The technical details and the methods of evaluation (photographic analysis by three independent evaluators in the 21 patients who had alterations visible in the photographs taken before treatment and satisfaction questionnaire at the end of the treatment in all 36 patients) are described in this article. RESULTS: In the photographic analysis, improvement was found in 81% to 100% of the 21 cases (p<.001). In the questionnaire regarding the degree of satisfaction, 91.6% said they were pleased with the result of the procedure and stated they would do it again. After 18 months of follow-up, the results were maintained. Only one of the 36 patients (3%) had early-onset subcutaneous nodules as a complication. CONCLUSION: Injection of PLLA seems to be a safe and efficacious treatment for the correction of some aspects of aging in the neck and chest.