INTRODUCTION

Poly-L-lactic acid (PLLA) is a biodegradable, biocompatible synthetic polymer from the alpha-hydroxy-acid family. Injectable poly-L-lactic acid, marketed as Sculptra (Dermik Laboratories) is used for the treatment of subcutaneous volume restoration. Injection of PLLA into the subcutis results in expansion of the area through a foreign body reaction that elicits increased collagen production from fibroblasts.

The Food and Drug Administration approved PLLA for the treatment of HIV lipoatrophy in August 2004. PLLA is used off-label for the correction of facial lipoatrophy secondary to the normal aging process. PLLA has been available in Europe since 1999 under the trade name New-Fill.

The use of injectable PLLA is growing. Treatment is safe and effective. Precise injection technique is essential for good results and to avoid complications.

PATIENT SELECTION

The best candidates for treatment with PLLA are those seeking volumetric correction secondary to aging or medical conditions such as HIV. On initial evaluation of the patient, facial volume, concavities, and tissue quality should be assessed. Treatment with PLLA involves a series of injections every four to six weeks.

MATERIAL RECONSTITUTION

Each PLLA vial is reconstituted with 3 mL of sterile water on the evening before the procedure. On the day of the procedure, an additional 2 mL of plain lidocaine is added for a total dilution of 5 mL. Some physicians utilize an even greater dilution. The material is stored at room temperature before and after reconstitution. The vials are thoroughly shaken with a laboratory vortex before suspension is drawn up into syringes.