Over recent years, a growing understanding and appreciation for the contribution of volume loss to facial aging has supported targeted use of fillers.PLLA's unique mechanism of action underlies the requirement for specific treatment methodologies that are outlined below and presented in more detail elsewhere.High patient satisfaction has been achieved with this long-lasting approach to volume restoration.
PLLA provides long-lasting results exclusively through stimulation of the body's own collagen synthesis. As noted above, because the effects of PLLA collagen stimulation are not immediate, volume restoration with PLLA may require several sessions that are at least 4 weeks apart.It is important to remember that the amount of PLLA injected in a single treatment is dictated by the surface area covered at that treatment session and not by the final degree of volumetric correction desired. Rather, the final degree of volumetric correction is addressed by the number of treatments. A firm grasp of this concept is critical for avoiding overcorrection, especially in light of PLLA's durability.
Appropriate product reconstitution, hydration, handling, and placement are central to avoiding adverse events. Higher reconstitution volumes and longer hydration times (up to 48 hours) have been shown to reduce the risk of nodule formation.Consensus recommendations further describe the procedures for optimal patient selection, product handling (including preparation and storage), and injection techniques. These consensus guidelines provide the information needed for current and best treatment practices. By increasing hydration time to between (24 and 48 hours) and volume to between 5 and 9 mL, as well as careful selection of the injection plane of PLLA (the uppermost portion of subcutaneous fat rather than lower dermis, and supraperiosteally), the incidence of nodules was lowered from 10%-the comparatively higher incidence reported in initial clinical studies-to 0.15%.
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