Poly L-Lactic Acid, PLLA, Biostimulator

Scientific Concepts and Natural Phenomena

Poly L-Lactic Acid (PLLA) as a Biostimulator

PLLA is a collagen stimulator widely used in aesthetic medicine to induce the skin’s fibroblasts to produce collagen, elastin, and hyaluronic acid—key components responsible for skin elasticity, freshness, and youthfulness.

• Collagen and elastin are located in the dermis layer of the skin.
• Fibroblasts are the cells responsible for producing collagen and elastin.
• PLLA does not act directly but stimulates the body’s natural collagen production.

Mechanism of Action

• PLLA is biodegradable and biocompatible; after injection, it is gradually broken down by the body’s enzymes and absorbed without causing inflammation or lumps.
• Collagen production stimulation typically begins to show results after about 3 months and can last up to 2 years.
• Initial volume effects from fluid injection are temporary and subside within 2 months.

Indications for PLLA Injection

PLLA injections are indicated for:

• Face frame enhancement: temple, pre-auricular area, cheeks, and jawline (not suitable for lips, under eyes, or nostrils).
• Lifting and slimming of the temple area to create a face-lifting effect.
• Volume restoration in the mid-face, especially for patients with significant weight loss or aging-related volume loss.
• Improving skin freshness and hydration in middle-aged patients (30s to 40s).
• Skin rejuvenation on the neck, chest, and hands.

Contraindications and Cautions

• Avoid injection around eyes and lips due to risk of lump formation caused by muscle movements compressing the injected particles.
• Patients with autoimmune diseases or those on steroids may have altered or poor responses.
• Avoid use in patients prone to keloids or hypertrophic scars.
• Proper product preparation and dilution according to manufacturer instructions are critical to avoid complications such as nodules or clumps.

Preparation and Injection Protocol

• PLLA powder is reconstituted with saline (usually 10 ml) and requires thorough mixing for 10–15 minutes until fully hydrated and no particles remain undissolved.
• The solution can be refrigerated and used within 72 hours, with remixing before use.
• The reconstituted solution is divided into 3 ml syringes (typically four syringes with 2.5 ml each) and injected using a 25-gauge, 5 cm cannula.
• Injection is performed via a retrograde technique along predefined lines on the face (temple, zygoma, jaw angle), with multiple small deposits spaced about 0.5 cm apart.
• The cannula size and length are chosen to minimize trauma and avoid vascular injury.

Post-Injection Care

• Patients should perform a “5-5-5” massage: 5 minutes, 5 times a day, for 5 days to evenly distribute the product and prevent clumping.
• Use topical creams before massage to reduce friction and skin redness.
• Adequate hydration and gentle skin care routines are recommended.
• Avoid excessive manipulation or trauma to injection sites.

Treatment Scheduling and Dosage

• Initial sessions typically use 1–2 vials; total number of vials depends on patient’s age (Rule of Decades: e.g., 33 years old = 3 vials total).
• Sessions are spaced 1.5 to 3 months apart depending on patient condition and treatment goals.
• Maintenance injections (“birthday shots”) are recommended annually to sustain results.
• PLLA can be combined sequentially with other fillers such as hyaluronic acid or calcium hydroxyapatite for enhanced rejuvenation effects.

Additional Notes

• PLLA is injected subdermally or on the bone for volume restoration and collagen induction, not intradermally.
• It is not suitable for use as a mesotherapy product or for direct scar treatment inside the dermis.
• Collagen loss begins after age 20–25 at about 1% per year, accelerating with sun exposure and poor skin care.
• PLLA improves skin quality and firmness, potentially reducing the frequency and amount of other filler use.

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Methodology for PLLA Injection

1. Preparation

   • Remove vial cap and sterilize stopper.
   • Inject 10 ml saline slowly into vial to hydrate PLLA powder.
   • Mix thoroughly for 10–15 minutes until fully dissolved.
   • Refrigerate if not used immediately; remix before use.

2. Syringe Preparation

   • Withdraw solution into four 3 ml syringes, each containing 2.5 ml.
   • Attach a 25-gauge, 5 cm cannula to each syringe.

3. Injection Technique

   • Create entry points with a trocar.
   • Insert cannula and perform retrograde injections along planned lines on temple, zygoma, and jawline.
   • Deposit small amounts (~0.5 cm length) spaced evenly to cover the treatment area.
   • Pinch and stretch skin as needed to facilitate cannula movement.

4. Post-Injection Care

   • Instruct patient on the 5-5-5 massage protocol.
   • Recommend hydration and gentle skin care.
   • Monitor for adverse reactions and avoid injection near lips or eyes.

5. Treatment Scheduling

   • Follow the Rule of Decades for total vial number.
   • Space sessions 1.5–3 months apart.
   • Use maintenance injections annually.

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Researchers and Sources Featured

• The lecture is presented by an unnamed expert who references a colleague, Dr. Asr, involved in a live demonstration.
• The product used is a Korean PLLA formulation with 360 concentration and carboxymethyl cellulose (CMC) as a diluent.
• Company protocols and instructions emphasize the importance of using reputable manufacturers for PLLA products.
• No specific published researchers or scientific studies are named in the transcript.