Soft-tissue augmentation and the role of poly-L-lactic acid.

BACKGROUND: Facial rejuvenation has traditionally centered on the correction of ptosis, lines, and wrinkles, typically achieved by surgical tightening of the skin or by injecting soft-tissue fillers. In recent years, volumetric augmentation and recontouring have been recognized as fundamentally important aspects of facial rejuvenation.

METHODS: An overview of volume restoration and recontouring is presented. A literature search was also conducted to identify the injectable products representing potential treatment options for facial recontouring. The author also presents the results of his extensive experience with poly-L-lactic acid in the treatment of thousands of cosmetic patients in Europe, with special emphasis on the efficacy and tolerability of this product.

RESULTS: Several injectable treatment options can be used to recontour and restore volume, to the face and beyond. All of these products, except calcium hydroxylapatite and poly-L-lactic acid, are nonresorbable, offering permanent volume augmentation, but with the increased risk of severe foreign-body reactions. Poly-L-lactic acid provides semipermanent results and has been documented to offer volume augmentation with a favorable safety profile. Achieving good efficacy and safety is dependent on the appropriate reconstitution of the product and adhering to the correct injection technique.

CONCLUSIONS: Injectable products offer a flexible means of recontouring the face and localized regions beyond the face. The potential of some of these products is supported by a wealth of published results and clinical experience, helping the physician to identify the most appropriate treatment for their patient.