Injectable poly-L-lactic acid for cosmetic enhancement: learning from the European experience

Currently a diverse range of injectable agents are used for noninvasive facial enhancement. Injectable poly-L-lactic acid (PLLA) is a biocompatible, biodegradable, synthetic polymer that is approved for correction of HIV-related facial lipoatrophy in Europe, Canada, and the United States. PLLA is also approved in several countries for cosmetic purposes, and is under review in the United States for this indication. After injection, PLLA elicits a gradual increase in facial volume via hypothesized endogenous production of fibroblasts and, subsequently, collagen, enabling global facial rejuvenation to be tailored, as required, over time. Substantial increases in dermal thickness after injection of PLLA have been observed to last for up to 2 years. This article reviews the use of PLLA in Europe and the United States with regard to practitioner experiences and techniques for optimizing outcomes. Correct reconstitution and administration of PLLA have been found to be important parameters for optimal use of this agent.