Poly-L-Lactic Acid in Aesthetic Dermatology: A Decade Beyond Volume Restoration Toward Regenerative Biostimulation

Area of Science:

• Regenerative Dermatology
• Aesthetic Medicine
• Biomaterials Science

Background:

• Poly-L-lactic acid (PLLA) has evolved from a treatment for HIV-associated lipoatrophy to a key agent in regenerative aesthetics.
• Its mechanism is increasingly understood as a biostimulatory scaffold promoting tissue regeneration rather than solely volumization.

Purpose of the Study:

• To systematically review the evolution and applications of PLLA in aesthetic dermatology over the past decade.
• To analyze PLLA's biostimulatory effects, including its role in neocollagenesis and extracellular matrix remodeling.
• To explore emerging applications and future directions for PLLA in regenerative aesthetics.

Main Methods:

• Systematic literature review of 67 studies published between January 2013 and March 2025.
• Analysis of PLLA's biological mechanisms, including cellular responses and collagen synthesis.
• Evaluation of clinical outcomes across various applications, including facial and body rejuvenation.

Main Results:

• PLLA effectively induces a regenerative cascade involving M2 macrophage polarization and fibroblast activation.
• Sustained neocollagenesis and extracellular matrix remodeling lead to improved dermal density and skin quality.
• PLLA applications have expanded to full-body rejuvenation, post-GLP-1 therapy restoration, and prejuvenation strategies.

Conclusions:

• PLLA is a versatile biostimulatory agent that promotes long-term skin rejuvenation and tissue remodeling.
• Refined protocols enhance PLLA's safety and efficacy in aesthetic dermatology.
• Future integration with advanced technologies like AI and digital imaging promises further innovation in PLLA-based treatments.