Layered PLLA with monopolar RF for facial rejuvenation: a case report

With the continuous expansion of facial rejuvenation techniques, the combination of energy-based devices and biostimulatory fillers has become a focal point in clinical research. Monopolar radiofrequency (MRF), such as Thermage, can achieve immediate tissue tightening, while poly-L-lactic acid (PLLA), a collagen stimulator, enables volumetric restoration and lifting through progressive collagen regeneration. This article describes a sequential treatment protocol combining MRF followed by layered PLLA injection in three patients with facial laxity and volume loss. Clinical photographs and Wrinkle Severity Rating Scale (WSRS) assessments were collected during follow-up. A split-face approach was applied in Case 1, with combination therapy (MRF + PLLA) administered to the more affected side and MRF alone to the contralateral side. Improvements in facial contour appearance, nasolabial fold severity, and facial symmetry were observed during follow-up. No treatment-related adverse events were reported during the observation period. These cases provide preliminary short-term clinical observations regarding this sequential treatment strategy; however, the contribution of each modality cannot be distinguished and further controlled studies are required.