A Decade of Experience with Injectable Poly-L-Lactic Acid: A Focus on Safety

Background Injectable poly-L-lactic acid (PLLA) is a biodegradable synthetic polymer device that stimulates collagen production, leading to gradual volume restoration. It has been used worldwide for more than a decade to treat the lines and wrinkles of the aging face and in individuals with the human immunodeficiency virus for treatment of facial lipoatrophy. Objective To provide an overview of the experience with injectable PLLA in Europe and the United States and the practices that have improved product use. Materials and methods A review of the literature was conducted, and the authors' clinical experience was included detailing the evolution of the use of injectable PLLA for facial restoration. Results Although relatively high rates of nodule and papule formation were reported during early use of injectable PLLA, updated methods have led to better safety and efficacy, including patient selection, preparation, and instruction; product preparation; timing of injections and avoidance of overcorrection; an updated understanding of the anatomy of the aging face; and site-specific injection techniques. Conclusion Important lessons have been learned that have enhanced the safety and efficacy of injectable PLLA and have made it a desirable product for restoring facial volume.