Poly-L-lactic acid may 'fill the void' for treatment of deeper facial defects

Washington - Injectable poly-L-lactic acid (Sculptra, Dermik Laboratories) is a welcome addition to the expanding armamentarium of filler materials because it can be used for deeper dermal filling to create more durable and greater volume replacement than available agents, says Tina S. Alster, M.D.

"This filler is a nice supplement to our growing bag of tricks for soft tissue augmentation. Poly-L-lactic acid will not replace any of the currently available filler options, but adds to our repertoire, filling the current void for correcting defects that require more volume and not just a minor spackling," says Dr. Alster, director of the Washington Institute of Dermatologic Laser Surgery and clinical professor of dermatology, Georgetown University, here.

Poly-L-lactic acid is the same material used in absorbable sutures and offers an excellent safety profile. It is highly biocompatible and non-allergenic; therefore, it can be used without skin testing. The material is biodegradable, yet the results achieved are relatively long-lasting.

The U.S. Food and Drug Administration (FDA) has approved injectable poly-L-lactic acid for treatment of HIV-associated lipoatrophy.

However, it also has great potential for aesthetic use, particularly for the treatment of prominent nasolabial and mesolabial folds, Dr. Alster says. "With aging, there is a loss of fat as well as elastic tissue, and poly-L-lactic acid can address the cosmetic consequences of lipoatrophy regardless of its etiology."

Another potential application for injectable poly-L-lactic acid is for the correction of atrophic scars. In addition, Dr. Alster suggests that as physicians become more familiar with this material, they may find it being used more as a lifter in the cheek region than as a simple filler, and they may begin to use it in combination with more superficial filler materials in a layering technique.

"For somebody who has a lot of dermal atrophy, a combination of injectable poly-L-lactic acid with a superficial dermal filler might provide a nice 'one-two' punch with enhanced final cosmetic results," Dr. Alster says.

Poly-L-lactic acid is supplied as a lyophilized powder in a vial that is stored at room temperature. It is reconstituted with sterile water for injection to a volume of 5 mL, and left to rehydrate for 30 minutes to two hours. The contents of the entire vial would generally be used per session for cosmetic correction of nasolabial or mesolabial folds. Greater volumes may be needed to achieve the desired results in persons with more profound defects, such as in individuals with HIV-associated lipoatrophy.

Disclosure: Dr. Alster is on the Dermik Laboratories advisory board, but has no other financial interest in Sculptra or that company.