Collagen Stimulators in Body Applications: A Review Focused on Poly-L-Lactic Acid (PLLA)

Abstract

The number of aesthetic procedures performed worldwide continues to grow together with an increase in the population seeking the restoration or preservation of a youthful appearance. Requests for non-surgical body rejuvenation are increasing. Patients are looking for safe and effective minimally invasive aesthetic procedures. Soft-tissue dermal fillers can meet these expectations. Based on the beneficial outcomes of these treatments in many facial areas, a new trend is developing to target body areas. Different dermal fillers are available and include collagen stimulators initially developed to restore facial volume. Furthermore, they are associated with long-lasting efficiency, a high level of patient satisfaction and a good safety profile, with mainly minor adverse events reported. In appropriate conditions of use, they are now used for body rejuvenation in clinical practice. Their use is expanding and allows addressing various issues including volume loss, skin laxity, cellulite, striae distensae and wrinkles. This review focuses on poly-L-lactic acid (PLLA), used in the first collagen stimulator and one of the most investigated in facial and in off-facial body applications. The available published data, although still limited, are presented by body area, neck and chest, buttocks, abdomen, upper arms, thighs, knees, and hands. Key features of the concerned zones and the main clinical signs affecting the body part as well as the injection modalities are provided along with the aesthetic results. This represents the state of the art on which to base further developments necessary for optimal and safe outcomes of treatment with the PLLA-based collagen stimulators and others in this class for body rejuvenation.

Poly‐L‐Lactic acid increases collagen gene expression and synthesis in cultured dermal fibroblast (Hs68) through the TGF‐β/Smad pathway

“…Poly‐L‐Lactic Acid (PLLA) is a biocompatible, biodegradable, absorbable, immunologically inert, malleable, and easy‐to‐process polymeric synthetic polymer derived from plants that have been used in previous studies of synthetic suture materials. It was approved by the food and Drug Administration (FDA) in 2004 for the treatment of facial fat atrophy following immunodeficiency virus infection and in 2009 for nasolabial folds and other dermal wrinkles 8 . The volume‐expanding of PLLA post‐injection is caused by the thinner.…”

“…It was approved by the food and Drug Administration (FDA) in 2004 for the treatment of facial fat atrophy following immunodeficiency virus infection and in 2009 for nasolabial folds and other dermal wrinkles. 8 The volumeexpanding of PLLA post-injection is caused by the thinner. As the thinner is absorbed, the PLLA particles slowly degrade, promoting the formation of fibrous tissue and new collagen.…”

Recent progress and clinical applications of advanced biomaterials in cosmetic surgery

“…In addition to its classic application in facial area, PLLA is currently used for volume increase, body contouring, sagging skin, scarring and fine line expansion in areas beyond the face such as neck and chest, buttocks, abdomen, arms, thighs, knees and hands. A recent survey reported that hip augmentation (42.4%) is the second most common use of PLLA in the USA, after HIV lipoatrophy (46.8%), which is enough to demonstrate the importance of PLLA in the field of body therapy [ 45 ].…”

Sculptra®—History and how it is best used today

“…Sculptra® is becoming a popular option for noninvasive buttocks augmentation, particularly in individuals who lack sufficient amounts of donor fat for autologous fat transfer 34 . Numerous studies of varying evidentiary strengths have investigated PLLA buttocks injection for a range of purposes: improvement in skin laxity; reduction in the appearance of cellulite, scars, and striae; and overall augmentation/contouring 36 . One of the earliest reports of this novel use was by Lorenc in 2012, who reported positive outcomes with one vial of Sculptra® per buttock 37 .…”