Fractional Ablative Laser-Assisted Delivery of Topical Poly-l-lactic Acid: A 2.5-Year Safety Review

Wang, Jordan V; Ugonabo, Nkemjika; Geronemus, Roy G.

doi:10.1097/dss.0000000000003333

Cited by 6 publications

(13 citation statements)

References 4 publications

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“…The microchannels created by the laser limit the depth at which PLA can penetrate. 9 Poly- d , l -lactic acid is the material used for PLA, which is a foam-type filler, compared with the crystal-type PLA, which is a chemical isomer. Poly- d , l -lactic acid has excellent tissue compatibility because the acidity change around the particles and inflammation is less frequent.…”

Section: Discussionmentioning

confidence: 99%

Intradermal Injection of Poly-d, l-Lactic Acid Using Microneedle Fractional Radiofrequency for Acne Scars: An Open-Label Prospective Trial

Hyeong

Jung

Seo³

et al. 2022

Dermatol Surg

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BACKGROUND Treatment with filler injections using a microneedle fractional radiofrequency (MFRF) device is a promising modality with proven efficacy for acne scar treatment. OBJECTIVE To investigate the efficacy and histologic differences of intradermal injection of a filler (poly-d, l-lactic acid, PDLA) using an MFRF device for the treatment of acne scars. METHODS Patients with acne scars on both cheeks were included. Poly-d, l-lactic acid was injected via the MFRF device every 4 weeks for a total of 4 sessions. Patients were evaluated using the grading system for acne scars before each session, as well as personal satisfaction. For histologic evaluation, 2 patients (who consented) underwent a skin biopsy from the upper arm before and after the same single session. RESULTS After the final session, the acne scar grading (échelle d'évaluation clinique des cicatrices d'acné) scale and visual analog scale for evaluation of satisfaction showed improvement compared with initial assessment (36.99% and 79.65% respectively [p < .001, respectively]). For histologic evaluation, biodegradation of PDLA materials and increase in collagen and elastic fibers were observed after 5 months of treatment. CONCLUSION Intradermal injection of PDLA using the MFRF device could be used as an effective treatment with fewer side effects in acne scar patients with Fitzpatrick skin type III-IV.

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Section: Discussionmentioning

confidence: 99%

Intradermal Injection of Poly-d, l-Lactic Acid Using Microneedle Fractional Radiofrequency for Acne Scars: An Open-Label Prospective Trial

Hyeong

Jung

Seo³

et al. 2022

Dermatol Surg

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“…In the authors' clinical practice, the authors routinely combine laser treatments with topicals to increase their penetration, which the authors have published. 5,[19][20][21] The authors do this frequently, especially for melasma, postinflammatory hyperpigmentation, pigmented scars, hypopigmented scars, hypertrophic scars, and photorejuvenation among other conditions.…”

Section: Discussionmentioning

confidence: 99%

Enhancing Skin Uptake of Topical Antioxidants With 1,440-nm Nonablative Fractional Diode Laser Pretreatment

Wang

Friedman

Rodeberg³

et al. 2022

Dermatol Surg

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BACKGROUNDEnergy-based devices, such as nonablative lasers, are a promising method to enhance the delivery and absorption of topically applied molecules.OBJECTIVETo characterize ex vivo uptake of common antioxidant topicals after pretreatment with a nonablative laser wavelength.MATERIALS AND METHODSUsing donor human skin tissue, uptake of 3 topical antioxidants was analyzed (C E Ferulic with 15% l-ascorbic acid [15% vitamin C serum], Phloretin CF with ferulic acid [10% vitamin C serum], and Phyto+ [botanical serum]; SkinCeuticals, Dallas, TX; 2010 formulations) after pretreatment with a 1,440-nm nonablative fractional diode laser.RESULTSPretreatment with the 1,440-nm laser enhanced uptake of 15% and 10% vitamin C serums by approximately 10 and 21 times, respectively, compared to controls. Laser pretreatment also enhanced uptake of botanical serum by approximately 6 times relative to controls. Permeation of vitamin C and botanical serums was also enhanced through laser pretreatment.CONCLUSIONNonablative laser pretreatment increased uptake and permeation of topical antioxidants. Optimizing treatment requires consideration of the device and treatment parameters as well as the properties of the topical formulation.

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“…Using a fresh cadaver cheek, they provided histologic evidence that topically applied PLLA moves into the microscopic channels created by the laser 31 . However, others maintain additional histopathologic studies using in vivo models are required to examine how fibrin plugs and inflammation might influence product delivery 32 . Rkein et al 31 conducted an uncontrolled, prospective study of ablative fractional CO 2 laser immediately followed by topical PLLA to treat atrophic scars in 19 patients.…”

Section: Off‐label Indicationsmentioning

confidence: 99%

“…No adverse events related to the treatment − including filler nodules, delayed healing, prolonged erythema, or abnormal scarring − was observed in the study. The authors postulate the lack of any delayed nodules is likely due to the nature of the laser‐induced channels, which limits the amount and depth of PLLA penetration and distributes product evenly throughout the upper dermis 32 . Despite promising preliminary studies, controlled investigations are still needed to compare combined fractionated CO 2 laser and PLLA treatments with each individual modality, and optimal laser settings and PLLA dosing still remains to be defined.…”

Section: Off‐label Indicationsmentioning

confidence: 99%

“…31 However, others maintain additional histopathologic studies using in vivo models are required to examine how fibrin plugs and inflammation might influence product delivery. 32 Rkein et al 31 conducted an uncontrolled, prospective study of ablative fractional CO 2 laser immediately followed by topical PLLA to treat atrophic scars in 19 patients. Four blinded observers determined that 3 months after a single treatment, 95% of the scars had improved with an average improvement of 33% in various criteria.…”

Section: Off-label Indicationsmentioning

confidence: 99%

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Sculptra®—History and how it is best used today

Eason

Snyder

Favre

et al. 2023

Dermatological Reviews

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Introduction: Sculptra ® is an injectable biostimulatory soft tissue filler containing microparticles of poly-L-lactic acid (PLLA) that is FDA-approved for the correction of HIV-associated facial lipoatrophy and nasolabial fold contour deficiencies and other facial wrinkles in immunocompetent patients. Injectable PLLA has been shown to provide gradual improvement in cutaneous thickness by inciting a subclinical inflammatory response that stimulates increased collagen deposition in the dermis, with results lasting up to 2 years.Discussion: The utilization of Sculptra ® in aesthetics has expanded to many off-label indications including panfacial revolumization, improvement in skin quality, and use in various non-facial sites such as the neck/décolleté, abdomen, arms, hands, thighs, and gluteal area. Clinical experience and scientific investigation have driven changes in the way PLLA is used. Simpler methods of product preparation, improved injection techniques, and attention to appropriate patient selection have led to improved outcomes and ease of use. Conclusion:PLLA's long safety history and ability to produce subtle yet significant results through a biostimulatory mechanism make it an attractive and versatile option for cutaneous volume augmentation.

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Fractional Ablative Laser-Assisted Delivery of Topical Poly-l-lactic Acid: A 2.5-Year Safety Review

Cited by 6 publications

References 4 publications

Intradermal Injection of Poly-d, l-Lactic Acid Using Microneedle Fractional Radiofrequency for Acne Scars: An Open-Label Prospective Trial

Intradermal Injection of Poly-d, l-Lactic Acid Using Microneedle Fractional Radiofrequency for Acne Scars: An Open-Label Prospective Trial

Enhancing Skin Uptake of Topical Antioxidants With 1,440-nm Nonablative Fractional Diode Laser Pretreatment

Sculptra®—History and how it is best used today

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