Safety of Laser-Assisted Delivery of Topical Poly-l-Lactic Acid in the Treatment of Upper Lip Rhytides: A Prospective, Rater-Blinded Study

Abstract

BACKGROUND Perioral rhytides are a common complaint among dermatologic patients and can be notoriously stubborn and resistant to therapy. OBJECTIVE We aimed to assess the safety of fractional ablative laser-assisted delivery of topical poly-l-lactic acid (PLLA) suspension in the treatment of upper cutaneous lip rhytides. MATERIALS AND METHODS Prospective, single-arm, rater-blinded trial. Ten subjects with moderate to severe upper lip rhytides underwent 3 bimonthly treatments of low-density fractional carbon dioxide laser followed by topical application of PLLA suspension. Wrinkle severity before and after treatment was analyzed using computer-generated analyses. Blinded raters and subjects assessed improvement of wrinkles after treatment using the Global Aesthetic Improvement Scale (GAIS) (scores ranging from −3 to 3). Adverse events were recorded at each visit. RESULTS Treatments were well tolerated. Other than expected post–laser erythema, no unanticipated adverse events were noted. After 3 treatments, the severity of upper lip wrinkles decreased by an average of 47% (p < .05) as calculated by computer-generated image analyses. Blinded raters and subjects rated wrinkles as much improved after 3 treatments (score of 2 on the GAIS). CONCLUSION Laser-assisted delivery of PLLA is a safe and possibly effective treatment for upper lip rhytides.

Evidence-Based Clinical Practice Guidelines for Laser-Assisted Drug Delivery

“…In total, 48 published studies of AF LADD met inclusion criteria (eFigure in the Supplement): 4 cosmetic studies,, 21 oncologic, and 23 medical (not cosmetic/oncologic) . In addition, 6 publications of NAF LADD were included at the request of the expert panel, for a total of 54 studies.…”

“…Abbreviation: GRADE, Grading of Recommendations Assessment, Development and Evaluation. a These are provided for illustrative purposes and are based on published reports b Level of evidence and strength of recommendation were determined by the guideline panel for the specific indication, but not necessarily for a particular technique or topical agent.…”

“…Multiple treatments, often at 1-month intervals, are often required to attain the desired clinical result . Patients tend to tolerate these treatments well, although reported adverse events include increased scar telangiectasia, postinflammatory hyperpigmentation, and transient treatment-related effects such as pain, burning sensation, and edema …”

Laser‐Assisted Hyaluronic Acid Delivery by Fractional Carbon Dioxide Laser in Facial Skin Remodeling: A Prospective Randomized Split‐Face Study in France

“…In the current literature, there was not any available data about the pro-penetration of HA. We could found two publications [22,23] about the LAD of poly-L-lactic acid to treat atrophic scars and upper lip wrinkles. To treat these conditions, a high density and thus an increased impact of the CO2 laser was needed to have a clinical result.…”

Treatment of an Atrophic Scar with Fractional Carbon Dioxide Laser-assisted Poly-L-lactic Acid Delivery

“…PLLA is a synthetic substance that not only acts as a filler for subcutaneous injection but also promotes collagen production and vascularization; histological findings have shown that skin thickness increases after treatment. 13,14 PLLA is usually limited in its absorption into the skin owing to its large particle size. To overcome this, we set the spot size of fractional CO2 to 120 μm and used a tightly controlled size of 30-50-μm PLLA to complement the existing large particle size.…”