Summary of "Poly L-Lactic Acid, PLLA, Biostimulator"

Scientific Concepts and Natural Phenomena

Poly L-Lactic Acid (PLLA) as a Biostimulator

PLLA is a collagen stimulator widely used in aesthetic medicine to induce the skin’s fibroblasts to produce collagen, elastin, and hyaluronic acid—key components responsible for skin elasticity, freshness, and youthfulness.

Collagen and elastin are located in the dermis layer of the skin.
Fibroblasts are the cells responsible for producing collagen and elastin.
PLLA does not act directly but stimulates the body’s natural collagen production.

Mechanism of Action

PLLA is biodegradable and biocompatible; after injection, it is gradually broken down by the body’s enzymes and absorbed without causing inflammation or lumps.
Collagen production stimulation typically begins to show results after about 3 months and can last up to 2 years.
Initial volume effects from fluid injection are temporary and subside within 2 months.

Indications for PLLA Injection

PLLA injections are indicated for:

Face frame enhancement: temple, pre-auricular area, cheeks, and jawline (not suitable for lips, under eyes, or nostrils).
Lifting and slimming of the temple area to create a face-lifting effect.
Volume restoration in the mid-face, especially for patients with significant weight loss or aging-related volume loss.
Improving skin freshness and hydration in middle-aged patients (30s to 40s).
Skin rejuvenation on the neck, chest, and hands.

Contraindications and Cautions

Avoid injection around eyes and lips due to risk of lump formation caused by muscle movements compressing the injected particles.
Patients with autoimmune diseases or those on steroids may have altered or poor responses.
Avoid use in patients prone to keloids or hypertrophic scars.
Proper product preparation and dilution according to manufacturer instructions are critical to avoid complications such as nodules or clumps.

Preparation and Injection Protocol

PLLA powder is reconstituted with saline (usually 10 ml) and requires thorough mixing for 10–15 minutes until fully hydrated and no particles remain undissolved.
The solution can be refrigerated and used within 72 hours, with remixing before use.
The reconstituted solution is divided into 3 ml syringes (typically four syringes with 2.5 ml each) and injected using a 25-gauge, 5 cm cannula.
Injection is performed via a retrograde technique along predefined lines on the face (temple, zygoma, jaw angle), with multiple small deposits spaced about 0.5 cm apart.
The cannula size and length are chosen to minimize trauma and avoid vascular injury.

Post-Injection Care

Patients should perform a “5-5-5” massage: 5 minutes, 5 times a day, for 5 days to evenly distribute the product and prevent clumping.
Use topical creams before massage to reduce friction and skin redness.
Adequate hydration and gentle skin care routines are recommended.
Avoid excessive manipulation or trauma to injection sites.

Treatment Scheduling and Dosage

Initial sessions typically use 1–2 vials; total number of vials depends on patient’s age (Rule of Decades: e.g., 33 years old = 3 vials total).
Sessions are spaced 1.5 to 3 months apart depending on patient condition and treatment goals.
Maintenance injections (“birthday shots”) are recommended annually to sustain results.
PLLA can be combined sequentially with other fillers such as hyaluronic acid or calcium hydroxyapatite for enhanced rejuvenation effects.

Additional Notes

PLLA is injected subdermally or on the bone for volume restoration and collagen induction, not intradermally.
It is not suitable for use as a mesotherapy product or for direct scar treatment inside the dermis.
Collagen loss begins after age 20–25 at about 1% per year, accelerating with sun exposure and poor skin care.
PLLA improves skin quality and firmness, potentially reducing the frequency and amount of other filler use.

Methodology for PLLA Injection

Preparation
- Remove vial cap and sterilize stopper.
- Inject 10 ml saline slowly into vial to hydrate PLLA powder.
- Mix thoroughly for 10–15 minutes until fully dissolved.
- Refrigerate if not used immediately; remix before use.
Syringe Preparation
- Withdraw solution into four 3 ml syringes, each containing 2.5 ml.
- Attach a 25-gauge, 5 cm cannula to each syringe.
Injection Technique
- Create entry points with a trocar.
- Insert cannula and perform retrograde injections along planned lines on temple, zygoma, and jawline.
- Deposit small amounts (~0.5 cm length) spaced evenly to cover the treatment area.
- Pinch and stretch skin as needed to facilitate cannula movement.
Post-Injection Care
- Instruct patient on the 5-5-5 massage protocol.
- Recommend hydration and gentle skin care.
- Monitor for adverse reactions and avoid injection near lips or eyes.
Treatment Scheduling
- Follow the Rule of Decades for total vial number.
- Space sessions 1.5–3 months apart.
- Use maintenance injections annually.

Researchers and Sources Featured

The lecture is presented by an unnamed expert who references a colleague, Dr. Asr, involved in a live demonstration.
The product used is a Korean PLLA formulation with 360 concentration and carboxymethyl cellulose (CMC) as a diluent.
Company protocols and instructions emphasize the importance of using reputable manufacturers for PLLA products.
No specific published researchers or scientific studies are named in the transcript.