Treatment of facial asymmetry with poly-L-lactic acid: A case study

Poly-L-lactic acid (PLLA) (Sculptra (R), Dermik Laboratories, Bridgewater, NJ, a business of sanofi-aventis US, LLC) is a novel biocompatible and biodegradable injectable device currently under review by the Food and Drug Administration for a cosmetic indication. When implanted into soft tissues, PLLA is thought to elicit a foreign body reaction, resulting in fibroplasia and subsequent collagen formation. This process leads to a gradual thickening of the dermis and long-lasting augmentation of facial contours. In the reported case, PLLA was used to treat a 69-year-old African-American woman who had undergone numerous unsuccessful procedures for correction of prominent facial asymmetry. One vial of PLLA (5-ml dilution) was injected into the dermal-subcutaneous plane using a lattice distribution in the right upper cheek and malar regions, followed by massage. The procedure was repeated 6 weeks later. Several months after the two separate PLLA treatment sessions, the contours of the right upper cheek and malar regions were visibly and cumulatively enhanced, and facial symmetry was gradually restored, to the patient's full satisfaction. The treatment was well tolerated on both occasions, and the benefits of treatment have been sustained 18 months after the last procedure. The author concludes that injectable PLLA is a safe and effective minimally invasive treatment for facial contour defects.