Polylactic acid (SCULPTRA)

Poly-L-lactic acid – also known as polylactate or polylactic acid – is a synthetically derived polymer of lactic acid.
Poly-L-lactic acid is produced through the polymerization of lactic acid, which in turn is obtained from fermentation processes generally carried out by bacteria of the genus Lactobacillus.
L’acido polilattico è largamente sfruttato nell’ambito della medicina estetica, dove viene utilizzato sotto forma di filler in alternativa alla chirurgia plastica.
Il successo dell’uso dell’acido polilattico nel campo della medicina estetica è da ricercarsi nelle sue interessanti proprietà. Difatti, esso è sì un polimero sintetico ma biodegradabile, assorbibile ed immunologicamente inerte.

A valid alternative to a facelift, poly-L-lactic acid (marketed as Sculptra ®) is successfully used to correct facial imperfections and blemishes, such as:

• Superficial wrinkles;
• Small furrows/natural skin creases;
• Small surgical scars or scars left by acne;
• Sagging, poorly defined, or barely noticeable cheekbones;
• "Weak" and unharmonious chin;
• Deep dark circles caused by the so-called "tear trough" (a typical sign of aging, characterized by a pronounced thinning of the skin in the periorbital area and the "sagging" of the lower eyelid).

• The poly-L-lactic acid micro-particles, properly diluted in sterile water, are injected very slowly into the sub-dermal layer using syringes equipped with ultra-thin needles.
  The presence of poly-L-lactic acid in the dermis gradually (but progressively) stimulates collagen synthesis: in doing so, a considerable increase in the volume of the atrophic areas of the face can be appreciated, even if only after 4 to 6 weeks.

  Since these are injections, the poly-L-lactic acid treatment is not completely painless: in fact, most patients undergoing this procedure complain of discomfort, burning, or an unpleasant stinging sensation, both during and after the infiltration of the product under the skin. To overcome this drawback and minimize pain, the area to be treated is generally anesthetized with local anesthetics (e.g., lidocaine, mepivacaine hydrochloride).

As mentioned, poly-L-lactic acid is a well-known dermal filler which – once injected into the facial skin – is able to effectively stimulate the synthesis of new collagen (neocollagenesis).
Specifically, it is capable of promoting the activity of fibroblasts, the dermal cells responsible for the synthesis of elastic fibers, glycosaminoglycans (such as hyaluronic acid), and, precisely, collagen.

Unlike other dermal fillers (e.g., hyaluronic acid fillers), poly-L-lactic acid does not produce its soft-lifting effects in the immediate post-injection period: the results appear gradually precisely because this substance stimulates long-term neocollagen production. In fact, the first results are visible only after 4 to 6 weeks and, to achieve the desired rejuvenation or remodeling effect, a total of 2 to 6 treatments may be required (depending on the blemish to be corrected).
As an indication, it is estimated that to achieve an appreciable and satisfactory result, at least 3 sessions are required for the correction of minor facial flaws, and 5 to 6 treatments to restore severe aesthetic alterations (e.g., volumizing the chin and cheekbones).
After a variable period of time ranging from 12 to 30 months, poly-L-lactic acid is completely reabsorbed by the skin: for this reason, the molecule is considered a resorbable biological filler (even though some sources erroneously consider it a semi-permanent filler).

Poly-L-lactic acid injections represent an important, minimally invasive, and long-lasting alternative to cosmetic surgery for correcting the typical defects of skin aging. Compared to other types of fillers, poly-L-lactic acid excels in several characteristics:

• Long-lasting effect (12-30 months);
• Few side effects;
• Quality of the injected material;
• Biodegradability of the product.

Furthermore, it should not be forgotten that poly-L-lactic acid corrects facial flaws while ensuring a completely natural effect, without affecting facial expressions in any way.
Da pochi anni a questa parte è stata ideata una nuova metodica d’applicazione dell’acido polilattico: anche glutei, braccia e cosce possono, infatti, beneficiare del trattamento con questa sostanza. Più precisamente, le iniezioni di acido polilattico in sedi differenti dal viso, trovano indicazione per:

• Reducing cellulite and reshaping orange-peel skin;
• Correcting sagging of the inner thighs;
• Reshaping the sagging inner arms.

To minimize the risk of side effects, it is first and foremost necessary to rely on highly qualified and competent cosmetic surgeons or aesthetic medicine physicians.
That being said, the incidence of side effects – such as small hematomas, bruising, edema, infections, redness, or minor bleeding – after a poly-L-lactic acid treatment is virtually comparable to that of other fillers.
Furthermore, some patients complain about feelings of tension and heat in the area where the poly-L-lactic acid was injected.
These effects, however, tend to resolve spontaneously within a few days.
It is highly unlikely for more severe side effects than those just listed to occur. However, should they manifest, the causes would be related to an incorrect execution of the injection rather than to the polymer itself.

The presence of skin diseases, autoimmune disorders, malignancies, or other major conditions constitutes a major limitation to the use of fillers in general, including those with poly-L-lactic acid.
In general, the use of poly-L-lactic acid to correct skin imperfections is reserved for patients who are in good health.
Furthermore, it should be remembered that poly-L-lactic acid cannot be injected during pregnancy and breastfeeding, nor in individuals who are sensitive or allergic to this substance.