Poly-L-Lactic Acid (Sculptra®Aesthetic) Basic Injection Techniques

CME VIDEO

After completing this CME activity, participants should be better able to:

• Describe the uniqueness of PLLA compared with other dermal fillers• Recite adverse events for filler injections and establish a clinic-wide plan to

handle adverse events• Decide on the best PLLA reconstitution methods for your clinic• Identify the best PLLA candidates for the injection sites demonstrated• Integrate into practice injecting PLLA into the most common areas in the face

Learning Objectives

2015 Nonsurgical Procedures in U.S.

http://www.surgery.org/sites/default/files/ASAPS-Stats2015.pdf

Nonsurgical procedures in 2015 accounted for 42% of the total expenditures in 2015

Percent Change in Nonsurgical Procedures 2015

http://www.surgery.org/sites/default/files/ASAPS-Stats2015.pdf

Common Dermal Filler Areas

www.clearskinmd.net/dermal-filler/

Aesthetic Facial Rejuvenation

Common Dermal Injectable Fillers in U.S.

Trade Name Generic

Radiesse® Hydroxylapatite

Restylane Lyft with Lidocaine® Hylauronic acid with lidocaine

Restylane Silk® Hylauronic acid with lidocaine

Juvederm Volumna Xc® Hylauronic acid with lidocaine

Restylane® Injectable Gel Hyaluronic Acid

Belotaro Balance® Hyaluronic Acid

Bellafill® Polymethylmethacrylate (PMMA) Beads, Collagen and Lidocaine.

Evolence®Collagen Filler Porcine Collagen

fda.gov/MedicalDevices/ProductsandMedicalProcedures/CosmeticDevices/WrinkleFillers

Poly-L-Lactic Acid (PLLA)*

• Only product in class• Not hyaluronic acid or collagen• Takes multiple treatments• Collagen stimulator• Gives subtle, longer lasting results• “Natural”• Not an immediate, dramatic change

Int. J. Mol. Sci. 2011, 12(6), 3857-3870

J Cosmet Laser Ther 2005 Dec;7(3-4):201-5.

Biomaterials. 1991 Jan; 12(1):32-6.

*Sculptra®Aesthetic)

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PLLA (116)

Collagen (117)

Months

Week 3

Month 13

Month 25

Effect of PLLA Lasts Significantly Longer vs. Collagen

Biostimulatory PLLA Overcomes Collagen Deficits

Young Collagen Aging Collagen

TIME

Collagen decreases with age

PLLA Stimulates Collagen Production Over Time

PLLA Treatments

Common• Bruising• Redness• Swelling• Pain• Tenderness• Itching, rash

Less Common• Raised bumps in or under the skin

(nodules or granulomas)• Infection• Open or draining wounds• A sore at injection site• Allergic reaction• Tissue necrosis

KNOW the Possible Adverse Events with Fillers

Avoid Unintentional Vessel Injections

Periorbital

Glabella

Expert Faculty

Sabrina Fabi, MD, FAAD, FAACSSan Diego, California

Expert Faculty

Rebecca Fitzgerald, MD, FAAD, ASDSLos Angeles, California

Patient 1

SABRINA FABI, MD, FAAD, FAACS

Dr. Fabi Reconstitution Method

• Mix 7cc Bacteriostatic water to 1 cc PLLA

.• Prefer to wait 24 hours,

but at least overnight

• At bedside, add 1 cc lidocaine without Epinephrine

Dr. Fabi Syringe and Needle Choices

• 1 cc Luer lock instead of 3cc Luer Lock

• Always a 25g needle

• 1.5 inch needle for face

• 5/8 inch needle for temple

Subcutaneous Plane for PLLA

Avoid DAO, DLI, and Orbicularis

Patient 2REBECCA FITZGERALD, MD, FAAD, ASDS

Fat reduces in the face over time

Thank you!Please complete the post-assessment to

obtain CME credit.