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 in the arm, chest, and buttocks
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
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)
-0.3
-0.1
0.1
0.3
0.5
0.7
0.9
0 3 6 9 12 15 18 21 24 27Me
an Im
pro
vem
en
t in
WA
S
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
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