Using poly-L-lactic acid (PLLA) to mimic volume in multiple tissue layers.

Sculptra (Sanofi-Aventis, Bridgewater, NJ) was approved by the U.S. Food Drug Administration (FDA) for use in HIV-related lipoatrophy in 2004 and received FDA approval for cosmetic use as Sculptra Aesthetic in July 2009. The authors have experience with this product in both applications. The purpose of this article is to share their methodology. Both soft-tissue and supraperiosteal injections will be illustrated and discussed in detail. Much progress has been made in the last decade in understanding of volume changes in all structural layers of the face, and this will be briefly reviewed as it is pertinent to the methodology. Equally important is the issue of patient selection. Ultimately, the quality of the result, and the time and amount of product that it takes to achieve that result, is contingent on the quality of tissues with which one starts. A very lipoatrophic patient, or an elderly patient with advanced volume loss and poor skin integrity is more difficult to correct-requiring more product and more treatment sessions (with any product) than that needed for a younger or plumper face.