The authors present a retrospective review of 241 patients who underwent facelift
surgery with fat grafting, associated with Poly-L-Lactic Acid (PLLA) injections for
facial volume maintenance after surgery.[1] They selected PLLA as the main filler used reporting
long-term stability of volume replacement - up to four years - in patients with no
weight fluctuations. The authors had 5 indications for PLLA injections and used
subjective before and after photographs to evaluate its effectiveness. It would have
been powerful to see a more objective assessment of volume retention such as
three-dimensional imaging or patient reported outcome metrics using validated survey
instruments (Video).An important detail of this study was that the authors used an off-label dilution of
PLLA, a common practice in facial aesthetics, reporting no complications or nodule
formation in this series. Integrating facial fillers into postsurgical maintenance
regime is especially helpful in patients with very low body mass index and
inadequate fat donor sites. This paper reflects current clinical facial aesthetic
surgery practices on facial volumization. In addition to PLLA, in our practice and
many others, the use of different filler types such as hyaluronic acid (HA) and
calcium hydroxyapatite is also very helpful for ongoing facial volumization and
rejuvenation.