High-Dilution Technique With Injectable Poly-L-lactic Acid

When using poly-L-lactic acid (PLLA) as an injectable device, undesired effects, most commonly subcutaneous papules, may occur and are thought to result from technique variations. To improve patient satisfaction, techniques must be developed to minimize adverse and undesirable effects. We sought to describe finite techniques that may minimize the occurrence of subcutaneous nodules, specifically through the technique of high-volume dilution. In total, 10 participants (3 men and 7 women) aged 51 to 65 years were injected using the high-dilution technique, with dilution of PLLA within 8 mL of solution rather than 5 mL of sterile water and lidocaine. In addition to the nasolabial folds, we involved off-label injection sites at the mandible, cheeks, upper zygoma, and temporal region to assess for versatility. Three participants (30%) reported the expected side effects of bruising and swelling immediately postinjection, with complete resolution within 5 to 14 days. The same 3 participants (30%) reported erythema immediately postinjection as well. There were no reports of inflammation or edema 1 to 14 days postinjection. Of the 10 participants now followed for more than 24 to 40 months, 1 (10%) developed a nonvisible papule on the midcheek. At the time of follow-up, all 10 participants reported being “very satisfied” given the options of: very satisfied, satisfied, neutral, or unsatisfied.