LAS VEGAS The filler poly-L-lactic acid is indicated for HIV facial atrophy, but in experienced hands it also is safe for volume replenishment of tear troughs and hands, Dr. Neil S. Sadick said at an international symposium on cosmetic and laser surgery.
Before the procedure, instruct patients not to take aspirin, ibuprofen, or platelet inhibitors. Apply a topical anesthetic, such as lidocaine, under occlusion for 30 minutes to the treatment area. "When the S-Caine peel is available, it will replace topical lidocaine," predicted Dr. Sadick, who is in private practice in New York.
Poly-L-lactic acid (Sculptra) is a synthetic filler that requires reconstitution at least 2 hours prior to treatment. Although the instructions for use indicate that the filler can sit reconstituted up to 2 weeks, "it can stay for a couple of months, according to several recent studies," Dr. Sadick said.
Proper dilution and technique are required. For tear troughs or hands, dilute the poly-L-lactic acid in 6 cc of sterile water and 2 cc of 1% lidocaine. For hands, 2 vials of poly-L-lactic acid and prepare eight 1-cc syringes (four for each hand) with 26-gauge half-inch needles. Have ice packs available.
"The most important factor is to tent the skin to minimize the bruising when injecting between each intraosseous space," said Dr. Sadick. "Always aspirate to make sure you are not in a blood vessel," he said.
Once the injections are finished, vigorously massage the area for 10 minutes and then apply ice packs for another 10 minutes. Repeat this regimen for three cycles to avoid the formation of nodules and to minimize pain, said Dr. Sadick, who is a consultant for Dermik Laboratories Inc., the manufacturer of Sculptra.
The volumetric effect goes away in the first few weeks, but collagen remodeling produces a late effect that lasts 69 months, Dr. Sadick said. Optimal results are seen after two or three treatment sessions at 3- to 4-week intervals.
Before and after images show the results of injecting a hand with poly-L-lactic acid (Sculptra), a filler approved for the treatment of HIV-associated lipoatrophy. Photos courtesy Dr. Neil S. Sadick
