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Chap. 21 - POLY-L-LACTIC ACID FILLERS
- from PART THREE - FILLERS AND NEUROTOXINS
- Edited by Sorin Eremia, University of California, Los Angeles, School of Medicine
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- Book:
- Office-Based Cosmetic Procedures and Techniques
- Published online:
- 06 July 2010
- Print publication:
- 08 February 2010, pp 88-90
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Summary
INTRODUCTION
Poly-L-lactic acid (PLLA) is a biodegradable, biocompatible synthetic polymer from the alpha-hydroxy-acid family. Injectable poly-L-lactic acid, marketed as Sculptra (Dermik Laboratories) is used for the treatment of subcutaneous volume restoration. Injection of PLLA into the subcutis results in expansion of the area through a foreign body reaction that elicits increased collagen production from fibroblasts.
The Food and Drug Administration approved PLLA for the treatment of HIV lipoatrophy in August 2004. PLLA is used off-label for the correction of facial lipoatrophy secondary to the normal aging process. PLLA has been available in Europe since 1999 under the trade name New-Fill.
The use of injectable PLLA is growing. Treatment is safe and effective. Precise injection technique is essential for good results and to avoid complications.
PATIENT SELECTION
The best candidates for treatment with PLLA are those seeking volumetric correction secondary to aging or medical conditions such as HIV. On initial evaluation of the patient, facial volume, concavities, and tissue quality should be assessed. Treatment with PLLA involves a series of injections every four to six weeks.
MATERIAL RECONSTITUTION
Each PLLA vial is reconstituted with 3 mL of sterile water on the evening before the procedure. On the day of the procedure, an additional 2 mL of plain lidocaine is added for a total dilution of 5 mL. Some physicians utilize an even greater dilution. The material is stored at room temperature before and after reconstitution. The vials are thoroughly shaken with a laboratory vortex before suspension is drawn up into syringes.
Ch. 9 - Advanta Expanded Polytetrafluoroethylene Implants
- Edited by Neil S. Sadick, Cornell University, New York
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- Book:
- Augmentation Fillers
- Published online:
- 26 February 2010
- Print publication:
- 18 January 2010, pp 81-88
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Summary
INTRODUCTION
The skin's natural aging process manifests itself in the form of contour changes, wrinkles, the depletion of subcutaneous fat, and the loss of dermal collagen and elastin. Today's patients are seeking skin rejuvenation to achieve a natural and youthful appearance through minimally invasive procedures with no downtime. Thinning of the lips and deepening of the nasolabial folds and marionette lines are common manifestations of the aging process. Despite multiple treatment modalities and advances in cosmetic surgery, long-lasting, natural-looking augmentation in these areas continues to present a challenge. Available since January 1, 2001, Advanta expanded polytetrafluoroethylene (ePTFE) implants (Ocean Breeze Surgical, Amherst, NH) have been used successfully for augmentation of thinning lips, deep nasolabial folds, and marionette lines without the risk, recovery time, and expense of major surgery.
DESCRIPTION OF THE ADVANTA ePTFE IMPLANT
Advanta ePTFE implants are an expanded porous polytetrafluoroethylene material with a unique dual- porosity structure. ePTFE is a stable polymer of carbon atoms with a coating of fluorine atoms. The unique dual-porosity structure has a soft high-porosity 100-μm central core surrounded by a smooth, medium-porosity 40-μm outer core. This unique dual-porosity concept promotes tissue integration, vascular ingrowth, and stability. This is critical in preventing migration and reducing shrinkage. The dual-porosity structure is also responsible for a soft feel giving it natural-looking results.
Advanta ePTFE implants are available in sheets and geometrical shapes with and without reinforcement. The implants are either round or oval (Figure 9.1).