ABSTRACT
Safety History Special training is required for the authorized use of PLLA. Without proper training, the potential for certain adverse events increases. However, PLLA use is especially safe. Since 1999, over 150,000 people in more than 30 countries have been treated with PLLA for a variety of facial volume and contour deficiencies ( 1 , 15 ). In our own clinicthe Center for Dermatology and Dermatologic Surgery (Washington, D.C., USA)—PLLA has been successfully used to treat lipoatrophy of the hands, feet, face, and buttocks in both immunocompetent and immunocompromised patients. In fact, of 61 HIV-infected patients treated with PLLA, excellent responses to treatment was observed in 100% of patients at 6 months follow-up. After treatment was complete, the patients were followed every 6 months from 2001 to 2005, with no reports of allergic reactions, infections, or severe adverse events ( 2 ). Several other studies have shown safety and efficacy in both immunocompetent and HIV-infected patients 16-18 . For example, a study in 102 HIV-positive patients receiving highly active antiretroviral therapy (HAART) and 620 cosmetic (presumed immunocompetent) patients, treatment with PLLA resulted in optimal volume enhancement in all the patients, even at two years post-final injection. In addition, adverse events were minimal, and included five cases of palpable, non-visible papules, and one possible foreign body reaction found one-year post-injection, resulting in a mild visible nodule. No allergic reactions were observed ( 19 ). Clinicians have begun to identify other conditions for the use of PLLA. For example, a recent publication has reported that the use of PLLA to treat acne and varicella scars yielded excellent safety and efficacy results ( 20 ). Also in development, is the novel use of PLLA as an injectable craniofacial implant in a supraperiosteal location to address both soft tissue volume loss and loss of craniofacial support ( 21 ).
