Polylactic acid is available as a lyophilisate that is dissolved with water for injections. In addition to microspheres, polylactic acid contains the products carboxymethylcellulose and mannitol. Poly-L-lactic acid is biocompatible, immunologically inactive, and biologically absorbable. Synthetic production is used; therefore skin testing is not necessary*.
■ Indication: deep folds, to provide contours and to build up volume, e.g., nasolabial folds, marionette folds, and cheeks, possibly chin, scars, and upper lip. Also to build up the cheeks in cases of lipoatrophy.
■ Mechanism: after Sculptra® has been injected, the wrinkle is mechanically filled with the injected volumes. The water contained in the suspension is, however, absorbed by the body within a few days and the wrinkle returns. A gradual and natural build-up of volume is achieved only after this as a result of the formation of new collagen fibers. This provides a lasting effect which, in a good case, may last for more than 2 years. Induration may sometimes occur.
■ Contraindications: allergy to one of the components; acute or chronic skin diseases: injections in the vermilion of the lips.
■ Explanation of procedure: a written declaration of consent must be obtained from the patient regarding possible complications such as hematomas, swellings, reddening of the skin and formation of nodules.
• Injection depth: deep dermis to the border to the subcutis.
• Materials required: poly-L-lactic acid (Sculptra®)
Water for injections Possibly local anesthetic
• Storage: at room temperature (not above 30 °C)
* Aventis Pharma Deutschland GmbH, Königsteiner Strasse 10,65812 Bad Soden, Germany.
■ Reconstitute the lyophilisate with 5 ml water for injection (note: it can £ also be dissolved with 4 ml water and 1 ml local anesthetic). Add the water to the bottle slowly and allow to stand for at least 2 h so that the water can penetrate the lyophilisate
■ roduce photographic documentation prior to treatment.
■ Possibly local anesthesia (cream or regional anesthesia).
■ Shake the bottle well until the suspension is homogeneous, immediately before use Shake again before opening the bottle in every case!
■ Use a 26-Ga needle for injection.
■ Check that the injection needle is unobstructed before every injection is given.
■ Linear injection technique: first insert the full length of the cannula, then inject with a slight punching pressure when withdrawing the needle. Inject only small quantities (0.1-0.2 ml per injection).
■ Then massage the area of the face treated (preferably with cream to reduce the friction) and cool if necessary to reduce the swelling.
■ Aftercare: cooling until the swelling has reduced. Massage the areas of the face treated for a few minutes over several days.
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