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BACKGROUND Injectable devices offer an attractive alternative to surgical cosmetic rejuvenation. Many injectable products are biocompatible but demonstrate varying levels of durability, ranging from temporary to permanent. Product duration is determined, in part, by its mode of operation. Passive fillers, such as collagen, generally add volume through mass, whereas other injectables, such as poly-l-latic acid (PLLA), rely on a foreign-body response in which endogenous collagen production by fibroblasts is thought to generate new volume.

OBJECTIVE To review the use of injectable PLLA, specifically regarding optimal injection technique that can reduce adverse events (AEs) and enhance out comes.

RESULTS PLLA has been used extensively to correct HIV-related facial lipoatrophy, with effects lasting for up to 2 years. The efficacy and safety of PLLA can be influenced by correct product reconstitution, dilution, and administration. Undesired AEs, such as papules and nodules, may result from incorrect reconstitution, uneven product distribution in the suspension, imprecise injection technique (superficial injection), or lack of posttreatment massage.

CONCLUSION Administration of PLLA with optimal techniques can help enhance treatment effect while simultaneously minimizing AES.