Injectible Fillers: Principles and Practice

Excerpt from Authored Chapter 6 : "Poly-L-Lactic Acid"

Rebecca Fitzgerald Dermatology Private Practice and David Geffen School of Medicine, University of California, Los Angeles, USA
Danny Vleggaar Centre Dermato-Cosmetique 'Roseraie' , Geneva, Switzerland

Facial Analysis and Mapping. A youthful face represents a point in time when a particular set of skeletal proportions is ideal for their soft - tissue envelope.
We grow into this from infancy and then lose it with age. As mentioned previously, although the sequence of changes as we age is somewhat predictable, the pace is not. In addition, the changes in each structural layer of the face do not occur independently, but interdependently, as an interlocking three - (Removed imagery and reference)

Subsequently, there is no one algorithm to address facial aging. Facial analysis is a process of observation and palpation / provocation that allows us to determine the nature and extent of the structural tissue changes aging the face in front of us at that particular point in time, and to then plan a treatment accordingly. It is not a "recipe", it is a "read". What you choose to address depends on the extent of the changes noted in each layer and the parity of these changes between layers, i.e. if there is a great deal of disparity, try to blend them all back to a more similar place (i.e. we have likely all experienced at some point the undesirability of putting a pair of young lips on an old face). If there is just a little change in all layers, almost any interventional approach will work. If there is a lot of loss of integrity in multiple layers, then multiple interventions may be needed to obtain optimal results.

PLLA is a versatile agent to use to address these changes because it can be used to strengthen the dermis, or to mimic volume elsewhere with "space - occupying" collagen: i.e. it mimics fat if placed in fat, or bone if placed supraperiosteally - allowing the practitioner to tailor the treatment according to the specifi c aging changes manifested in that individual face. 31 Deep supraperiosteal injections are done wherever possible, and subcutaneous injections are carried out where there is no underlying skeletal support as outlined above in the section on technique..."