What is PDLLA?Aesthefill

When will I see the results from PDLLA?

Immediately after the injection, however, this is due to the diluent (saline/- local anesthetic)  in addition to the carrier gel (carboxymethyl cellulose). Collagen stimulation starts at 4-8 weeks after the injection & the best results are seen after the last injection. A series of 2-3 treatments are required, spaced 4-10 weeks apart. 

*For low level biostimulation, hyper diluted PDLLA  is used. In this application the aim is not volume correction but it is employed to stimulate the production of collagen, preventing future collagen loss. Hence employed as a biostimulator, results may not be apparent. 

PDLLA can be performed using a cannula or via a needle. Cannulas are more comfortable, carry less risks & are faster to perform. The procedure takes 2-3 minutes to perform. Expect-

• Mild swelling for several hours
• Redness that is transient
• Bruising (rare)  

Makeup can be worn 30 minutes after the procedure & physical activities can be carried out later that day. Biostimulatory injectables do not carry any downtime. 

2-3 sessions, spaced 4 to 10 weeks apart. One session is required for maintenance. 

As of early 2023, no, however a TGA submission has been made. We do expect new biostimulatory injectables to be available in the next few years. The current repertoire of injectables in Australia include; Profhilo, Radiesse, Sculptra, Rejuran & soon, Gouri. 

Sculptra is also made of poly-L-lactic acid or PLLA. The composition is similar to PDLLA may have some advantages over PLLA as less treatments are required (2-3), as compared to Sculptra (2-5). Split face studies are required to confirm this theory. 

Sculptra has a long safety record of over 15 years in Australia, whilst PDLLA is still yet to be TGA approved. 

Profhilo is composed of high & low molecular weight hyaluronic acids. It works best as a hydrator, replacing dermal hyaluronic acid (as compared to derma fillers that are usually placed deeper). PDLLA provides more volume & dermal collagen stimulation than Profhilo. Aesthetfill

Rejuran is classed as a polynucleotide injectable, derived from salmon gonad DNA. It works best as a superficial scaffolding agent that improves skin elasticity & quality. Collagen stimulation is limited. It does not provide any volume correction. 

PDLLA stimulates an inflammatory response in order to trigger the skin’s natural production of collagen. This is termed fibrosis. Aesthefill 

After  injection, the body’s immune system responds by creating cells known as fibroblasts (connective tissue cells) to surround the “foreign body,” the filler, the result being firmer, thicker skin. The more ‘proinflammatory’ an injectable is, the better the result (within reason). This is why PDLLA, Sculptra & Gouri injections are better at producing collagen as compared to Profhilo. 

PDLLA has FDA approval & it is undergoing TGA approval as of 2023. It has been researched in Korea for the past decade & has been approved for use in many Asian countries. It has an excellent safety record, however it is relatively new as compared to PLLA or Sculptra. 

PDLLA is degraded to CO2 & water by the body’s immune system & typically last 2 years. 

Between 8 to 10 ml per vial. This compares to Sculptra at 9 to 20 mls, Radiesse at 1.5 to 4.5 mls, Profhilo at 2-4 mls, Gouri at 1.2 to 2.4 mls & Rejuran at 2 mls. Dilution will depend on the ratio of volume: biostimulation. 

Reconstitution can be with SWFI, sterile water for injection, or SWFI plus xylocaine. PDLLA, much like other dermal fillers – biostimulants contain CMC. 

It is complex. A simple explanation is that dermal fillers lean towards correction of volume, whilst collagen stimulating injectables are more biased towards skin tightening & firming. There are however overlaps, depending on the product. 

PDLLA is biased towards volume, with secondary collagen stimulation. Gouri on the other hand (PCL) is biased towards skin tightening with minimal volume, Profhilo is more hydration than tightening. PLLA & CAH can volumise & or stimulate collagen (firm & tighten), depending on the dilution. Aesthetfill

It depends on the injectable itself. HA biostimulatory agents have the least side effects, whilst older PCL such as Ellanse have higher side effects. They include-

• Delayed nodules (especially around the eyes)
• Swelling (PCL, higher incidence in high volume & or subsequent injections)
• Post inflammatory pigmentation (Gouri)
• Persistent redness
• Vascular occlusion (rare) *
• Allergic reactions 

Vascular occlusion & blindness has been reported with PDLLA injections to the face. Though this is rare, injectors should be mindful of the risks. Cannula injections can reduce, but not totally eliminate this complication.

Low level biostimulation can be achieved with the following methods-

• Multipass radiofrequency devices (Pelleve, Tempsure, NuEra)
• Low level lasers
• Clinical peels

It depends on the type of thread employed. Threads are best used to reposition skin & tissue via anchoring points. 

• Monofilament threads (Mint PDOs): just don’t work by themselves. They are fun to perform & easy to do. 
• Cog threads are better
• Filler threads are much better than PDOs (surface area & weight) 

In general, biostimulatory injectables are better than threads as they provide more predictable results, have less downtime & less side effects. Obviously if you see someone who does threads but doesn’t understand the repertoire of biostimulatory injectables, you will get a different answer.  

These are classed as higher level biostimulatory devices, meaning that you can only perform a set number of treatments. Think of these as ‘tokens’ at an amusement park. The same applies to high power fractional lasers, high heat RF (Thermage) & HIFU (Ultraformer- Ultherapy). 

Though useful for intermittent correction of laxity & loss of tone, these devices are only employed in an ‘as required’ role. Biostimulation with injectables are preventive.