Introduction
The midface
region plays a crucial role in youthful facial contours and overall aesthetic
balance. Volume loss in this area due to aging can lead to nasolabial folds,
tear trough depressions, and sagging cheeks. Poly-L-lactic acid (PLLA), a
biostimulatory injectable, offers a regenerative approach by stimulating
collagen production over time rather than simply filling volume with immediate
effect. This article presents clinical insights from a case series evaluating
the efficacy, safety, and aesthetic outcomes of PLLA injections for midface
volumization.
Clinical Overview
PLLA has
emerged as a reliable option in facial rejuvenation protocols, particularly in
patients seeking gradual, natural-looking results. Unlike traditional fillers
that provide immediate volumization, PLLA induces fibroblast activation and
neocollagenesis, resulting in progressive volume enhancement. The case series
under review included adult female patients aged 35 to 55 years presenting with
age-related midfacial volume depletion.
All
patients underwent two sessions of PLLA injection, spaced 6 to 8 weeks apart.
The protocol included reconstitution of PLLA 48 hours before injection and use
of a fanning technique with cannulae to ensure even product distribution across
the malar and submalar regions.
Clinical Results and Study Insights
According
to the 2023 clinical study published in the Journal of Cosmetic Dermatology,
all patients showed a statistically significant improvement in midface volume
scores based on the Midface Volume Deficit Scale (MFVDS). The most prominent
volumizing effects were observed between 3 and 6 months post-treatment,
aligning with the expected collagen biostimulation timeline of PLLA. At the
12-month follow-up, most patients retained a noticeable improvement in cheek
projection and midface contour.
Patient-reported
satisfaction was
high, with 90% of participants stating they would recommend PLLA for midface
rejuvenation. Only minimal side effects were reported—mainly transient swelling
and mild bruising—resolving within 3 to 5 days.
Technique Considerations
The study
emphasized that the success of PLLA in midface restoration relies on proper
patient selection, reconstitution timing, and injection technique. Key
technical recommendations included:
- Use of a 22G or 25G cannula
to minimize vascular trauma
- Deep subcutaneous or
supraperiosteal placement for optimal scaffold support
- Avoiding bolus injection near
the nasolabial or infraorbital areas to reduce nodule formation risk
Pre- and
post-injection massage protocols were also followed to ensure even product
distribution and reduce the risk of granulomas.
Conclusions
This case
series supports the safety and long-term efficacy of PLLA in restoring midface
volume with natural, progressive results. The findings reinforce PLLA’s value
as a biostimulatory alternative for patients unwilling to commit to more
invasive procedures or synthetic fillers. With proper technique and patient
education, PLLA injections in the midface can lead to high satisfaction and
durable aesthetic outcomes.