Poly-L-Lactic Acid (PLLA-SCA) as a Safe and Effective Method to Soften Transition Between Lower Eyelid and Midface

Worsening depression around the lower eyelid and midface are seen over time with age. Skin thinning, fat atrophy, along with pigmentation, skin texture, and shadow changes contribute to the "tired" look of the area. Current minimally invasive treatments approved by the US Food and Drug Administration (FDA) include hyaluronic acid injections, but these come with limitations, such as patient selection and potential risks of Tyndall effect and swelling, which are dependent on injection technique and product selection. However, poly-L-lactic acid (PLLA-SCA) may be an alternative treatment option as it regenerates the patient’s own collagen and elastin and improves skin quality. The aim of this case series is to discuss the technique to improve maxilla/malar projection, pigmentation, texture, and volume after PLLA-SCA treatment. This is a case series where healthy adults with lower eyelid- midface deficiency due to congenital or age-related soft or hard tissue atrophy were injected with 2 to 2.5 mL of PLLA-SCA collagen activator (PLLA-SCA, Sculptra) per injection site diluted to 8 to 9 mL of sterile water for injection (SWFI) and 1 cc lidocaine 2%. Patients returned typically for 3 sessions every 6 weeks. Patients had improvement in maxilla/malar projection, pigmentation, texture, and volume. Clinical outcomes are seen as early as 6 weeks after last session (3 sessions average) with minimal to no touchup required 4 to 5 years post-initial treatment. No unanticipated adverse events were noted. PLLA-SCA is a safe and possibly long-term effective treatment option for patients who require softening of the lower eyelid and midface transition.