Clinical Experience of Poly-L-Lactic Acid (Sculptra) Across Different Patient Profiles Using the AART Methodology and Expert Consensus on Minimizing the Risk of Complications—The Malaysian Perspective

BACKGROUNDPoly-L-lactic acid (PLLA-SCA) is a well-established regenerative collagen stimulator used for correction of shallow to deep nasolabial fold contour deficiencies, fine lines and wrinkles in the cheek region, and other facial wrinkles. Despite its widespread clinical use, variability in injection techniques and limited standardization contribute to inconsistent outcomes and potentially preventable complications. This paper presents expert recommendations for minimizing complications associated with biostimulators, including nodules, granulomas, and vascular occlusion. In addition, clinical cases demonstrating the application of the AART methodology with PLLA-SCA treatment are presented based on author clinical experience.

METHODSAn expert consensus process was conducted involving six experienced aesthetic physicians specializing in biostimulator treatments. Consensus discussions focused on the identification, prevention, and management of complications associated with PLLA-SCA, including nodules, granulomas, and vascular compromise. Four clinical cases demonstrating the utilization of AART methodology in routine practice were included.

RESULTSThe expert panel achieved consensus on key preventive strategies to minimize the risk of nodules, granulomas, and vascular occlusion, highlighting the importance of comprehensive anatomical assessment, precise injection techniques, appropriate product preparation, and proper post-treatment care. Across all clinical cases, PLLA-SCA treatment demonstrated improvements in Facial Assessment Scale (FAS) scores, Global Aesthetic Improvement Scale (GAIS) outcomes, and skin pinch test, with patient-reported satisfaction with the treatment outcomes. No significant adverse events were observed in the presented cases.

CONCLUSIONThis expert consensus provides practical guidance for reducing complication risks associated with biostimulator injections in clinical practice. A thorough understanding of facial anatomy and adherence to appropriate injection protocols are essential to ensure optimal safety and efficacy. In addition, a structured approach to patient assessment and treatment planning using the AART methodology may assist practitioners in achieving consistent outcomes with PLLA-SCA.

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