A Prospective Single-Arm Study of Poly-L-Lactic Acid Injection at Outer Facial Contour Points for Mid- To Lower-Face Aesthetic Improvement

BACKGROUNDConventional nonsurgical facial rejuvenation primarily relies on direct volumization to correct wrinkles and contour deficits, but may have limitations in addressing global structural changes such as tissue laxity. Emerging strategies aim to improve tissue quality and support through biostimulatory effects and may produce indirect aesthetic improvements.

OBJECTIVETo evaluate the clinical outcomes and safety of an indirect PLLA injection technique targeting outer facial contour points for improving mid- to lower-face laxity.

METHODSThis prospective single-arm study included 52 participants who received three PLLA injection sessions at 1-month intervals, with 6-month follow-up after the final treatment. Injections were performed using a cannula-based fan-shaped technique in the deep subcutaneous plane. The primary outcome was change in nasolabial fold severity assessed by the WSRS. Secondary outcomes included changes in marionette lines and jawline contour, GAIS assessments, and safety. Outcomes were evaluated by an independent evaluator.

RESULTSAt 6 months after the final treatment, nasolabial fold severity improved, with median WSRS scores decreasing from 3.0 (IQR: 3.0–3.0) to 2.0 (IQR: 1.0–2.0). A total of 92.3% of participants achieved at least a 1-grade improvement. Consistent improvements were also observed in marionette lines and jawline contour. Overall, more than 95% of participants were rated as improved or better on GAIS by both evaluator and participants. No serious adverse events were reported, and all treatment-related adverse events were mild and transient.

CONCLUSIONPLLA injection at selected outer facial contour points was associated with improvements in mid- to lower-face aesthetic scales and a favorable safety profile. This approach may represent a promising exploratory strategy for aesthetic improvement in addition to, or partly distinct from, conventional volumization-based effects.

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