The treatment of facial wrinkles, depressions, and aging in general is a hot issue in modern times and amenable to numerous treatments. Biorestructuring drugs are very useful in volume production and subcutaneous restructuring.

It greatly benefits all those thin patients who would like to gain a little weight and look fuller, especially in the face, but also all male patients who see their cheekbones drooping and hollow.

These substances I would like to talk about today differ markedly from all the fillers (fillers) on the market, both in the results they can give and in the implantation protocol and technique. There are two in particular:

• l’acido polilattico
• il fosfato tricalcico

What is polylactic acid?

Polylactic acid is the polymer of lactic acid, is produced by chemical synthesis, and has total biodegradability and biocompatibility when injected into human tissues. This means that the active ingredient is completely reabsorbed within 6 to 8 months.
In addition, it is immunologically inactive and therefore meets those safety criteria we so much seek when injecting any substance into the face.
It is virtually free of the risk of allergic-type reactions (as reflected in a large body of literature worldwide). With polylactic acid, it is possible to reduce the depth of wrinkles and increase subcutaneous volumes.
It originated from research by the French CNR in the late 1990s. it now has almost a decade of experience and the results are very good. In addition, since 2004, when it was distributed by the company Aventis, it requires a dedicated training course for young doctors approaching this material.
Since this time, side effects have fallen to almost zero. Therefore, it is absolutely important that the doctor who performs this implant has taken these courses that are held all over Italy.

How it works
The special feature of polylactic acid is that it results in an increase in the thickness of the dermis by neocollagen formation. In other words, the polylactic acid microparticles are covered by a patient-made collagen mousse that goes on to thicken the dermis and increase the subcutaneous tissue. This is why the skin also improves markedly in texture and turgor.
So when the polylactic acid is reabsorbed (about 6 months) the collagen that has been formed remains, and this for quite a long time (2 to 3 years).
The immediate effect is that of a filling due to the amount of liquid injected with which the active ingredient has been diluted: it is essential to understand and be well informed about the transience of this result in order to avoid dissatisfaction. In fact, the true result appears late in the first 3 to 4 sessions (i.e., about 2 to 3 months) and will reach full clinical evidence even several months after the first implantation. This time is necessary for the polylactic to carry out its action of stimulating neocollagen production.

What is tricalcium phosphate?

Tricalcium phosphate (beta TCP) is a synthetic ceramic that has been used for many years for treatments particularly on bone. It is very well known by dentists for recreating subgingival volumes.
It has been appearing on the aesthetic market for a few years and has about the same mechanism of action as polylactic acid, but it does not have to be prepared beforehand because it comes in a ready-to-use syringe dissolved in uncrosslinked hyaluronic acid. In this way , the filling effect is immediate.

What areas can be treated?

In particular, the cheeks respond well to treatment, in all those cases in which those vertical wrinkles begin to appear, at first only when laughing, but later even at rest. But still, in all cases of loss of subcutaneous thickness. Also for cheekbones and to support nasogenic wrinkles it can be very helpful. For neck wrinkles it can be indicated just in the sense of filling them in, filling in the reabsorption of collagen that has occurred with age. It is important to understand that you should not treat the individual wrinkle, but the whole district that has the blemish.

Polylactic acid is usually injected into the subcutis, while tricalcium phosphate is injected into a slightly more superficial layer.

In addition, tricalcium phosphate has an excellent indication for deep lines and furrows such as nasogenes, instead of a depth filler.

In contrast, for different areas of the body, such as the neck, hands, or revitalization of the arms and legs , polylactic, which can be diluted in a variety of concentrations finds an important use that does not exist for tricalcium phosphate.

Can they also be used for the mouth?
No, it is best not to use them in particularly mimicry areas.

Is special care needed after implantation?

In the 2-3 days following treatment, it will be advisable to avoid exposure to temperatures that are too hot or too cold.

Immediately after the implantation also, massage is essential, preferably done directly by the operator, especially for polylactic acid. In fact, the polylactic acid microparticles must be distributed with absolute uniformity in the treated district: this will give rise to a uniform and very natural result. If, on the other hand, a buildup of polylactic acid forms at any point, this will give rise to a buildup of collagen.
It is therefore absolutely clear that massage is essential for the uniform distribution of the active ingredient.

How long do they last?

It is important to understand that the onset of correction does not occur as with normal fillers immediately, but arises gradually over the following months.
The duration of correction is variable depending on the frequency with which the area where the implant is placed is stressed; it tends to be at its best from 6-8 up to 12-14 months after the first implant, but can differ greatly from patient to patient.

The implantation of these materials is not particularly painful. An anesthetic cream is used half an hour before treatment. Sometimes injection anesthesia may be necessary.

What problems can they give?

Very rare inflammatory and infectious reactions are reported in the literature.

If the implantation technique is not precise, and if accumulations of product are left behind, the appearance of even long-lasting subcutaneous nodules is possible, as indeed with other fillers. The formation of subcutaneous nodules was more frequent during the first years of experience because polylactic acid was diluted little and especially massaged in little. It was used as a normal filler.
Today, polylactic acid is diluted more and above all, the importance of massage has been understood, so nodule formation has become extremely rare.
However, it is very important to choose an operator who is absolutely expert in this product, which can give results that no other filler can, but only in the face of a rigorous and very accurate implantation technique.

Easier to inject is tricalcium phosphate, as we mentioned, which is ready-to-use and very easy to inject. The only very important detail remains that of never injecting too large boluses.