Polylactic acid (New Fill or Sculptra)

Polylactic acid is already used in cosmetic surgery as treatment for fine lines, wrinkles and furrows. Also known by the brand name New Fill, or Sculptra in the United States, it works by stimulating the growth of collagen, a structural component of the skin and other body tissues, and the development of a thicker layer of skin which fills out the wasted regions of the cheeks. Polylactic acid is not immunologically active, and thus cannot cause any allergic or inflammatory response. In addition, unlike silicon implants, it is broken down and absorbed by the body.

Three French studies have investigated polylactic acid for facial wasting. In the first study, on average, four injections of polylactic acid were given to 33 HIV-positive men with facial wasting. All the patients had some degree of improvement, but the facial fat was not fully restored. Following this cosmetic procedure, skin thickness had increased from an average of 3.1mm to 8.15mm - a highly significant improvement. Seven patients had their normal facial appearance restored by the third injection. ¹

A second study, the Vega trial, enrolled 50 patients with severe facial wasting, who received four or five polylactic acid injections. At month two, the median increase in skin thickness was 8.1mm, and by month six this had increased to 9.5mm. By week 72, 48% of patients had a total cutaneous thickness greater than 10mm. The reduction in facial atrophy could be noticed in most of the patients as soon as the second injection, and improved further with subsequent injections. Improved quality-of-life was reported by patients in this study. ² The physical improvement was sustained in 42 of 50 patients who had completed 96 weeks of follow-up, with a median cutaneous thickness of 6.5mm. ³

In a third study, 94 patients received a median of five injections of polylactic acid; six months after the end of treatment the average increase in dermal thickness was 2.3mm (average of both cheeks). Although no difference in quality of life score was recorded between baseline and six months after the end of treatment, patient rating of their satisfaction with their lipoatrophy was significantly improved (from 3.3 to 7.0 on a 10-point scale). Only one significant adverse event - an anaphylactic reaction - was reported. However, the benefit may be short-lived; 17 patients needed further injections during a 12-month follow-up period.⁴

A randomised study carried out in the UK compared immediate to deferred treatment, to allow for a control group comparison while still providing treatment to all participants. After 12 weeks, treated patients reported improvement, and a trend toward lower anxiety scores. One case of bruising and one case of cellulites delayed further treatment, by no more than a week in either case. No negative changes in average viral load or CD4 cell count occurred. ⁵