Modified Poly-L-Lactic Acid Injection Technique Safety and Efficacy of Cross-Fanning in Non-HIV-Related Facial Atrophy

Proper injection of poly-L-lactic acid has a role in avoiding development of subcutaneous papules. We evaluated the safety and efficacy of our injection technique (cross-fanning) and compared it to 4 previous studies. Forty patients were evaluated for adverse events (bruising, edema, erythema, subcutaneous papules) and satisfaction. Papule incidence was compared with the other studies. The incidence of papules (4/40) was significantly lower than that of VEGA and Chelsea and Westminster (P = 0.00003, P = 0.03), but not significantly different than APEX002 or Blue Pacific (P = 0.42, P = 0.61). Bruising (5/40), edema (2/40), papules (4/40), and patient self-satisfaction (80%, P = 0.0001) was also documented. We maintain that cross-fanning has an excellent safety profile and patient satisfaction rate. We also maintain that our modified technique has advantages over the recommended tunneling cross-hatch and depot technique. Because 38 of 40 patients were HIV-negative, this study also represents the first single-practice series of proper injection of poly-L-lactic acid administration in the immuno-competent patient.