Non-facial (body) rejuvenation is a treatment of increasing demand, with patients seeking to harmonize the benefits of rejuvenated facial appearance with other areas of the body. Poly-l-lactic acid (PLLA)-SCA (Sculptra®) has been approved for facial aesthetic uses since 1999 in Europe and since 2009 in the USA and more recently evaluated for the treatment of cellulite of the buttocks and thighs and other body indications. The current evidence base consists largely of prospective observational analyses and case series although systematic evaluations for a number of body areas are underway. Current data support a potential benefit for the use of PLLA-SCA for the aesthetic treatment of the neck, knees, abdomen, hands and upper arms. Improvements in aesthetic appearance (e.g. sagging, wrinkling, dimpling, cellulite) that are sustained over time with minimal side effects can be achieved. Standardization of injection protocols for different body areas is now needed along with the validation of clinical tools that can be used to agree on treatment goals and to evaluate aesthetic improvements over time. A group of international experts in the fields of facial and body aesthetics, plastic surgery and dermatology were selected based on their educational, scientific and publication merits together with clinical experience using PLLA-SCA for body rejuvenation. Here, we provide an evidence-based and expert-led consensus (14 years of off-face treatment experience) on recommendations for appropriate injection protocols for different body sites and evaluation tools when using the biostimulator PLLA-SCA for body aesthetic and rejuvenation procedures. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

This study evaluated the thermal properties, crystallinity, particle size, morphology, and in vivo local inflammation and persistence of two poly-L-lactic acid (PLLA) injectable implants, Sculptra^® (PLLA-SCA) and GANA V^® (PLLA-GA). PLLA-SCA and PLLA-GA underwent differential scanning calorimetry and X-ray powder diffraction to evaluate their thermal properties and degree of crystallinity. X-ray powder diffraction spectra displayed a sharper, more intense peak for PLLA-GA than PLLA-SCA, with smaller peaks on either side of the main peak of PLLA-GA but not PLLA-SCA. Differential scanning calorimetry thermograms indicated three thermal events for both PLLA-SCA and PLLA-GA. For PLLA-SCA, the first two events occurred between 65 °C and 90 °C, and the third event occurred at 165 °C. For PLLA-GA all three events occurred between 156 °C and 169 °C. Heating samples to 120 °C and cooling to room temperature prior to differential scanning calorimetry resulted in no thermal events being observed between 65–90 °C with either product, while three events were observed with PLLA-GA and one event with PLLA-SCA between 156 °C and 169 °C. The median volume distribution diameter was 46.4 µm for PLLA-SCA and 31.7 µm for PLLA-GA. Scanning electron microscopy showed PLLA-GA particles were irregular in shape, had no sharp edges and had a wrinkled and crimped surface, while PLLA-SCA particles displayed plate-like shapes and had smoother surfaces. In vivo inflammatory reactivity scores indicated a slight reaction for PLLA-SCA at all time points (3.7 ± 1.1, 6.1 ± 1.6, 5.7 ± 1.2 and 6.2 ± 1.2 at 2, 12, 26 and 52 weeks, respectively), while for PLLA-GA, a moderate reaction was observed at 12 and 26 weeks (2.9 ± 1.5, 10.1 ± 1.0, 9.4 ± 0.7 and 7.1 ± 1.3 at 2, 12, 26 and 52 weeks, respectively). PLLA-SCA and PLLA-GA had similar persistence scores at 2, 12 and 26 weeks, while at 52 weeks the score was markedly higher for PLLA-SCA versus PLLA-GA (1.9 ± 0.2 versus 0.7 ± 0.2). In conclusion, PLLA-SCA is more amorphous than PLLA-GA. The single melting point of PLLA-SCA contrasts with the broader spectrum of melting points for PLLA-GA suggests a more homogenous formulation of PLLA-SCA. This, and its less crystalline structure, result in the slower degradation rate and more sustained biological response of PLLA-SCA compared with PLLA-GA. The physiochemical properties of PLLAs affect the biological response in clinical practice and should be taken into consideration when selecting a PLLA treatment for aesthetic use.

The objective of this study was to evaluate thermal properties and crystallinity of two poly-L-lactic acid (PLLA) injectable implants, Sculptra® (PLLA-SCA) and GANA V® (PLLA-GA), and the extent to which these properties might impact their biological response. PLLA-SCA and PLLA-GA (800mg/sample) underwent differential scanning calorimetry and X-ray powder diffraction to evaluate their thermal properties and degree of crystallinity. X-ray powder diffraction spectra displayed a sharper, more intense peak for PLLA-GA than PLLA-SCA, with smaller peaks on either side of the main peak of PLLA-GA but not PLLA-SCA. Differential scanning calorimetry thermograms indicated three thermal events for both PLLA-SCA and PLLA-GA. For PLLA-SCA, the first two events occurred between 65°C and 90°C and the third event occurred at 165°C. For PLLA-GA all three events occurred between 156°C and 169°C. Heating samples to 120°C and cooling to room temperature prior to differential scanning calorimetry resulted in no thermal events being observed between 65–90°C with either product, while three events were observed with PLLA-GA and one event with PLLA-SCA between 156°C and 169°C. In conclusion, PLLA-SCA is more amorphous than PLLA-GA. The single melting point of PLLA-SCA contrasts with the broader spectrum of melting points for PLLA-GA suggests a more homogenous formulation of PLLA-SCA. This, and its less crystalline structure, result in the slower degradation rate and more sustained biological response of PLLA-SCA compared with PLLA-GA. The physiochemical properties of PLLAs affect the biological response in clinical practice and should be taken into consideration when selecting a PLLA treatment for aesthetic use.

Background/Objectives: Calcium hydroxylapatite (CaHA) is widely used in aesthetic medicine as a biostimulatory dermal filler. While its ability to induce neocollagenesis is well established, its broader transcript-level effects on fibroblast biology under aging-like conditions remain incompletely characterized. This study aimed to compare the gene-expression responses induced by three commercially available CaHA formulations in an EX-527-induced aging-like human dermal fibroblast model. Methods: An aging-like fibroblast phenotype was induced in primary human dermal fibroblasts using the SIRT1 inhibitor EX-527, which was maintained in culture throughout the CaHA treatment period. Cells were exposed to three commercially available CaHA formulations (D, R, S) for 72 h. Gene expression was assessed by RT-qPCR, evaluating markers related to extracellular matrix remodeling, Ki67 expression, inflammatory and regulatory cytokine signaling, mitochondrial stress response and energy metabolism, and longevity-associated genes. Results: All CaHA formulations induced upregulation of COL1A1 and Ki67, with greater responses observed in samples S and R. ELN expression was more selectively increased, particularly in sample S. Distinct cytokine gene-expression profiles were observed, with sample D associated with increased TNF-α expression, while samples R and S demonstrated reduced TNF-α and increased IL-10 expression. Genes associated with mitochondrial stress response and energy metabolism, including PGC-1α, SOD2, and PINK1, were upregulated across groups, with the highest induction generally observed in sample S. FOXO3, SIRT1, and SIRT3 expression also increased following treatment, with sample S showing the most pronounced response for FOXO3 and SIRT3. Conclusions: These transcript-level findings suggest that CaHA exposure is associated with differential gene-expression responses involving markers related to extracellular matrix remodeling, inflammatory and regulatory signaling, mitochondrial stress response, and longevity-associated pathways. Functional and protein-level validation will be required to determine whether these transcriptional changes translate into meaningful biological effects in more complex models of aging skin.