Poly-L-Lactic Acid Fillers: Tips for Optimizing Use : Experts discuss how to achieve the best results through dilution, reconstitution, administration, and follow-up.

Another pearl is to put cotton swabs in an open bottle of Drysol (aluminum chloride) to use during the procedure. Dr. Rendon uses this technique to promote coagulation and minimize point bleeding at injection sites.

▸ Postprocedure care. Have an assistant stay with the patient and massage the injected areas for 5–10 minutes. "Always massage, but don't overdo it," Dr. Rendon said. "If they are on Coumadin [warfarin] or aspirin, you will create bruising."

"Some advocate further massaging at home, but I think that is less important," Dr. Hanke said.

Both Dr. Rendon and Dr. Weinkle recommend follow-up massaging of the treated areas. Dr. Weinkle tells patients to follow the "rule of fives"—5 minutes five times a day "This compliance with postop care is associated with better outcomes," she said. Dr. Rendon advises 5 minutes of massage three times per day.

▸ Adverse events. Avoid injection of certain areas to minimize the risk of adverse events such as papules, nodules, or inflammatory granulomas. "You can use the product anywhere there is fat loss in the face, except the glabellar area and vermillion border," Dr. Rendon said.

"If you get close to the eye with injecting Sculptra, sometimes [patients] will not be able to close their eyes afterward," Dr. Weinkle said. "I had some Sculptra injected near my eye, and I was unable to close my eye for 3 hours. It freaked me out. Warn patients about this."

In addition, "do not inject this product into the lips. The skin is too thin—you'll get nodules," she said.

Caution is also advised regarding perioral injections in a heavy smoker.

"I got burned once with a woman who had an adverse effect," Dr. Weinkle recalled. "As they smoke and contract the muscles so strongly by pursing their lips, they move the product and get nodule formation."

▸ Long-term expectations. Most patients require three to four treatment sessions for maximal results with poly-L-lactic acid. "The timing of repeat injections is every 4–6 weeks until you get the desired effect," Dr. Rendon said. "It's not a product with immediate results. It's a slow, progressive improvement over 4–6 months."

Dr. Weinkle said, "Patients also need to be educated that time marches on and they may need to return for a Sculptra booster."

Dr. Weinkle is on the speakers' bureau for Dermik Laboratories, the manufacturer of Sculptra. Dr. Hanke and Dr. Rendon do not have disclosure statements regarding Sculptra or Dermik.