PLLA vs HA Dermal Fillers

By Florence Goulbourne

The PLLA filler category is predicted to grow significantly between 2022 and 2028, as customers seek subtler rejuvenation alternatives to traditional dermal fillers. Fox Pharma explores the differences between PLLA and HA fillers, from injection protocols to patient suitability, to help you determine the best anti-ageing treatment routes for your patients.


Hyaluronic acid dermal fillers are ideal for all adult patients seeking instant aesthetic results. They provide an excellent treatment option for patients looking to enhance the structure of specific areas, such as the jawline or cheekbones. They can be injected with precision to sculpt and enhance smaller areas of the face such as the lips.

So why may a patient opt for PLLA fillers for volume restoration in the face instead of more traditional, hyaluronic acid dermal fillers? Dr Apostolos Vlachogiorgos MD, MSc Plastic Reconstructive and Aesthetic Surgeon at Reflect Clinic and The Edge Dental told us ‘Although PLLA fillers are definitely not new in the industry, they are gradually becoming very popular alongside a large shift of the aesthetic industry edging towards more natural results.’

Dr Vlachogiorgos, @dr.apostolos_vlachogiorgos on Instagram, shared some key benefits of PLLA ‘firstly, they stimulate the natural production of collagen, in turn producing really natural results. They are also safe and fully compatible with our bodies, having been used in medicine for more than 30 years. They [PLLA fillers] are also long-lasting, with several studies showing that they last more than 2 years.’

PLLA fillers harmonise with the skin’s natural function to create subtler and more gradual results. They are ideal for patients 30+ who are concerned with the volume loss that occurs with ageing and are seeking natural-looking rejuvenation. Whilst PLLA fillers can be injected into specific treatment areas, the results are not immediately visible and are generally more dispersed, therefore PLLA fillers are not suitable for patients who are seeking structural augmentation or instant volumisation. PLLA fillers are not suitable for treatments such as non-surgical rhinoplasty or lip filler.

Material Properties

Dermal fillers such as REVOLAX are formulated with hyaluronic acid. They arrive in various viscosities to address specific treatment concerns.

REVOLAX fine is ideal for the treatment of fine lines and delicate areas, whereas REVOLAX Sub-Q is a thicker formula that is used to create structure and definition in treatments such as non-surgical rhinoplasty. Hyaluronic acid fillers create volume and structure due to the volume of material injected, enabling structure to be built up over time.

Treatment Timelines

Hyaluronic Acid fillers offer instant visible results, typically lasting from 6-18 months, depending on the product and the patient’s metabolism. For best results, practitioners should start with smaller amounts of filler, gradually building up the filler through top-up treatments, to achieve the patients desired results.

PLLA fillers require an initial course of around 3-4 treatments spaced four weeks apart, to achieve optimal results. Patients can expect the treatment course to take around 3-4 months, the results will then be visible from 6 weeks post-treatment, as the filler takes time to stimulate the body’s natural collagen production. PLLA filler results are longer-lasting than those of HA fillers, offering volumisation for around two years post-treatment.

Dermal Filler Complications

Alongside the typical side-effects of dermal fillers that include bruising and swelling, there are also more serious complications that can occur as a result of HA and PLLA dermal filler treatments. There is a risk of infection at the injection site if the area is not adequately sterilised, therefore Fox Pharma recommends using Clinisept to prepare the skin for injection. Incorrect injection into a blood vessel can lead to vascular occlusion and necrosis, the most serious of complications.

HA Filler Complications:

  • Lumps
  • Palpability of the filler under the surface of the skin
  • Asymmetry

PLLA Filler Complications:

  • Nodules
  • Over-correction
  • Granulomas

As HA fillers can be dissolved, cosmetic complications such as lumps or overfilling can often be easily rectified. PLLA filler complications can be more difficult to treat and tend to take longer to present. Inflammatory nodules can occur with some PLLA products, where the body reacts to concentrated particles of product. This can be avoided by ensuring a dispersed injection and thorough massaging of the treatment areas. Some practitioners also dilute their PLLA solutions more than the amount indicated by manufacturers to help mitigate this risk.

Foreign body granulomas are the result of non-allergic reactions that occur further down the line, typically around 6-24 months after filler injections. Granulomas consist of mainly multinucleated giant cells and can be difficult to treat. Whilst in some cases they resolve themselves spontaneously, this can be a lengthy process and distressing for the patient. PLLA complications can be harder to treat, some practitioners utilise injections of steroid solutions such as Kenalog to help break down resistant nodules, however this in turn, poses potential for atrophy. Patients will need to seek the advice of a medical professional who is experienced in PLLA products.

HA fillers and bio-stimulatory fillers differ vastly from their mode of action, injection protocols and treatment timelines. Candidates for PLLA fillers tend to be mature patients seeking natural-looking, volumisation and rejuvenation, whilst HA fillers offer versatility for patients of all age groups, allowing practitioners to sculpt, define and enhance specific treatment areas with instant results. The PLLA market is set to witness exciting developments in the near future, with new product innovations introducing simpler protocols, faster results and a reduced risk of complications.

What are your thoughts on PLLA fillers? Keep up with the Fox Pharma blog to learn more about this rapidly developing category.

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