The PLLA injection procedure requires specific preparation and technique that differ from those used with standard dermal fillers.
Reconstitution Process
Unlike pre-filled syringe products, PLLA comes as a freeze-dried powder that must be reconstituted with sterile water before injection. The dilution ratio matters significantly—earlier formulations used only 3-5mL, which caused higher rates of nodule formation. Modern protocols typically use 8-10mL of sterile water plus 1mL of 2% lidocaine for even distribution throughout the treatment area.
A US chart review of 1,002 patients (4,483 treatments total) who received PLLA diluted to 7-10mL found nodule rates of only 0.4%, compared to 5.7-6.9% in earlier studies using lower dilution volumes. Most practitioners prepare the solution 24-72 hours before the procedure, allowing the PLLA particles to fully hydrate. Some newer Korean products like BEAUY dissolve in under 60 seconds with a vortex mixer, reducing preparation time considerably.
Injection Technique
The practitioner injects the reconstituted solution into the deep dermis or subcutaneous tissue using a needle or blunt cannula (typically 25G-27G needle gauge). The choice of needle affects both patient comfort and product placement accuracy. Common techniques include:
Cross-hatching for broader coverage
Fanning from a single needle entry point
Linear threading along wrinkles and folds
Small volumes are injected at multiple sites using a fine needle to ensure even distribution. Unlike HA fillers where you see immediate volume, the treated area may appear only slightly fuller initially due to the sterile water content.
Post-Treatment Massage
The "5-5-5 rule" is standard protocol: massage the treated areas 5 times daily, for 5 minutes each session, for 5 days. This helps distribute the PLLA particles evenly throughout the tissue and significantly reduces the risk of nodule formation.