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.