Resumen

Objectives: This study presents a hybrid regenerative strategy combining supercritical CO₂-processed acellular dermal matrix (ADM) filler with PDLLA as a cellular recruitment stimulator. Attendees will understand the critical limitation of ECM-based fillers—progressive resorption due to insufficient cellular activity—and how PDLLA overcomes this barrier. The session highlights that PDLLA is not merely an adjunct, but a key factor enabling long-term tissue maintenance, allowing a single-session treatment to achieve prolonged clinical durability exceeding one year. Introduction: ADM provides an ECM scaffold that enables immediate structural restoration and collagen support. However, without sustained cellular interaction, ECM is prone to gradual degradation and loss of effect. In regenerative physiology, ECM requires active fibroblast engagement to maintain its architecture. This study introduces a biologically integrative concept: ADM as a structural “framework” and PDLLA as a “cellular activator,” promoting fibroblast recruitment, neocollagenesis, and long-term preservation of the matrix. This synergy aims to overcome the intrinsic limitation of ADM resorption. Materials / method: A supercritical CO₂-processed, prefilled 8% ADM filler (1 cc) was combined with a small quantity of PDLLA prior to injection. The mixture was delivered intradermally into horizontal neck wrinkles using a 30-gauge needle. Unlike conventional ADM protocols requiring repeated sessions, the ADM-PDLLA combination was administered as a single treatment session. Clinical evaluation included standardized photography, wrinkle severity grading, and longitudinal assessment of treatment durability, focusing on immediate correction, absence of Tyndall effect, and sustained structural integrity. Results: The ADM-PDLLA combination achieved immediate wrinkle correction through ECM-based volume restoration without Tyndall effect. Importantly, the addition of PDLLA resulted in sustained fibroblast activation and progressive tissue remodeling. Clinical outcomes demonstrated maintenance of wrinkle improvement for over one year following a single injection session. Compared to ADM alone, which typically requires multiple sessions and shows gradual resorption, the combination exhibited more than a twofold increase in longevity, with enhanced skin quality and structural stability. Conclusion: PDLLA plays a pivotal role in transforming ADM from a temporary scaffold into a long-lasting regenerative platform. While ADM provides immediate ECM architecture, PDLLA ensures continuous cellular activation necessary for maintaining and remodeling the matrix. This synergistic approach enables single-session treatment with durability exceeding one year, representing a paradigm shift in regenerative aesthetics. The findings emphasize that ECM-based therapies require active cellular support, and PDLLA is essential for achieving sustained clinical outcomes.