Resumo

Objectives: This presentation aims to explain why Poly-L-lactic Acid (PLLA) remains my primary biostimulatory injectable despite the rapid expansion of skin boosters and new collagen stimulators. Participants will understand the long-term clinical rationale, safety considerations, and strategic treatment principles that support continued PLLA use in modern aesthetic and regenerative practice. Introduction: The injectable market has evolved rapidly, with numerous skin boosters and biostimulatory agents introduced in recent years. However, only a limited number of products are supported by long-term clinical evidence. In daily practice, durability, safety, and reproducibility often outweigh novelty. PLLA remains one of the most extensively studied collagen stimulators, with more than two decades of global data and consistent clinical performance. Materials / method: This review summarizes five evidence-based reasons for selecting PLLA: long-established safety and efficacy, consistent outcomes over 14 years of clinical use, reproducibility under standardized dilution and interval protocols, regenerative potential beyond aesthetics, and analysis of current concerns regarding fibrosis and tissue adhesion. A real-world cohort of 47 patients with at least two years of follow-up was evaluated for durability, safety, and patient satisfaction. Results: PLLA demonstrated predictable and sustained clinical benefits, including natural volumization, lifting effects, and long-term improvement in tissue quality through controlled fibroplasia. When appropriate patient selection, dilution, dosing, and treatment intervals were applied, outcomes were consistent and reproducible with high patient satisfaction. Emerging surgical reports suggest possible tissue adhesion after prior PLLA treatment, likely reflecting physiological collagen remodeling rather than pathological fibrosis, though excessive dosing or over-treatment may increase risk. Conclusion: Despite the availability of numerous new injectables, PLLA remains a robust and reliable biostimulatory option supported by long-term evidence. Its regenerative potential extends beyond cosmetic volumization to therapeutic applications in atrophic conditions. Adherence to the principle of “less is more,” with strict control of dose, interval, and distribution, is essential. For experienced clinicians seeking durable and predictable rejuvenation, PLLA remains a strategic cornerstone—Still Poly-L-Lactic Acid.