The concept of facial rejuvenation currently includes a three-dimensional perspective, which recognizes as signs of aging not only the loss of the skin's texture and the emergence of expression wrinkles, but also the volumetric losses secondary to bone remodeling and redistribution of facial fat. This article was aimed at reviewing the literature on poly-L-lactic acid for facial rejuvenation – including its indications, injection techniques, expected results and possible adverse effects – and offer practical guidelines, based on the authors' 12-year experience with the product.

Keywords: SKIN AGING; INJECTIONS; COLLAGEN

Skin quality and function drastically reduces with age due to chronological aging, photoaging, environmental factors and hormonal deficiencies. Decreased menopausal estrogen levels play a role in cutaneous atrophy, collagen and water content, loss of elasticity, skin wrinkling and deficiency of wound healing. Much research has been done to elucidate the beneficial effects of topical estrogen, which would have a more localized action on the skin without systemic side effects. The objective of this study was to review the relevant literature, demonstrating that this may be a safe and effective alternative for the treatment of women's skin in perimenopause.

Keywords: Estrogens; Phytoestrogens; Skin aging; Collagen; Antioxidants

The clinical use of combined technologies has been increasing to address the effects of skin aging on the face and other areas of the body. Poly-L-lactic acid is a biocompatible, semipermanent synthetic filler used for volume enhancement through neocollagenesis induction by fibroblast activation. Similarly, energy-based technologies, such as high-intensity focused ultrasound and microneedling radiofrequency devices, promote fat reduction and collagen contraction by heating the deep dermis. This article presents expert panel recommendations and a literature review on the topic.

Keywords: Polylactic Acid-Polyglycolic Acid Copolymer; Radiofrequency Therapy; Collagen Type I; Collagen Type III; Adipose Tissue.

INTRODUCTION: The search for minimally invasive aesthetic procedures to improve non-facial skin laxity has been increasing annually. The biostimulator poly-L-lactic acid stands out as one of the most versatile products for aesthetic procedures in this field.
OBJECTIVE: To develop a systematic assessment framework tool to guide treatment decision-making for skin laxity in extra-facial areas, since there are no reports regarding how to select the most appropriate patients for non-invasive body shaping with biostimulators to date.
METHODS: The authors developed the tool described herein based on their collective experience with treatment of extra-facial skin laxity with poly-L-lactic acid.
RESULTS: This assessment method collates input from four fundamental factors: somatotype/morphotype, skin quality/severity of laxity, distribution and quantity of adipose tissue, and nutritional and hormonal profile.
CONCLUSIONS: Each aspect of the framework has been developed to optimize decision-making and tailor the clinical experience for each patient, enabling clinicians to select the most favorable candidates for biostimulator use, leading to more predictable and optimized outcomes.

Keywords: Rejuvenation; Classification; Skin Aging.