Evaluation of the Therapeutic Potential of Bioestimulator in Areas of Repetitive Movement: A literature review and case report

Abstract

Poly-L-lactic acid (PLLA) is a collagen biostimulant widely used in facial aesthetics. However, there is little evidence for its use in areas of high muscle movement, such as the forehead, which may be an area at higher risk for adverse events. The objective of this study was to conduct a literature review and evaluate the therapeutic potential of PLLA (Angelis®) in areas of repetitive movement, under a hyperdilution protocol and in combination with botulinum toxin. A narrative review of PLLA and its correlation with tissue response was performed, complemented by a clinical case report. A 48-year-old female patient underwent combined application of botulinum toxin and hyperdiluted Angelis® PLLA in the forehead. Clinical follow-up was performed at 5 and 90 days post-procedure. The protocol resulted in immediate, stable reconstitution, with no signs of clumping or precipitation, allowing for safe application immediately after preparation. At 90 days, significant improvement in firmness, texture and dermal thickness was observed, with no adverse events. The optimized micromorphology of Angelis® PLLA and the hyperdilution technique reduce tissue polymer density and promote homogeneous dispersion, minimizing the localized inflammatory response. The combination with botulinum toxin created an environment of reduced muscle tension, enhancing the orderly deposition of collagen and promoting safe rejuvenation in dynamic areas. Thus, Angelis® PLLA demonstrated no side effects and efficacy in areas of repetitive movement, supporting its immediate use after reconstitution and confirming its potential as a next-generation biostimulator. This formulation represents a significant advancement in aesthetic practice, expanding the clinical indications for PLLA with a lower risk of complications.