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This article discusses two methods for reconstituting injectable poly-D,L-lactic acid (PDLLA) using vacuum-assisted hydration (VAH). The first method, known as the "wet" VAH method, involves attaching a syringe containing sterile water for injection (SWFI) to a syringe housing PDLLA lumps and creating negative pressure to draw the SWFI into the lumps. The second method, known as the "dry" VAH method, involves creating a vacuum within both syringes before introducing the SWFI. Both methods are based on Boyle's law and can be completed in less than 1 minute. However, practitioners must follow aseptic procedures and have a thorough understanding of the process to avoid contamination or process failure. [Extracted from the article]

Background: Filler injection for lower eyelid rejuvenation remains a difficult subject due to many complicated anatomic changes as the face ages. Objectives: To propose an alternative, simple, and effective filler injection method in lower eyelids for Asian patients. Methods: Any patient who has tear trough deformities, infra‐orbital hollows, nasojugal grooves, dark eye circles, as well as mild eyebags is a potential candidate for this method. Our filler choice is injectable poly‐d,l‐lactic acid (PDLLA; AestheFill; REGEN). PDLLA must be reconstituted with sterile water for injection (SWFI) before administration. When the patient's troughs, grooves, or volume deficit are classes II and III, 3–4 ml of SWFI and 1 ml of lidocaine are used. When the deficits are class I, 5–7 ml of SWFI and 1 ml of lidocaine are used. With the fanning injection technique, a wide region that covers all the deficits is evenly injected. The depth is under the dermis layer. The total amount of filler injection is not more than 2 ml on each side. Results: Since 2019, we have injected more than 100 patients by following these steps in Taiwan. The level of patient satisfaction is high. Only some mild and transient post‐injection complications such as edema, erythema, and ecchymosis were found. Conclusions: We propose an alternative, simple and effective method for non‐surgical lower eyelid rejuvenation for Asian patients. However, anyone who wants to perform this procedure should be well‐trained and knowledgeable about the anatomy, product, and procedure to prevent adverse events. [ABSTRACT FROM AUTHOR]

Prior to injection, reconstitution with sterile water for injection (SWFI) is required.[[1], [4]] However, injectable PLLA tends to form dry PLLA micro-clumps in the suspension after reconstitution with SWFI. In conclusion, retaining an even distribution of biostimulators both microscopically (pre-injection) and grossly (post-injection) is crucial to prevent non-inflammatory nodules formation and other irregularities. Retaining even distribution of biostimulators microscopically and grossly: Key to prevent non-inflammatory nodules formation. [Extracted from the article]

PLLA is a polymer that is completely composed of l-lactic acids; whereas PDLLA comprises various proportions of d- and l-lactic acids. Poly-d,l-lactic acid filler (AestheFill; REGEN Biotech, Inc) is a new subdermal filler that was first approved by the Korean Food and Drug Administration in 2014.[3] It consists of PDLLA microparticles and sodium carboxymethyl cellulose and is supplied as a lyophilized powder. Like the PLLA filler, the PDLLA filler must be reconstituted with sterile water before administration. [Extracted from the article]