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Injectable poly-D,L-lactic acid (PDLLA), which was first approved by the Korean Food and Drug Administration in 2014, is a relatively new subdermal biostimulatory filler (AestheFill; REGEN Biotech, Seoul, Korea) [1-3]. It is used for the correction of deep and shallow facial wrinkles, and it is supplied as lumps of lyophilized powder in vials. Reconstituting PDLLA with sterile water for injection (SWFI) to form a homogeneous suspension before injection is crucial to reduce the likelihood of complications. A vial of injectable PDLLA contains 200 mg of product [2]. According to the manufacturer’s recommendations, 1.4 mL of SWFI should be used for the treatment of deep wrinkles, whereas 8 mL of SWFI should be used to treat shallow wrinkles [4]. The recommended reconstitution methods are agitation by hand-shaking or use of a vortex generator. After the desired volume of SWFI is injected into the vial, the mixture must be agitated until the suspension becomes homogeneous. Then, the injectable PDLLA is ready for use. However, if 8 mL of SWFI is used, it usually takes more than 30 minutes to achieve a homogeneous suspension by handshaking, and the process is exhausting. If 1.4 mL of SWFI is used, it often takes more than 1 hour to obtain a homogeneous suspension using vortex generator-assisted agitation. To dissolve all PDLLA lumps more easily and quickly, we propose a novel “back-and-forth” method to reconstitute injectable PDLLA. This is a simple and efficient method to obtain a homogeneous suspension.

The back-and-forth method: A quick and simple technique for reconstitution of injectable poly-D,L-lactic acid