Abstract

Background: Poly-L-lactic acid (PLLA) is a well-established biostimulatory filler, but earlier formulations were associated with granulomas and irregular outcomes. Next- generation PLLA (e.g., Infini V10) offers improved safety due to its uniformly spherical microparticle morphology. Objective: To describe the Directional Tension Line Protocol (DTLP), a novel anatomy-guided injection technique that aligns PLLA deposition with Langer’s lines, enhancing both safety and predictability. Methods: Infini V10 was reconstituted to 10 mL (8 mL sterile water, 2 mL lidocaine). And rested for > 12 hours prior to injection. Using 22 G blunt cannulas, injections were administered through defined facial entry points, with approximately 0.75 mL delivered per site. Greater deposition was directed to static regions. With specific adjustments for zygomatic and perioral vectors. Results: Preliminary clinical observations demonstrated homogeneous collagen distribution, improved skin elasticity, subtle volumization, and a low incidence of papules or nodules. Patients reported high satisfaction with natural outcomes and minimal downtime. Conclusion: The DTLP integrates the safety of modern PLLA formulations with anatomical principles. By orienting collagen induction along Langer’s lines, this protocol enhances reproducibility and reduces complications. Controlled studies are warranted to validate its efficacy.

Keywords

poly-L-lactic acid, collagen biostimulation, injection protocol, langer’s lines, granuloma prevention