Hybrid Poly-D,L-Lactic Acid and Autologous Fat Transfer for Forehead Augmentation

Abstract

BackgroundForehead augmentation is a foundational procedure for facial harmonisation, particularly in Asian populations where a smooth, convex forehead is aesthetically desirable. Existing modalities such as implants, hyaluronic acid fillers, and fat grafting alone have limitations including irregular contours, surgical risks, or inconsistent long-term retention.ObjectiveTo evaluate the 12-month safety, efficacy, and volume stability of sequential poly-D,L-lactic acid (PDLLA) and autologous fat transfer for forehead augmentation.MethodsA retrospective case series of 44 Korean patients (32 females, 12 males; mean age 42.3 years) treated between January-December 2024. All patients received 1 vial of Juvelook GLAM (reconstituted in 15 ml) followed by 20-25 ml of purified autologous fat injected using a multi-directional cannula fanning technique. Outcomes were assessed using the Global Aesthetic Improvement Scale (GAIS), modified Carruthers Forehead Contour Scale, standardised photography, and patient-reported satisfaction at 6 and 12 months.ResultsAt 12 months, 39 patients (88.6%) maintained moderate-to-marked improvement on the GAIS, compared with 40 patients (90.9%) at 6 months. Mean satisfaction at 12 months was 8.1/10 (compared with 8.3/10 at 6 months). Clinical assessment confirmed sustained convexity and contour retention, with an estimated 72-78% mean fat graft retention. Complications remained minor and transient: swelling (29.5%), bruising (11.3%), and mild erythema (15.9%). No granulomas, vascular events, infections, or long-term adverse events occurred.ConclusionsThe combined PDLLA-fat technique provided stable 12-month outcomes, with minimal decline from 6-month results. PDLLA appears to support adipocyte viability and scaffold integration, contributing to improved retention beyond traditional fat grafting. Longer prospective comparative studies are needed to confirm additive effects and 24-month durability.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.