Reduced scar nodule formation and enhanced facial volume in a 63-year-old female with combined radiofrequency and poly-L-lactic acid treatment

This report details the case of a 63-year-old female who achieved significant facial volume enhancement and skin tightening with a remarkably low incidence of poly-L-lactic acid (PLLA)-related nodules following a unique combined treatment of PLLA (Sculptra®) injection immediately followed by radiofrequency (Thermage FLX®) therapy. A 63-year-old female presented to our clinic in April 2025 seeking improvement for age-related facial volume loss and skin laxity. She underwent a single session of PLLA injection (Sculptra®), immediately followed by a full-face radiofrequency (Thermage FLX®) treatment. Independent photographic assessments at 1 and 3 months posttreatment were conducted to evaluate changes in facial volume, skin tightening (using the Global Aesthetic Improvement Scale [GAIS]), and the incidence of nodules. Patient satisfaction was also evaluated using a Visual Analog Scale. At the 3-month follow-up, the patient showed substantial improvement in overall facial volume (GAIS 4, “much improved”) and skin tightening (GAIS 4, “much improved”). During the 3-month observation period, no palpable or visible nodules were detected. Visual Analog Scale: only mild, transient erythema and edema were observed, both resolving within 48 hours. This case suggests that combining PLLA injection with immediate Thermage FLX® treatment offers a highly effective approach to comprehensive facial rejuvenation, delivering favorable outcomes in both volume restoration and skin tightening. Furthermore, this innovative protocol appears to significantly minimize the common risk of PLLA-induced nodules. While this is a single case, it provides valuable initial insights into an optimized treatment paradigm for facial aging and strongly supports the need for further, largescale investigations into this promising synergistic therapy.