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Research in Dermatologic Surgery demonstrating that poly-L-lactic acid biostimulators produce durable collagen induction with results that persist for up to two years in patients with facial volume loss reinforces their clinical role in longer-term structural restoration

This is due to cumulative damage to mitochondrial DNA which would otherwise have been reduced by glutathiones antioxidant activity and protective effects

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Its effects have been linked to endothelial nitric-oxide synthase (eNOS) and to VEGFR2-driven angiogenesis, and its influence on fibroblast outgrowth and migration is attributed to the FAKpaxillin signaling pathway

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Considering the number of patients and the few reported cases, you can see how rare these reactions really are