What is Sculptra used for?

Sculptra is an injectable liquid used to add volume to areas of the face. It is best for adding volume to:

• hollow cheeks
• softening boney cheekbones
• nasolabial and melolabial folds (nose to mouth/mouth to chin)
• hollow chin area
• defining the jawline
• hollow temples
• some body sites

What is Sculptra?

Sculptra, (generic name is "poly-L-lactic acid" or PLLA) is a synthetic of lactic acid. Lactic acid is made in our muscles after exercise. Polylactic acid is lactic acid molecules stuck together in strings (a polymer). It is made in a laboratory and contains no animal products and no human DNA. It very gradually disappears by the action of your own cell enzymes.

Is Sculptra FDA approved?

Sculptra recently got FDA approval for cosmetic use.  And you will certainly be hearing more about it in the next six months.

It had already been FDA-approved for individuals who are HIV positive who have hollowing of their faces (facial lipodystrophy), and it has been used "off-label" for cosmetic purposes for several years. Sculptra is approved in Canada, Europe and over 20 other countries.

How is Sculptra different than Juvederm/Restylane (HAs)?

Sculptra adds volume to the face and fills grooves and hollows. This can give some lift and help with wrinkles because many wrinkles are created by loss of volume (think of a deflating balloon). HAs fill specific wrinkles and and lines.

Sculptra lasts approximately 2 years once the series of treatments is completed but generally one maintenance treatment a year is needed so you don't completely return to your original volume. HAs last 4 to 9 months on average depending on the product used. Sculptra stimulates your own cells to make more collagen which it why it lasts longer. HAs are implanted gels (hyaluronic acid – a natural substance in skin) that gradually goes away.

How are the treatments different?

Sculptra is injected approximately every 6-10 weeks for a total of 2 to 5 treatment sessions. Usually 1 or 2 vials are needed per treatment. HAs are injected every 4-9 months and anywhere from 1-3 syringes are usually needed.

Is Sculptra safe?

Sculptra has been used in Europe since 1999. Since 2002 when the product was reformulated, it has had an excellent safety profile when treatments are done correctly. Dr. Vleggar in Geneva has a series of over 4,000 patients and less than 10 more serious problem, all of them temporary (lasting 1 year or less). Be aware that small, invisible bumps can occur and will gradually go away. The area around the eyes is more prone to temporary bumps and they can be visible there because the skin is so thin. There are very rare cases reported of longer lasting nodules. Most of these were prior to 2003 when the product was reformulated with a smaller, smoother particle size.

Sculptra is much more difficult to inject than Botox or fillers like Restylane and Juvederm.  So be sure your Sculptra injector is very experienced.  For example, I have been injecting Sculptra for several years and have done hundreds of Scultpra injections.  I have attended trainings, spoken with one of the Sculptra pioneers, Dr. Vleggar in Switzerland, and observed skilled Sculptra injectors.  Other skilled injectors on the West Coast that I have seen do Sculptra treatments are Dr. Marla Klein in Portland, Oregon and Dr. Becky Fitzgerald in Los Angeles, California.

Is there anyone who should not use Sculptra?

Your provider will give you a complete list, but do not use Sculptra if you are allergic to lidocaine or are pregnant or nursing. Do not use if you have lupus, Sjogren’s Syndrome, or rheumatoid arthritis. Ask your doctor if you have other autoimmune diseases.

How long will it last?

It will last up to 2 years in most patients. It takes 45-90 days after the treatment to see the full results. This is because you are building your own collagen.

Do I need maintenance treatments?

One maintenance treatment a year is common so you don't completely return to your original facial volume. However, everyone is an individual and this cannot be predicted exactly.

How much does it cost?

Sculptra is expensive. Each treatment costs approximately $600-$2,000. You will probably need 2-3 treatments about 4-8 weeks apart, depending on your age and the problems you are trying to correct.

However, balancing that cost is Sculptra's longevity. Because after the initial correction, usually only 1 treatment is needed per year to maintain the correction. It may be more cost effective in the long run.

What does a treatment feel like? Is it painful?

There is little discomfort with the injections because Sculptra is mixed with lidocaine, which is a local anesthetic. Most offices including ours also apply a topical numbing cream about 45 minutes before the treatment.

What will I look like right after the treatment?

You can put on makeup immediately (some doctors may prefer you wait a day or two) and go back to normal activities. It’s best not to exercise vigorously for one to two days. There is almost undetectable fullness (from the water in the product) for about two days after a treatment. A little bruising is normal, but it’s usually minimal. You may have mild to moderate swelling at the injection sites which could last up to a week.

Is Sculptra compatible with other procedures such as laser or Thermage?

Generally yes but there are a couple of exceptions. There are anecdotal reports of Sculptra bumps after Thermage and Fraxel. This is probably due to the deeper collagen stimulation of these technologies. The combination of Sculptra with these could produce too much collagen in the form of bumps. I recommend waiting 6 months after Sculptra to have Thermage on the face and waiting 1-2 months to have Fraxel done and avoiding deeper Fraxels (greater than 40 mJs).

Is Sculptra compatible with Botox, Restylane/Juvederm, and lasers?

Sculptra is fine to use with Botox, lasers (other than deep Fraxels) and Restylane/Juvederm.

What could I do instead of Sculptra?

Other injectable materials could be used like Juvederm, Restylane or collagen. Surgical implants can be done to augment some areas of the face. Fat transplantation is an option as is a facelift.

Are there side effects?

· You could develop small, usually invisible temporary bumps. These will go away on their own. Small visibile bumps are rare, and more common around the eyes. These can be massaged out or sterile normal saline can be injected to break the bump up. Rarely, a small amount of an antiinflammatory (such as Kenalog) may be need to be injected into the bump

· After the treatment some common injection-related reactions might occur, such as swelling, redness, pain, itching, discoloration and tenderness at the injection site. Occasionally, a treatment can trigger an acne flare. These side effects resolve naturally within 1 to 14 days after the treatment.

· The use of anti-inflammatory drugs or aspirin might cause bleeding or increased bruising at the injection site.

· If you’ve previously had facial herpes simplex at the injection site, the injection might provoke an outbreak.

Sculptra Q & A Discussion

I'm a serious runner and have low body fat. My cheeks have really gotten hollow in the past few years. Would Sculptra help with this problem?

Yes, it would be perfect for you to replace some of the volume in your face you've lost through your exercise program. And, if you're under 45, it's likely that 2-3 vials might be enough. The Scuptra would slowly build enough collagen in that area to give your face a more rounded contour.

I'm 65 years old and would really like to have a facelift but I have a heart problem and my doctor thinks it would be too risky. Could I get a similiar effect with Sculptra?

No, not exactly but you could probably get an almost facelift-like effect depending on the quality of your skin (how much sun damage), your facial shape, and your weight. Plan on needing 5-8 vials though over a period of about 9 months. It's better to go slowly. If you combine it with 1 Thermage before you start the Sculptra and 1 Thermage 6 months after you finish, you could get a very nice result. It takes patience though to go this route.

Link to Guide to Cosmetic Areas - Cheek issues