Guide To Sculptra
What is Sculptra Aesthetic?
Sculptra is an injectable liquid used to add volume to areas of the face to create a soft, natural, more youthful recontouring of the face. It builds your own collagen while it gradually disappears. When done well, it doesn't have that "over stuffed" look that is all too common when too much Juvederm, Restylane or Radiesse are used in the cheeks. It is best for adding volume to:
What is Sculptra made of?
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?
In 2009 Sculptra got its full FDA approval for cosmetic use in the United States. It has had partial FDA approval here for over five years. It has been used extensively in Europe for over ten years and 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). Juvederm and Restylane (HAs), in general, fill specific wrinkles and lines. In the past few years longer lasting HAs have been added like Juvederm Ultra Plus and Perlane. These can also be used for cheek contouring and a "lift" effect. The choice between the HA fillers and Sculptra often comes down to the amount of volume replacement desired, your age, and maintenance issues.
If a small amount of filling is all that’s needed, then I generally recommend an HA. If more than 2-3 syringes of HA are needed, then Sculptra may be more cost effective over time (2-3 years). Only one maintenance treatment a year is typical with Sculptra, while 2-3 maintenance treatments per year are needed with Juvederm/Restylane. There are longer lasting HAs available in Europe and other parts of the world.
I personally don’t use Radiesse, although there are many excellent dermatologists who do, because to my eye it looks a little stiff and wooden when the face is in motion.
I also don’t recommend other HAs beside Juvederm or Restylane at this time. Restylane and Juvederm have had the best safety record over time. Adverse reactions to them are extremely rare outside of bruising or slight tenderness at the injection sites for a few days. See the section below on adverse reactions.
Allergies to HAs are usually related to the protein load and other contaminants, so inferior products or companies who are less than compulsive in their formulation result in complications even though they are sometimes cheaper. For example, you can read about the recent problems with Evolence.
The best result may be with both Sculptra and HAs. Sculptra will re-volumize the cheek area, chin, and temples, and 1 syringe of Juvederm/Restylane 1-2/year will fill right around the lips where Sculptra can’t go.
Sculptra lasts approximately 2 years once the series of treatments is completed.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 person and 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.
Is there any place Sculptra should not be used?
It should not be used in the frown lines, the forehead, around the eyes, around the mouth, or in the lips. There may be other areas that are prohibited in your particular situation. Your doctor will inform you.
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 treated a series of over 8,000 patients and had less than 20 more serious problems, all of them temporary (lasting 1 year or less). Be aware that small,invisible bumps can occur and will gradually go away. 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.
The company does not now recommend treating the eye area because it is more prone to temporary bumps. They are more likely to be visible there because the skin is so thin.
Sculptra is more difficult to inject than Botox or fillers like Restylane and Juvederm, so be sure your Sculptra injector is experienced. Also be sure you follow all the office recommendations regarding massage and any post care.
Is there anyone who should not use Sculptra?
Your doctor 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 Sculptra last?
It will last up to 2 years in most patients, but one treatment once a year is important for maintenance. You don’t want to go from full to zero. 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 Sculptra cost?
Sculptra is expensive. Each treatment costs approximately $600-$2,000 depending on your age and amount of correction needed. Average is 2-3 treatments about 6-10 weeks apart for the initial "repair" series, depending on your age and the problems you are trying to correct.
However, balancing that cost is Sculptra's longevity. After the initial series of treatments, 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 Sculptra treatment feel like? Is Sculptra 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 Sculptra 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.
To avoid bruising don’t take aspirin, ibuprofen or Aleve (naproxyn) or any other drug which increases bleeding for 1 week prior to your treatment unless required by your doctor.
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 some Fraxel treatments. 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. Have your Thermage before your Sculptra treatments. I recommend waiting 6 months after Sculptra to have Thermage on the face. Ask your doctor about Fraxel if you are considering both. It may depend on the exact Fraxel setting that are being planned.
Is Sculptra compatible with Botox, Restylane/Juvederm, and lasers?
Sculptra is generally fine to use with Botox, most lasers, and Restylane/Juvederm (in most situations). Your doctor will advise you. If you have had multiple cosmetic treatments, be sure to let your doctor know exactly what those were before your Sculptra treatment. Sculptra should not be used with permanent fillers like silicone or Artecoll/Artefill.
What could I do instead of Sculptra?
Other injectable materials could be used like Juvederm, Restylane, Radiesse or collagen. Surgical implants can be done to augment some areas of the face. Fat transplantation is an option as is a facelift. I do not recommend permanent fillers like silicone or Artefill/Artecoll.
Are there side effects with Sculptra?
You could develop small, usually invisible temporary bumps. These will go away on theirown. Small visible bumps are rare, and more common around the eyes. The company does not recommend treatments around the eye area. Small bumps can usually be massaged out or sterile normal saline can be injected to break the bump up. Rarely, a small amount of an anti-inflammatory (such as Kenalog) may need to be injected into the bump.
Rarely, small visible bumps may develop which can take months or even a year or two to go away. These are usually related to the massage not being done correctly, a too concentrated Sculptra solution, an injection technique that doesn’t follow the company protocol, or injection into an area that is not recommended (see above).
After the treatment, some common injection-related reactions might occur, such as swelling, bruising, redness, tenderness, itching, and discoloration 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. Talk to your doctor about this before the treatment.
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 total over 6 months 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 6-9 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.
See Dr. Irwin's Guide to Cosmetic Areas - Cheek issues
See Dr. Irwin's expert answers to other reader's questions on Sculptra:
Is sunscreen really needed if I'm at home? Problems with pigment increase after peels. Can Thermage, Exilis and Ultherapy be used for prevention? Are Dysport/Botox and Sculptra compatible? A problem! Which retinol is best for use on the delicate eye area? How does radiofrequency (Thermage & Exilis) compare with Ultherapy? All these different forms of Retin A (Renova, Atralin, tretinoin) -- arghhhh!
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