Sculptra: today’s stealthy age-eraser

You might not know every detail about collagen (and if you’re interested in learning more, including my experience on drinking collagen click on the links included) but you know that more of it is a good thing for skin, and both having and making less is part of the natural aging process.

Poly-L-lactic Acid: Background

Sculptra Aesthetic is an injectable form of poly-L-lactic acid that is designed to kickstart the skin’s collagen production. It launched back in 1999 in Europe and received FDA approval in 2004 for HIV patients who suffer from lipoatrophy. Lipoatrophy is the diffuse loss of adipose (aka fat) tissue which can happen in varying areas of the body. Those with HIV may experience wasting of the fat and muscle with progression of the disease, and the idea was that poly-L-lactic acid would help activate collagen to alleviate severe gauntness. Poly-L-lactic acid has also been used in the body and as part of dissolvable sutures since the ’60s. If you think about it, it makes sense. When you get absorbable sutures, it helps to close and reinforce the wound while turning on the skin’s healing process (and collagen production). Light bulb moment!

Sculptra: the collagen biostimulator

Many aesthetics treatments arise from clinical needs that find themselves repurposed as important tools in today’s plastic surgeon and medical spa arsenals. For instance, did you know that Botox was discovered while trialing treatments for strabismus and is used to treat contractures in those with cerebral palsy? I find this part of medical aesthetics fascinating. #themoreyouknow

Sculptra Aesthetic is part of the Galderma portfolio. It comes in powdered form and is reconstituted at varying levels with bacteriostatic water. It is an injectable “drug” so it may only be administered by licensed medical professionals. Do not try this (or any aesthetic injectable for that matter) at home.

Sculptra Aesthetic

Sculptra is one of my favorite treatments, and it is not your typical filler. It is a biostimulator (meaning that it tells your body to kick in its own collagen production). It is extremely important as both injector and patient to understand what Sculptra is, what it does, who is the best candidate, and what proper expectations plus risks of the treatment are.

What it is

As mentioned, Sculptra is not your typical filler. It does not work the same as fillers do, and requires a level of prep, skill and patience beyond HA fillers.

The best way to describe it without getting too technical is that the Sculptra acts as “collagen seeds” mixed with water. When Sculptra is injected, the water helps to diffuse the seeds into the tissue. Once the seeds have settled into place, over the next 2-3 months and up to one year they will start to grow collagen. The results can last up to two years or longer depending on the rate that your body builds and breaks down collagen.

Why it’s tricky

Sculptra requires planning, communication and setting proper expectations. With typical HA fillers like Restylane and Juvederm, you should leave product in place and leave it alone. Not Sculptra. This is very important. Over the next five days the patient MUST massage 5 times per day, for 5 minutes each time with moderate pressure with intention to move the mixture around in the skin. I liken this to laying a cement driveway which seems odd but hear me out. You want to move this thick “cement mixture of seeds” around the tissue and have it be evenly distributed before it “hardens” (aka settles). Like that cement driveway, once Sculptra seeds have settled, they grow where they lie. The process cannot be stopped or “turned off” and it cannot be dissolved.

Sculptra also requires time to prepare. It needs to hydrate for days to be its most effective. It is not a product that you show up and say, “let’s do Sculptra today!” The product can be expensive, is the right fit for a small portion of patients, requires tending-to by the injector and isn’t requested as much as its more well-known filler friends like Restylane and Juvederm. Most places don’t have it mixed just sitting on the shelves.

The communication between injector and patient is so important. Choosing the right candidate is paramount.

Good candidates:
  1. Someone who wants a natural look.
  2. Patience is key. Once Sculptra is injected, the water will help show some of the volume immediately after. This gives a rough idea of what to expect. Over the next few days the body will absorb that water and it will look like nothing happened. It will take several months and possibly several treatments, to see results.
  3. Good candidates need diffuse collagen-building. Sculptra is not precise, and isn’t used towards the mid-face or areas with thin skin. It is great for the peripheral face, general cheek bones, temples and hairline, even the neck, chest and buttocks. It is not for undereyes, lips, or somewhere that you need a dot here, and a dot there.
  4. Patients with thick, sebaceous skin which need a strong foundation that might have better luck with longevity vs. HA fillers.
  5. Someone with diffuse lipoatrophy in which too many HA fillers may be needed, or may be outside the budget.
Candidates better fit for HA fillers or other collagen-induction therapies:
  1. Someone with thin skin. Sculptra can cause nodules which may be more visual in thin skin.
  2. Healing issues. Autoimmune diseases, prone to nodules or keloids, or other healing issues would be too much of a risk for a set it and see what happens type of treatment. If the body is prone to inflammatory responses, it isn’t worth the risk.
  3. At an age where collagen production is too low. I would suggest regular HA fillers to someone whom may not see the results due to low collagen production.
  4. Is impatient and wants instant gratification (or has an event coming up too soon for results). Sculptra, like any garden, takes time to grow.
  5. Someone you know will forget or “forget” to massage. Sculptra can cause nodules if collagen seeds clump together and grow and are unable to be dissolved. The massage is important to spread the seeds around. Sometimes it can be uncomfortable but needs to happen through the pain (and even throughout the day when you may be wearing makeup, etc).
  6. Someone who just received Botox or another HA filler in the area which should not be disturbed (since Sculptra requires decent pressure and massage which may move products around that shouldn’t be moved).

What to expect during your Sculptra treatment

Have a consult a few days minimum in advance to discuss the treatment. You will likely do multiple vials over the course of months. Because Sculptra is the body’s own collagen stimulator, you need at least 8 weeks between treatments to see how you’re moving along. The only way to undo too much Sculptra is…well I guess get older and your body will break it down. Patience is key.

The provider will have everything mixed and may choose to add lidocaine topically or to the solution. Depending on which areas you’re doing, it may be quite a few pokes and with or without cannula. Don’t be alarmed if your provider has to pull the needle out multiple times. Sculptra tends to clog in the needle. It is a very annoying part of the procedure for the injectors, but it happens almost every time. Don’t be alarmed. Everything is okay 🙂

Afterwards you may look full. Areas like the temple and jaw may be sore to touch, and when opening the mouth or chewing. You might even have a headache. This is because a) you’ve been poked with needles and b) Sculptra contains a decent amount of fluid which puts pressure on the areas (think when your sinuses are full and you have a headache). Mild to moderate pain for the first few days is normal and YOU STILL MUST MASSAGE THE AREAS. Excruciating pain, intense pain on one side, blanching of the skin or traveling bruising is not normal. Those could be emergencies which require a call to your provider right away.

Why I love it

Sculptra is one of my favorite treatments and I highly recommend it for the right candidate. It looks so natural and gives an all-over kick of collagen glow to the skin. I fit smack dab in the ideal candidacy for the treatment: I have very thick, heavy skin. I tend to yo-yo in weight a bit, and like to do collagen adverse things like drink wine, run and jump which eats up collagen and puts pressure on the supporting structures of my skin. I have a high metabolism which eats up HA fillers. Sculptra helps to maintain the structure and reinforces the strength needed to lift this heaviness. S is for Stacie and Sculptra. And maybe S is also for you!

Have you tried Sculptra before? Have questions about this treatment? Drop us a line in the comments.

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