Sculptra is one of the most popular dermal fillers in New York but one significant problem has been the lumps or bumps which can occur as a side effect of Sculptra injection. Unlike hyaluronic acid based dermal fillers, such as Juvederm and Restylane, Sculptra has been associated with the formation of granulomas, which cannot be dissolved easily. When Sculptra was first FDA approved in 2009 for the cosmetic injection of HIV patients lipoatrophy, there was an increased incidence of granulomatous reactions reported from this injectable. However, currently, these lumps are a rare side effect, since the proper injection technique, dilution, and reconstitution, has changed over the past decade. Dr. Michele Green, in her boutique NYC private dermatology office, has been on the forefront of Sculptra injectables and establishing the best and safest injection protocols for her NYC patients.
What is Sculptra?
Sculptra is a synthetic, biodegradable injectable fillers, which is composed of microparticle beads of poly-L-lactic acid (PLLA). PLLA is a biocompatible, biodegradable, synthetic polymer, which is a derivative of the alpha hydroxy acid family. Sculptra treats the visible signs of aging on the face, by restoring lost facial volume, and treating shallow and deep facial lines. The mechanism of action of Sculptra works by stimulating the body toincur collagen production. Currently, it is also very popular to use Sculptra for buttock augmentation, hip dents, skin laxity of the inner arm, chest and neck wrinkles, knee and elbow wrinkles, and the treatment of cellulite. Sculptra injections create new collagen and elastin in the skin, firm and tighten the skin, and restore lost volume. Through pan facial rejuvenation, Sculptra is able to treat almost the entire face and replicate the results of a facelift with these injections. Sculptra treatment is often referred to as a “liquid facelift” for just this reason, and allows many patients to avoid undergoing a facelift or other plastic surgery.
What are the side effectsof Sculptra?
Any dermal filler can have a lump which needs to be dissolved at the injection site. For products which are composed of hyaluronic acid, such as Juvederm and Restylane, often massaging the treated area will dissolve this lump. These lumps can be easily dissolved with hyaluronidase, if the lumps do not dissipate, or if you are unhappy with the cosmetic results of your injections. However, if you have lumps or granulomas, from Sculptra injections, these lumps cannot be easily dissolved. There are several reasons for the formation of these granulomas. The most common side effects of Sculptra injections are:
- granulomas – this is especially seen in patients with autoimmune disease.
- skin discoloration
- lumps, bumps
- bruising – especially if the patient is still on blood thinners at the time of Sculptra injection. This bruising can be treated with theVbeam laser treatmentand Arnica supplements.
- tenderness
- swelling
- facial asymmetry
- areas of the face overfilled with Sculptra. It is best advised when injecting Sculptra to fill the treated areato correction and avoid overfilling an area of the face.
- limited results due to cigarette smoking which may interfere with new collagen formation.
These unwanted side effects of Sculptra can occur for various reasons. For example, during the consultation with Dr. Green for filler injecting, she advises her patients to refrain from taking blood thinners, Vitamin E, Fish oil, multivitamins, Advil, Alleve, Motrin, or any other oral supplements or medications which can cause bruising. Post injection, we will advise our patients on the correct skincare and after care for Sculptra injections. Post-injection, most patients can apply make-up immediately after the injections. The most worrisome complication reported in the past from Sculptra injections are granuloma formation. The following are the most common causes of granuloma formation:
- Improper injection technique by the injector. If Sculptra is injected to superficially to an area of the face, a granuloma can form.
- Injection under the eyes or into the lips.
- Improper dilution of the product.
- Reconstitution of the product and use immediately afterwards. If it best to reconstitute the product several days before Sculptra injection with 7cc of sterile water. Immediately before Sculptra injection, 2 cc of lidocaine is added into the Sculptra mix to make the injection process more comfortable to the patient.
- Not massaging the treated area by the “rule of 5’s”. Massaging the treated area allows the product to be absorbed uniformly, and prevent unwanted Sculptra lumps.
Other more common side effects from injection are bruising, swelling, redness, tenderness, and rarely infection. If any of these more serious side effects, such as granuloma formation or infection occurs, you should consult a board certified plastic surgeon or dermatologist, like Dr. Michele Green, immediately for medical advice to help remedy the situation.
Recovery time from Sculptra aesthetic
There is no downtime after Sculptra injections and most patients return to work or other daily activities immediately after the procedure. Optimum care after your treatment is to:
- apply a cold pack wrapped in a cloth for several minutes at a time for the first 24 hours after the procedure to minimize swelling.
- Carefully follow the “rule of 5″s” and massage the treated areafor 5 minutes a day, 5 times a day, for 5 days, to evenly distribute the product and prevent lump formation and hard nodules.
- Avoid excessive heat, saunas, sunlight, or UV lamp exposure, as this can exacerbate the swelling and redness of the area.
Where should Sculptra aesthetic be injected?
The most common area that skilled dermatologists, like Dr. Michele Green, and plastic surgeons inject Sculptra is the nasolabial fold or smile lines. Other facial areas including the temples, cheeks, marionettelines, chin, jowls, jawline, neck, and acne scars, are popular places for facial rejuvenation and are well suited for Sculptra treatment. There are several areas of the body which are becoming very popular to inject Sculptra including the arms, upper knees, decolettage, buttocks, hip divets, and areas of cellulite. Sculptra is becoming increasing popular in Dr. Green’s NYC for augmenting calves, pecks, and biceps in male patients.
Sculptra is a deep injection, and proper injection technique needs to be followed to prevent nodule formation. Since the skin of the lips and under the eyes is quite thin from the other areas of the face, Sculptra injections should be avoided in these two areas. The result of Sculptra treatment in this area is nodule or granuloma formation, which is difficult to eliminate. The lips are better suited forlip enhancementwith Juvederm or Restylane.
How do you dissolve Sculptra lumps?
Unlike hyaluronic acid fillers, such as Juvederm, and Belotero, these dermal fillers dissolve over months, and if a lump or papule forms, they can be easily dissolved with hyaluronidase. Belotero and Restylane, are in fact, ideally suited for the under eye area, since they are less likely to cause skin discoloration and the Tyndall effect, and leave a bluish hue under the skin. Stimulatory dermal fillers like Sculptra and Radiesse are most likely to form these lumps.
When Sculptra injections cause granulomas, there are a limited number of options to treat this:
- Wait for the Sculptra to naturally resolve, which can take several years, depending on the area of the face injected.
- Attempt to dissolve with diluted cortisone (kenalog) injections, to break up the nodule. Sometimes, 5-Floururacil is mixed into the solution to further accelerate dissolving the lump.
- Subcision of the nodule or lump.
- Excise the nodule completely to remove it by a facial plastic surgeon.
If the lumps are only palpable, and not visible, it is usually best to refrain from excising the papule as this can cause a visible scar in the area.
Is Sculptra a safe dermal filler?
When Sculptra is injected properly, by an expert injector like Dr. Michele Green in NYC, it is a safe and effective method for facial rejuvenation. Sculptra stimulates the body to produce its own new collagen in the areas treated. A typical treatment will be done in 3 sessions, from 4 to 6 weeks apart. Sculptra can last up to 2-3 years in many patients. However, touch up treatments are needed at about 1 to 2 years to maintain these rejuvenated results. It is important to choose your treating physician carefully and google their qualifications and experience in using Sculptra injections. Sculptra cannot be reversed like hyaluronic acid fillers, such as Juvederm and Restylane.
Can Sculptra be injected with Botox and other dermal fillers?
Many patients have Botox and other dermal fillers injected at the same time as Sculptra. Since Botox is a a neuromodulator, it will treat the muscles of facial expression such as periorbital (eye wrinkles), and forehead lines, that Sculptra does not treat. Hyaluronic acid fillers are well suited for lip enhancement and under eye rejuvenation and these injections are often performed at the same time as Sculptra injections. Dermal fillers can be layered on top of Sculptra, since Sculptra is injected deep to stimulate new collagen formation.
Will combining Thermage with Sculptra maximize the amount of collagen produced?
The best way to maximize the amount of new collagen produced is to have both Thermage and Sculptra performed. They work synergistically to create new collagen. While collagen stimulates your body to produce new collagen, Thermage works through radiofrequency and stimulates new collage production in the deeper dermal layer of the skin. Having Thermage performed with Sculptra maximizes the new collagen produced and creates younger and healthier looking skin.
What is the cost of Sculptra?
The cost of Sculptra injections is generally around $1,000 per vial. You may need 3 to 4 treatment sessions to achieve your cosmetic goal. Depending on the area injected, different number of vials may be needed. For example, the face may need two vials, whereas the buttocks may need ten vials per session. It is always best to consult an expert injector, like Dr. Michele Green, to formulate a treatment plan and understand the cost involved in having Sculptra aesthetics injected.
Find out more about how much Sculptra costs
How do I get started with Sculptra injections?
Botox injections and dermal fillers, like Restylane, Juvederm, and Voluma, are fantastic. However, sometimes, Botox and hyaluronic acid fillers are not enough. Perhaps there has been a dramatic weight loss, or skin laxity, or simply as a result of aging, there are many patents who lack the structural support or volume in their face. Sculptra is the key to providing this structural framework of the face to stimulate new collagen, and hyaluronic fillers can be layered on top to give an immediate lift or improvement to the treated area.
Since Sculptra is a bio-activator, it stimulates your own collagen, and over several months, produces new tissue and volumizes the treated area. The results of Sculptra are not immediate, but build up over several months to create a refreshed, younger-looking appearance.
The first step to see if Sculptra is the best dermal filler for you is to schedule a consultation with Dr. Michele Green in her discreet private NYC office. Dr. Green is an expert in cosmetic injections and laser procedures and will create a unique treatment plan to rejuvenate your skin. Please call Dr. Green’s New York office at212-535-3088orcontact us online today
