Initially fillers were viewed as relatively inert materials, such as collagen, that were injected, immediately plumped up the area to be filled, and gradually were absorbed. These type of fillers still exist, as exemplified by the hyaluronic acid fillers (Restylane and Juvederm). However, a new type of filler has emerged, a filler that works by stimulating the body to make more collagen in the area where the material has been injected.
Currently there are at least three fillers that fill this role. The first of these is Radiesse. Radiesse is a calcium based filler which was first introduced as a traditional filler. However, subsequent studies showed that much of the injected material was absorbed, and the prolonged effect seen was due at least partially to the production of new collagen in the area. In our hands, Radiesse has been essentially problem free.
Sculptra, in contrast, has always been recognized as achieving its effect by inducing the body to produce new collagen. Sculptra consists of tiny particles of poly-L-lactic acid, the same material that is used in absorbable sutures. The Sculptra is suspended in liquid and when injected, the area appears filled, similar to the immediate filling seen in other fillers. However, the liquid is absorbed within 24 hours, and the filling effect vanishes. The filler particles gradually stimulate the formation of new collagen, and it takes at least a month before results can be seen. The final result may not be seen until three to six months or longer.
There are several problems with Sculptra. First, because the result depends on the body's production of collagen, the results are not very precise and Sculptra is best used to fill a wide area, such as the hollows of the cheeks. Second, Sculptra has a propensity to produce nodules, sometimes not visible, but at other times visible. Furthermore these nodules can develop long after the Sculptra has been injected. We have seen Sculptra nodules develop 18 months after the injection and nodules starting as late as three years after injection have been reported. Needless to say, the patients in whom this occurs are not happy. Because of this, we have almost completely stopped using Sculptra.
The last of the fillers that induce new collagen formation is a permanent filler called Artefill. It is currently unclear how much of a problem there will be with nodules with this agent, but some have been reported.
Gerald N. Bock MD
Stockton and Lodi CA
California Skin Laser Center