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January 29, 2008

Sculptra: The Filler as Time Bomb

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

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Comments

Jane

I have sculptra lumps. I had the injections 19 months ago. They started showing 11 months after the injections. I met a doctor who says he can give me very good results with using kenalog injections. Any opinions?

Sculptra bumps are very difficult to treat, but they do eventually resolve spontaneously.
Gerald N. Bock MD

Jane

I have sculptra lumps. I had the injections 19 months ago. They started showing 11 months after the injections. I met a doctor who says he can give me very good results with using kenalog injections. Any opinions?

melanie smith

I had radiesse 3 weeks ago and now have terrible nodules under my eyes, are these permanent? How can they be treated?

M. Smith

Most filler bumps disappear eventually. You will have to discuss the details with the person who did the injections. Hopefully this was a physician who has significant knowledge about fillers and about dealing with skin problems.
Gerald N. Bock M.D.

Sue Ibrahim

At our Medical Skin Clinic in Essex we recommend that clients massage the treated sites twice a day for at least a week following treatment. Lumps have never been an issue at our clinic. elan medical clinic

Keith,  Atlanta

I have been getting Sculptra injections in my face (even around my eyes) since 2001 and have NEVER experienced lumps or nodules. I have not once been told to massage my face. The results have been nothing short of amazing and really life-changing. Of course, my Doctor is a facial surgeon in Paris who has treated over a thousand patients with with this product. The results are neither instant nor permanent but more natural-looking.(for me,anyway) But I have come to the conclusion that Sculptra is only as good as the Doctor's technique. It requires extraordinary skill to properly inject Sculptra. Most US Doctors do not invest the time and energy to really understand the complexity of it and that is why I would rather pay to fly to Europe every six months than risk my face to an inexperienced Sculptra injector here at home. If there are any Doctors out there who know what they are doing with this product I would be more than happy to come to them than pay the $2000 extra I spend to get to Europe twice a year. Let me know!

Sue Ibrahim

Keith. You are right, Sculptra needs to be injected by a properly trained practitioner. The product need to be injected deep into the subcutanious skin layer and a lot of problems can occur if the product is injected too superficially. Sanofi- Aventis, the manufacturer now recommend that the product is massaged twice a day for four weekes following treatment.

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