Sculptra: An Old Filler Resurrected

 Sculptra is a unique filler that was first approved in the US in 2004, for treating facial lipoatrophy (fat loss) in AIDS patients. It consists of a suspension of particles of poly-L-lactic acid, a material that has long been used in the skin as an ingredient in absorbable sutures. Although it was legally used for cosmetic purposes immediately after its initial approval, it received official FDA approval for this indication in July 2009.

The features that make Sculptra unique are that it, like Artefill, relies for its effect on stimulation of the skin to make collagen. Sculptra is unique in that its particles are suspended in water, while the Artefill particles are suspended in collagen. This makes Sculptra the only filler that does not produce a sustained immediate effect. The initial filling is transient, and vanishes within a day. This is both an advantage and a disadvantage. The most feared side effect of filler injection is the rare interference with the circulation to an area of skin, producing a skin ulcer. This happens when a filler is accidentally injected into a vessel, usually a named artery, blocking the blood flow, or a bolus filler is injected near a vessel producing enough pressure to obstruct flow in the vessel. Because Sculptra consists of particles in water, and water diffuses fairly rapidly, the probability of either of these events occurring with Sculptra is much reduced, when compared to other fillers.

The disadvantage of Sculptra is that patients must wait at least 6 weeks to begin to see the improvement in their facial structure,. Furthermore, although every filler can occasionally produce nodules, Sculptra appears somewhat more likely to do this in comparison to most other fillers. Treatment with this product requires a series of usually 3 injection sessions, at 6 week intervals.

As we have increased our understanding of the aging process, and our skills in the use of fillers, we have come to appreciate the importance of bone loss in producing the changes in facial appearance and the loss of the youthful facial proportions. Correcting these bony changes requires us to place fillers in some areas we had previously avoided due to the proximity of important vessels. It is in these areas that filler safety is most important, and Sculptra becomes the filler of choice.

In recent years changes in the preparation of the Sculptra particles has reduced the risk of nodules. Unlike other fillers, it is very important that the patient massage the injection site vigorously for 5 minutes, 5 times daily for 5 days after injection. This greatly reduces the risk of nodules, and with the new injection techniques, nodules, if they occur, tend to be deep, and a minor aggravation rather than something that is visible.

While we abandoned the use of Sculptra several years ago due to the occurrence of nodules, which all eventually resolved, we have resumed the use of this filler and anticipate that it will assume increasing importance in the palate of fillers we use and are comfortable with.

Gerald N. Bock MD

California Skin & Laser Center

Stockton & Lodi, CA