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.

Pan-Facial Filling: The End of the Facelift?

As our understanding of what causes facial aging advances, our approaches to this problem are advancing as well. Gravity as an explanation for the aging changes in the face has been discredited. Three factors are now recognized as important in facial aging: changes in the skin quality, mostly due to insults from the environment, but also due to biological changes that are not fully understood; repeated folding of the skin and loss of volume of the underlying tissues that support the skin. It is the last of these changes that I will discuss here.

For a while we have recognized that the loss of facial soft tissue: fat, muscle and connective tissue, have played an important part in facial aging. More recently it has become clear that loss of bone also plays a very important role. The openngs for the eyes are much larger in the skull of a 50 year old, than in the skull of a 20 year old. The jaw bone of a 20 year old is thicker and wider than the jaw bone of a 50 year old. These changes not only cause deflation of the face, but change the proportions. In the young individual the upper lip occupies 1/3 of the distance from the bottom of the nose to the tip of the chin. In the elderly it takes up 1/2.

Hand Rejuvenation: An Underappreciated Treatment

"All the perfumes of Arabia will not sweeten this little hand." William Shakespeare, MacBeth

Fortunately, since Shakespearean times, we have become much better at improving the appearance of hands, although perhaps not much better at washing away their sins.

If you look at the hands of children, the skin is smooth and of uniform color. No bones or veins are visible. With time the hand skin becomes sun damaged and irregular discolorations and rough spots appear. As in other areas, the deeper tissues are lost, and bones and veins become more visible. Many people put up with this because they are not aware that treatments are available. We had a patient in this week who is very attractive with clear facial skin. She regularly gets Dysport and filler. Her hands look like the hands of an 80 yer old. When I mentioned her hands, she said that she feels like she should wear gloves all the time. We discussed other options.

The "Wow" Effect

There are precious few procedures that we perform where, immediately after the procedure, we can hand the patient a mirror and their typical response is "wow". The injection of filler is the outstanding example of this phenomenon. The results are immediate and frequently very impressive. The final result, however, is more of an art, rather than a science. This is especially true now that filling has evolved from plumping up a specific groove to re-contouring the face, producing a more youthful facial structure. This is very operator dependent and it is unusual to see physicians who are not members of "core" cosmetic specialties (dermatology and plastic surgery) venture into this arena.

"I love you, Dr. Bock"

That is how I was greeted last week by a long time patient. She had undergone a number of noninvasive procedures in the past few years, but two weeks before I saw her I had, for the first time, injected filler in her cheeks. The aging of the mid-face has, with the development of better and linger fillers, become recognized as one of the primary events that makes a person look aged. The young face is full, with smooth, convex surfaces, while the aging face becomes concave, with the loss of deep tissue and other structures. This produces depressions such as the "tear trough", a groove that extends downward and sideways from the inner (medial) part of the eye. It was this area that was filled in my patient. She was smiling as she reported that even her teenage son, without knowing that anything had been done, told her that she looked good.

Sculptra Article: New York Times

There will be an article about Sculptra published in the New York Times on Thursday September 24. I have been interviewed for the article and, unless I'm edited out, you can read my thoughts about the topic.

Gerald N. Bock MD
California Skin & Laser Center
Stockton & Lodi, CA

Finally a Use for Sculptra?

Sculptra has been one of the products that we have used and discarded. The advantage of Sculptra is that it is the longest lasting of the fillers, frequently lasting 2 years or more. The disadvantages of Sculptra have been many: it requires a series of injections and was slow to produce visible improvement; it can be expensive and it has a propensity to develop nodules, sometimes starting more than a year after the material was injected. Because there were other fillers that were less expensive, relatively long acting and produced immediate improvement without the same propensity for nodule formation, there seemed little reason to use Sculptra. Now there is a report from Brazil that describes new uses for Sculptra that allow it to treat problems that previously had no good solution.

Evolence: The New Filler in Town

Evolence was approved by the Food & Drug administration in late June 2008, and is now being rolled out across the nation. It is a porcine (pig) collagen based product which has been available in Canada and Europe for about 2 years. It is much longer lasting than the original bovine (cow) collagen or the human based collagen that is now available as well. It has a number of advantages and at least one significant disadvantage.

One Filler Down

We are used to hearing announcements for new fillers, but we now have an announcement of the disappearance of an FDA approved filler. Artes Medical, the company that makes Artefill, announced its intention to file for bankruptcy. Artefill was the first "permanent" filler approved in the US, although silicone, now available in a medical grade, has been used off-label for this purpose.

The Lure of the New

New fillers are in various stages of development. Each new filler has to establish a niche for itself, to be able to differentiate itself from the already well established fillers. Evolence, which has recently been approved in the US, is the newest of the collagen fillers.