Dr. Lindsey's Newsletter #33: All About Sculptra

Sculptra, also known by its generic name poly-L-lactic acid (PLLA), is a revolutionary injectable filler that has been around for quite some time now. Sculptra is distinct from traditional hyaluronic acid fillers in its mechanism of action and long-lasting results. This newsletter will explore the composition, mechanism of action, uses, benefits, and potential side effects of Sculptra.

Composition: The April Showers Analogy 

Unlike hyaluronic acid fillers, which provide immediate results by plumping the skin, Sculptra is composed of PLLA microspheres suspended in a water-based gel. PLLA is a biocompatible and biodegradable synthetic polymer that has been used for various medical purposes for decades. When injected into the skin, Sculptra stimulates the body's natural collagen production, resulting in gradual and subtle volumization. The growth process takes place slowly over several weeks and thus I love to compare the procedure to April showers bringing May flowers. Sculptra is not an injectable filler that delivers volume, instead it is like the rain that soaks your tissues in order to stimulate growth. 

Mechanism

If you are a reader of mine, you know that I would not expect you to sign up for a procedure without first dropping the basic science knowledge. The mechanism of action of Sculptra involves the stimulation of fibroblasts, the cells responsible for collagen synthesis. Much of visible features of aging are the direct result of collagen loss with age. Sculptra targets aging at the cellular level. As Sculptra microparticles are gradually absorbed by the body, they create a scaffold for new collagen formation. This process leads to increased skin thickness, improved texture, and overall rejuvenation over time. Unlike traditional fillers, which provide immediate but temporary results, Sculptra's effects are gradual and long-lasting, typically lasting up to two years or more.

We Love Natural 

One of the key benefits of Sculptra is its natural and subtle results. As my lovely Sculptra team tells me, “This is so on brand for you Dr. T”. I do love subtle and natural results.  Since the volumization occurs gradually over several months, the outcome is more natural-looking compared to traditional fillers, which can sometimes result in an overfilled or unnatural appearance. Sculptra's long-lasting effects reduce the need for frequent touch-up treatments, making it a cost-effective option in the long run. Natural results that are budget smart, what more could you want? 

Unlocking the Potential: Diverse Applications of Sculptra

1. Facial Volume Restoration - if you have been reading my newsletter series over the past few weeks you have learned all about facial aging, how volume is lost over time, and how this contributes to an aged appearance. Facial aging follows certain predictable patterns but is never one-size-fits-all. Before injecting Sculptra for facial aging, I perform a facial analysis on my patients to assess their needs and customize their plan. Common areas that I target include: cheeks, temples, jawline, and nasolabial folds. 

2. Hand Rejuvenation - who remembers my newsletter on the aging hand? At that time I offered two solutions for the aging hand with thin skin and overly prominent bone + tendon. I recommended surgical fat grafting and HA filler. The truth is that Sculptra can achieve absolutely stunning results in the hand, but it wasn’t until recent refinements in technology that I was willing to offer this procedure (more on that later). If you have thinning skin, prominent appearing bones and tendons then Sculptra injection of the hands is a fantastic treatment. 

3. Buttock/Hip Dip Augmentation - this off label use is gaining more traction lately is non-surgical buttock and hip/dip augmentation with Sculptra. The financial investment can be significant due to volume needed, but if your goal is to avoid surgery and the associated recovery, this could be the right fit for you. The thinner you are, the more readily apparent each syringe injected will be. A careful evaluation and honest conversation with me, your plastic surgeon, will elucidate if this investment is the right fit for you. 

4. Acne Scar Treatment - in the case of soft tissue loss after severe acne, or after acne treated with steroid injections (that in turn cause tissue loss), Sculptra can be used to target areas of irregular volume loss. This treatment can help  smooth contour and disguise irregularities of the tissues when combined with other treatments like microneedling. 

Navigating Nodules: Understanding the Risks of Sculptra

There has been an ongoing discussion about the safety of Sculptra because of an unwanted side effect seen in some patients, the dreaded nodule. Nodules are exactly what they sound like, small firm clumps of tissue under the skin that can either be visible, or only noticed with physical touch. Nodules do not cause direct harm, but they can cause an unwanted cosmetic appearance. I have personally taken care of patients who have come to me seeking treatment for nodules that arose from prior Sculptra injections with other providers. Because of this history of nodule formation and the patients that I have seen, I have been very slow to adopt Sculptra into my own practice. 

One of the core tenants of my practice as a surgeon is to strive to be transparent and honest when counseling my patients on risks and benefits of a procedure. I will tell you what I tell my patients, this is my transparency. Sculptra historically has been associated with unwanted nodule formation, however after years of careful work to refine the procedure it has been established that with increased dilution there is decreased nodule formation. Because of this I dilute to the modern standards of increased volume, and I counsel my patients that they must comply with massage after injection. With these two measures and a well educated injector, I believe the risk profile is acceptable. 

The 5 5 5 Rule 

After Sculptra injection and in order to prevent nodule formation, you must commit to 5 minutes of masage, 5 times a day, for 5 days. So put on your favorite music, listen to two songs and massage to it. Do that 5 times a day. This will help you avoid lifelong regret if you develop a visible nodule. 

General Risks of Injection Procedures

Anytime you undergo an injection procedure there are certain established risks and side effects that you should know about including:

• Common, minor side effects - include swelling, bruising, redness, tenderness, and itching at the injection site, which typically resolve within a few days to weeks. 
• Uncommon, serious side effects - with any injection there is a risk of intravascular injection causing an embolic phenomenon which can lead to tissue loss and/or blindness. 

As a plastic surgeon I have a surgical knowledge of the anatomy of the face. I have seen each plane from the inside out. The dangers that lie under the surface of your skin are not just abstract concepts to me, rather they are structures that I manipulate in surgery. This quality sets me apart from non-surgeon injectors and it is my privilege to apply my surgical knowledge to the practice of keeping my patients as safe as possible. 

As we work together toward your aesthetic goals, I want to express my heartfelt gratitude for your unwavering commitment and trust in my practice.