Questions answered about Sculptra by Dr. Steven Weiner, Facial Plastic Surgeon

 

Q: Do you have experience with Sculptra injected in front of ears to improve slightly flaccid jowl?

A: Jowls are not affected much with Sculptra

Part of the routine areas of injection for Sculptra is the preauricular area. There is loss of volume in this area related to loss of fat that is contiguous with the temple fat pad. Injecting this area does pull up skin from below and defines the jaw line better and rounds out the face. Helping the jowls is probably not going to happen that much. Steve Weiner, MD, Panama City, FL.

Q: Sculptra – Can the Effects Be Reversed?

A: Sculptra in the temples – overfilled, is hard to fix

The reason to have about 3 sessions, at least 6 weeks apart, of Sculptra to get to full correction is so that the risk of overfilling is less.  Once overfilling has set in, it is hard to correct.  Surgically removing the product/collagen can be done but this is probably worse than living with the problem.  Steroids will only work if there is excessive inflammation or granuloma formation.  It will gradually improve, but it will be months.  I am a trainer for Sculptra now and my techniques are to fill to correction, not overcorrection.  Steve Weiner, MD, Facial Plastic Surgeon.

Q: I take warfarin 3mg daily & Have INR fortnight can I still Have Sculpture?

A: You can still get Sculptra while on coumadin but you will bruise

Placement of Sculptra requires multiple injections.  A blood thinner will cause you more bruising than if you were not on one, but this won’t affect the long term results. Bruising after Sculptra can be improved with the VBeam which is offered complimentary to any Sculptra patient that bruises in my office.  Steve Weiner, MD, Destin, Florida.

Q: Sculptra and Dexamethasone Question?

A: Taking one dose of steroids 2 months after Sculptra will not affect results

Steroids inhibit the inflammatory process which is exactly what Sculptra needs to work.  So long term steroid use would counteract the results you would get from Sculptra.  One dose should not matter at all.  I do worry about dental procedures infecting fillers and Sculptra so I tell patients NOT to get dental procedures within 2 weeks after I inject them.  Steve Weiner, MD, Panama City, Florida.

Q: About Sculptra and Swelling in Cheeks?

A: Wait for things to settle down before being worried about Sculptra done a few days ago

The results from Sculptra take about 6 weeks to appreciate.  Being worried at this point is just going to be spending negative energy on something that might be fine.  Its possible there is some bruising or asymmetric swelling going on that makes things uneven. Steve Weiner, Facial Plastic Surgeon, Sculptra Trainer, Destin, Florida.

Q: Aggressive Rings/ridge Under Eye? (photo)

A: Agree, there appears to be a ridge around the undereye area after Sculptra and Belotero

I can see what you are complaining about.  I would try to dissolve the Belotero in this area with hyaluronidase.  If you have no improvement, its probably due to poor placement of Sculptra and then you can’t do much, other than try to camouflage the area with filler around it.  Steve Weiner, MD, Facial Plastic Surgeon, Destin, Florida.

Q: Why Are Those “Completely Safe and Natural” Facial Fillers Causing Me to Be Extremely Ill 3-4 Days After Receiving Them?

A: Around the eyes, Restylane is a better choice than Sculptra or Radiesse

I would switch the product to Restylane instead of Sculptra or Radiesse for the eye area.  Your symptoms are unusual, but this would be a good test to see if it is those products.  Sculptra and Radiesse can leave lumps when injected close to the eye and Restylane is a much better choice.

Q: Probability of Sculptra Lumps?

A: Lumps after Sculptra were mainly when using older dilution

It took me a long time to come on board with the Sculptra because of this very issue.  After observing the very low frequency of issues with the newer dilution, I started using it (early 2012).  Other measures which have helped are: not injecting around the eye or mouth, avoiding people with autoimmune disease, mixing the Sculptra days in advance, and massaging the areas injected.  At this point, the most likely reason to get lumps would be technique (injecting too much Sculptra in a single location).  I am now a Sculptra Instructor too.  Please see my blog which addresses this very issue.  Steve Weiner, MD, Destin, Florida.

Q: Should Extra Volume Still Be There 5 Days After Injections?

A: Swelling persistent 5 days after Sculptra is not a concern

Even though the injection of Sculptra is mostly sterile saline and lidocaine which is absorbed in about 24-36 hours, there can still be swelling related to the injection at day 5.  This is just related to trauma from the injection (bruising and swelling) and by no means is an indication of what the final result will look like.  Steve Weiner, MD

Q: Does Smoking Delay Results for Sculptra?

A: My gut instinct is that smoking negatively affects sculptra results

Smoking decreases blood supply to the face by up to 60 percent. So all the inflammatory response which creates the collagen is muted because it has trouble getting to the Sculptra via the bloodstream. This isn’t proven to my knowledge but most likely true.

Q: Ultherapy Plus Sculptra? (photo)

A: Sculptra and Ulthera in combination is the bomb for the aging face

These 2 treatments work together to help volumize the face from fat, bone, and muscle loss, and then tighten skin which has sagged due to gravity and aging.  I frequently do both on the same client.  There are reports which say they are synergistic (ie 1+1=3) when someone gets both.  I have written a blog about doing both procedures which I note that I think that Sculptra and Ulthera are better than a facelift because of the very low risk and downtime….see the link.

Q: Dr Injected my Lips with Sculptra and Im Worried the Visable Lumps Are Permanent or Can Erupt into Something Worse Later On?

A: Sculptra is not a lip filler, Juvederm, Belotero or Restylane is better choice

Almost certainly after getting Sculptra placed in the lips, you will get nodules.  They will last for months or years.  It is recommended not to place Sculptra close to the lips or eyes because this is a known complication.  The HA fillers are best for lip augmentation.

Q: Sculptra Decomposition?

A: Collagen that is made from Sculptra will last usually 7 years but aging continues

In general, most people quote the volumization effect from Sculptra lasts 2-3 years.  However new collagen has a 1/2 life of about 7 years.  What is happening is that the body is aging and countering the effects of the improvements from Sculptra.  I recommend touch up treatments at 12-18 month intervals to keep the correction rather than go all the way back to baseline and then refill then.

Q: Is Sculptra Safe for People with SLE and APS?

A: Sculptra has been shown to have more granulomas in patients with autoimmune disease

With retrospective analysis, people who developed granulomas after Sculptra injections were disproportionately more likely to have an autoimmune disease than ones without granulomas.  In reality, very few people actually develop granulomas.  It has been recommended by the company not to inject a person with autoimmune disease like SLE but it is still safe.  The theory is that the immune system is not normal and the reaction to the Sculptra is not predicatable with some over reacting and cause granuloma formation.  It’s something you need to discuss with your physician and decide amongst yourselves.

Q: Average Amount of Lidocaine Per Sculptra Vial?

A: Amount of Lidocaine added per vial of Sculptra is 3cc in our office

The consensus for mixing Sculptra these days is adding about 9 cc of a combination of sterile saline and lidocaine.  It used to be 3-4 cc total, but the greater dilution seems to lead to less nodule formation.  How much is Lidocaine and how much is saline is really up to the doctor.  In our office we use 3cc of 1% Lidocaine and 6 cc of saline.  I’ve known offices which reverse that mixture, but in the long run, it doesn’t matter one bit.  I feel that the 3 cc gives enough numbing to the injection without worry of giving too much lidocaine.

Q: Is One Month Post Sculptra Treatment Too Soon for Restylane Under Eye Treatment? (photo)

A: Tear troughs and undereye area need Restylane, not Sculptra to improve

When you have concerns which are close to the eye, you can’t use Sculptra to correct.  You can get nodules if you do this.  Restylane is great to improve this and can be done at this time.  You can get the two treatments simultaneously as well.  The results from Sculptra take 6 weeks to see.  I also notice that the first session leads to only minor changes, and it’s the second and third sessions which result in the wow factor with Sculptra.  A recent study showed that getting even more treatment sessions, 4 or 5, leads to even greater patient satisfaction.

Q: Scultpra for Thin Face with High Cheekbones?

A: Sculptra is a good choice for someone with a thin face and is starting to get jowls

Without seeing you, it is hard to say.  But in general, Sculptra is great to replenish volume lost with an aging face and starting to see jowls.  You might not need Sculptra in your cheeks, if you still have prominent cheek bones.  However, the temples, jawline, lateral cheeks, chin, marionette, and chin area might need to be volumized.

Q: Is Sculptra the Best Filler to Help Produce Your Own Collagen?

A: Sculptra is the best filler to produce collagen and results last for a couple years or more

Sculptra is a collagen stimulant.  It’s usually done in 3 sessions, about 6 weeks apart or more.  Most people need between 4-6 vials total, but some might need more and some less.  The longevity of collagen is about 7 years, but you continue to age, so touch ups are needed at about 1-2 years.  Radiesse will produce collagen too, but not as robustly as Sculptra.  It is great for temples, cheeks, jawline, marionette, chin, preauricular areas.  It can’t be used close to the eyes or mouth area. It is a rather long lasting filler, so carefully choose your physician.  It can’t be reversed like Juvederm and Restylane.

Q: What is the Difference Between Artefill and Sculptra?

A: Artefill is a permanent filler made from synthetic material, Sculptra is a natural substance, is long lasting but not permanent

Sculptra is a very popular filler which is used to volumize a face.  It causes the body to produce collagen where it is injected and then is degredated by the body.  The results will last about 2-3 years because of the collagen which is produced.  Artefill, is never degredated, and will last a lifetime.  I don’t recommend this filler because the body changes as we age and the filler might not look good down the road.  Also, complications can occur with this fillers years after it’s placement.  Although the attractiveness of having a long corrrection with the Artefill is appreciated, the long term potential issues keep me from using it.

Q: Considering Sculptura to Enhance my Cheekbones And Ultherapy?

A: Sculptra and Ulthera in combination are a great way to improve collagen, build up cheek bones, and tighten skin

Many of my patients are doing exactly what you asked.  Sculptra and Ulthera.  They work differently to build up collagen and increase lost volume from aging.  The end result is a fuller face that is lifted and tighter.  They can be done on the same day, and because the Sculptra has lidocaine added, the Ulthera is more comfortable.  There is no destruction of fillers with laser, Ulthera, or any other device.  A recent presentation and soon to be published study has shown when Sculptra is done with Ulthera, it’s like you are getting 2 1/2 times the benefit of the Sculptra than without doing the Ulthera

Q: Is Sculptra Likely to Cause Lumps if Injected in the Temples?

A: Sculptra is my filler of choice for filling the hallows in the temples

As we age, a fat pad in the temples shrinks and makes them depressed.  To fill this area, Sculptra is injected deeply in the temples, along the bone in a series of about 3 sessions.  By injecting at this level, the risk of nodules is very low, and the product spreads out evenly.  It creates the collagen at the periosteal layer (lining of the bone).  It’s a very quick and easy procedure.  It cause some skin tightening around the eyes and eyelids too.

Q: Does Having Sculptra After Ultherapy During the Same Visit Increase Risks for Bruising?

A: Sculptra can be done at the same visit as Ulthera

You can have both procedures done at the same visit.  I would say there is no additional risk of bruising with the Sculptra injections.  Bruising is fairly common after Sculptra, but the VBeam can significantly decrease the time it takes for the bruise to resolve.  I have a photo where the bruise was gone in 2 days after the VBeam on RealSelf.  This is offered complimentary after any treatment and is painless.  The VBeam can’t be used on skin types 5 or 6 or if the skin is recently tanned.  I would do the Ulthera first, then the Sculptra injections, as your doctor has suggested because the water in the Sculptra could affect the Ulthera treatment.

Q: I Had Sculptra Injections Yesterday. I Am Severely Bruised, All Purple from my Nose to my Chin?

A: Bruising after Sculptra can be improved with the VBeam within the first couple days

I offer complimentary VBeam treatments (painless and quick) for any bruising after a dermal filler treatment.  This can cut the bruising down to a couple days.  I have a picture on Realself in the VBeam sectioin showing this.  Arnica can help as well.  Blunt cannulas can decrease the bruising with dermal fillers significantly, but I don’t’ use them with Sculptra because it needs to be placed more superficial than the layer which the cannulas place product.  Obviously, limiting physical activity for the first 24 hours and avoiding blood thining supplements like aspirin, motrin, ibuprofen, fish oil, vit E, etc. will decrease bruising as well.  It’s unusual to be as bruised as you describe although bruising is common with Sculptra.

Q: Time Between Sculptra Treatments?

A: Spacing of Sculptra treatments should be at least 6 weeks, but no problem with longer

The timing of the Sculptra treatments is based on the fact that it takes about 6 weeks to fully appreciate the collagen that one is going to produce from Sculptra.  If you want to wait longer, that is no problem what so ever.  There is no advantage to doing it at exactly 6 weeks other than getting the entire treatment completed sooner.

32 Comments

  1. Rabab hardiman

    Had sculptra a week ago , when I opened my mouth to massage from inside I noticed black purplish legions in the inner side if the cheek . What could that be ?

  2. Maureen Brennan

    I had Sculptra injected in my cheek area April 2013. I noticed a light colored lump below the injected site within 3 weeks of injection. I believe I developed a track where the Sculptra settled. I know this sounds odd but thinking back I had a lump develop in same area from Juvaderm. It really bothers me and have spent quite a bit of money and aggravtion trying to blend it into the surrounding area. Hyaluronidase doesn’t seem to do anything? Are there any lasers or other treatment options to accelerate dissolving the remaining Sculptra?

  3. Eloise Glick

    i need help with lumps near the mouth from sculptra , will like some answers .
    I will like to know were is your office to see if you can help me with the lumps

    • There is not much that can be done for lumps from sculptra.

  4. Marina

    I had 1 session of sculptra 7 months ago. Not loving it. When can I hopefully expect the results to start diminishing? Thank you.

    • One session of Sculptra should see minimal results. Duration of results lasts for 2-3 years.

  5. Vania Johnson

    I had 1 syringe of sculptra injected into my temples by a board certified plastic surgeon. Day one I felt extreme pain in my temples and could barely open my mouth.
    Chewing food was excruciating. It is now day two and I’m still really sore and can barely open my mouth to eat or brush my teeth. I feel like my jaw won’t open no matter how hard I try. I’m in a panic and would appreciate any advice you may have.

    • Prob a bruise or hematoma in the temporalis muscle that should get better. Discuss W your doc.

  6. I have a couple complicated question regaurding sculptra and the PRP facelift. Can someone e-mail me and tell me where to post my question.? Valerie val98@comcast.net

  7. delan

    hello dr Stevenfweinermd best doctor %100– i need to know which filler is the best and safe and long lasting ,,especially for cheek area .,,,i know some –revanesse–perlane—voluma–and this one bellafil–…. long lasting vary important to me and safety thank u

    • Longest lasting is Bellafill. Sculptra will last about 2 or 3 years. Perlane best of the others and will give about 12 to 16 months

      • delan

        thank you ..which on the best for cheek area for safety and lasting ?how about voluma ?

  8. See reply above, Sculptra or Bellafill are longest lasting.

    • delan

      thank u

    • delan

      i understood you have said for cheek area longest lasting ,but you mention about perlane best of others and ll give about 12 to 16 months ! i am confused what did u mean by that ?

      • Longest lasting after Sculptra and Bellafill. Further discussions should be made in person.

  9. AM

    Help, please: a nodule/granuloma is growing at the cheek in the area of injection into the nasolabial fold.
    It is now tender to touch. Have you any experience with 5FU and Decadron off label to diminish the nodule? If so, how often and what are the expected outcomes? There are no current signs of infection. would like to try any other options before excision….Thank you.

    • I don’t have experience for this. Dr Fitzgerald in Los Angeles you might try.

  10. Barbara Earnest

    I had sculptra 5 days ago. I am getting a flu shot, and my general practioner doctor gave me methylprednisolone 4 milligram pack qty 21. This is for me to take along with the flu shot I am getting because I’m allergic to the flu shot. Will this affect my Sculptra from my dermatologist 5 days ago??
    .

    • no, prolonged use of steroids might, not a short course

  11. Teresa

    I have a possible autoimmune condition. I tested negative but my naturopath believes it was a false negative because of all my symptoms. I am scheduled to get Sculptra later this month as I have lost so much volume in my face. Is the only concern about getting granulomas? Or is there other possible concerns?

    • I cases of autoimmune disease, the incidence of granuloma is increased. It doesn’t mean you’ll get a granuloma. No other concerns. Granulomas are different than nodules. They are inflammatory, painful nodules.

      • Teresa

        Thank you for the response. I appreciate your time and feel more at ease with the procedure.

  12. Awesome website .Nice informative post you share .I read many article but this article is the best..Thanks

  13. James

    Dr steven , What dilution do you use for BBL using sculptra. can you please let me know what is the device that your assistant holds in most of your videos. Thanks in advance for your help.

    • I use 16-20cc. She’s holding the Artek Cooling device from Thermotek.

Trackbacks

  1. After years of evaluating Sculptra, “I’m a believer”. | stevenfweinermd
  2. The Combination of Sculptra and Ulthera is better than a Facelift and here’s why! | stevenfweinermd
  3. The Top 14 Trends in Cosmetic Procedures (Plastic Surgery) for 2014 as Predicted by Dr. Steven Weiner | stevenfweinermd

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