Sculptra is Different Than All Other Fillers: Natural, Structural Support, Cost Effective

The concept of volume loss in the aging face is a relatively new realization by the aesthetic industry. Up until about 12-15 years ago, the dogma was correcting loose skin using primarily surgical approaches. Post surgical patients were very pleased parading around their newly tightened faces, free from wrinkles and sags, but prominently showing off their skeletonized features. There was no hiding the fact that something had been done, it wasn’t subtle, and it was obvious. Something didn’t jive with what the brain recognized as youthful or aesthetically pleasing. This dichotomy between what Plastic Surgeons and the brain thought was beautiful was due to the lack of understanding of the impact of volume loss on the aging face.

It is now widely documented that there is significant loss of volume in the face as one ages. Fat pads throughout the face become less prominent, and there is also bony resorption throughout the entire facial skeleton and jaw. Even if the skin didn’t stretch from gravity, there would be sagging related to loss of the structural support. A great analogy is in a youthful face, the dress (skin) and your body (facial structures) are the same size. An aging face wears the same dress, but the body is now a size or 2 smaller, so the dress doesn’t fit correctly.

How much volume loss occurs? Beginning at the age of 30, about 1-2 cc of loss occurs per year. However, it is so slow and subtle, and it isn’t until the late thirties or early forties that there is any noticeable changes. It seems to match the so called “tipping point” in women, just as they end their most “fertile” years. Doing the math, a person in their 50’s can have 20-30 cc’s of volume that needs replacing. Its up to the aesthetic physicians to combat this long standing evolutionary process, and keep women (and men) beautiful, well beyond their child bearing ages.

Fortunately dermal fillers can reverse the loss of volume that inevitably comes with aging foregoing the costs, downtime, and risks associated with surgery. The most recognized fillers, Restylane, Perlane, Juvederm, Voluma, are hyaluronic acid fillers. These all last about a year, with most of their longevity based on their ability to absorb water, hydrophillic characteristics. These are great fillers for small corrections around the eyes, lips, marionettes, and nasolabial folds. The cost/benefit ratio turns negative, once the number of syringes exceeds about 6. At this point, correction is still far from optimal, but the costs are significant. Also, in the author’s opinion, multiple syringes of HA filler give a “boggy” appearance to the correction, directly related to their hydrophillic nature.

The only filler that can correct large volume deficits in a cost effective manner is Sculptra.

Sculptra works by stimulating one’s own collagen to volumize the face “naturally”. Studies have shown Sculptra’s effect to last at least 2 years. The problem is, aging is always going to happen, so even after full correction with Sculptra, touch ups with one to two vials every 12 to 18 months are required.  Not only does Sculptra produce a long lasting and natural result, it is a cost effective solution. When comparing Sculptra to an HA filler, one vial of Sculptra will volumize what approximately 4 (4 cc) syringes of an HA will do. The cost of Sculptra is usually about 1.5x the cost of a syringe of HA filler.  It turns out that full volumization is usually about “1 vial per decade” with Sculptra. Sculptra should be considered the “workhorse” for replacing the structural loss of the face. Fine tuning, once the volume is replaced, is the job of the HA fillers.

Darker skin ethnicities are naturally better protected from the sun so the aging process is delayed (Skin aging is mostly related to sun exposure). These patients require less volume when compared to lighter skinned individuals. Also, severely sun damaged and unhealthy skin won’t respond quite as effectively in collagen production from Sculptra as the healthy, well protected skin, and will require more volume than the norm.

Although there is still a component of excess skin in the aging face, the primary cause of wrinkles and skin laxity is due to volume loss. Correcting volume deficits should be the primary focus of reversing the signs of aging. Of the fillers, Sculptra stands out from all the others in it’s ability to produce a long lasting, cost effective, and natural solution for large volume replacements.






  1. Richard

    In your opinion, how does Bellafill (formerly Artefill) compare to Sculptra?


    • Bellafill is also a collagen stimulator. It is not as robust as Sculptra. A syringe of Bellafill is comparable to a syringe of an HA in volume. Please see my blog on Bellafill.


  2. Hi,I hope it’s alright for me to contact you here. I have a complex case regarding an overfill of Radiesse and Sculptra. It has been nearly a year now and I am desperate to sort this out. I have a collagen over fill and I do appreciate you reading it, because it is a complex case:

    I had Radiesse and Sculptra injected a few weeks apart in the same areas late last year (October/November). These were my second rounds of both injections. Stupidly I thought losing weight would be the answer and things started looking a bit better (I preferred looking gaunt to puffy – but I didn’t really like looking like either! ) – but then I decided to have Belotero and more Radiesse in February and it’s made the situation worse.

    The Radiesse and Sculptra were injected by two different people – and this was a stupid decisions on my behalf, and I’ve learned my lesson the hard way. I don’t know what can be done about the Sculptra, Radiesse or Belotero. I know I can’t lose anymore weight because I’m very thin anyway and it’s not good for my health (plus it won’t make any difference now) I can’t face two more years of looking this way, especially as I am due to be promoting a book early next year in the mainstream media. I have ruined the contours of my face and because I had so many injections in such a short space of time – I don’t know what the results will be. I’ve read some horror stories about the Sculptra and Radiesse lasting for as long as 5 years – even a lifetime if injected on top of one another and layered. More so because this was done by two different practitioners. The results are horrific – I am 28 years old and have a pillow face like Madonnas.
    I know this is a complex case and I thank you so much for taking the time to read this. I’m wondering if has experience in this area and would be able to help?

    Kind regards


    • Only Belotero can be reduced (w hyaluronidase). The others have to gradually decrease.


  3. Ria

    Hello, Dr. Weiner:

    I’ve never used fillers–or anything else–so I’ve been reading up on the various types.
    I’m familiar with the ones you mention here but I was wondering about Swiss made fillers
    (used with the Anteis Computerized Advanced Injection System)
    and your take on them:

    Esthelis, Fortelis, Mesolis, Modelis, & Teosyal

    Thank you.


    • I don’t know enough about them to make a call on them.


  4. Jeane

    Hi Dr. Weiner,

    I’d greatly appreciate your opinion in my situation. I have a thin face and had voluma placed in cheekbone areas, on one side of face it is quite noticeable (like a crescent shape figure in a sense). I’ve been advised to use sculptra to correct the imperfection as well add volume to mid face. I appreciate the idea of adding smooth volume, but am concerned about “layering” sculptra over a “bulging appearance” of voluma. Would you recommend such an idea? Or would you suggest smoothing out the voluma first (as difficult as I have heard this may be). Thank you so much if you can take the time to advise! 🙂


    • Layering Sculptra with Voluma is fine but nothing is perfect. The only reason to do Sculptra is if you are doing more than this area and doing a volumization of the face. If just doing this one area, try to correct with an HA like Restylane or more Voluma.



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