Us non-physicians tend to view ‘filler’ as one category, but actual aesthetic experts are quick to note that there is a difference between hyaluronic acid (HA)-based dermal fillers and biostimulatory injectables. HA-based fillers, like Juvéderm® and Restylane®, quite literally fill treatment areas — like the lips, tear troughs, and cheeks — to temporarily add volume, contour, and smooth lines and wrinkles. This is different than the way biostimulants work.
While they often get lumped together for the sake of simplicity and the fact that they sometimes have similar end goals, biostimulatory injectables actually deserve their own category. Sculptra® is perhaps the buzziest of the bunch. “Sculptra® isn’t a conventional filler,” says Michele Green, MD, a board certified dermatologist in New York City, which is a sentiment echoed by fellow providers. “It definitely is not a filler,” adds Samuel Hahn, MD, a double board certified facial plastic and reconstructive surgeon in Baltimore.
Instead of hyaluronic acid, Sculptra® injections are made from poly-L-lactic acid (PLLA), a compound that stimulates natural collagen production. Once injected, it encourages the body to create new collagen, which leads to a firmer skin, fuller features, and an overall rejuvenated look. So, why is everyone talking about the biostimulant? Here’s what you need to know.
How Does Sculptra® Work?
With HA fillers, the filling effect comes from the substance itself. The same cannot be said of Sculptra®. Instead, volume enhancements come from the collagen your body creates as a result of the PLLA (a synthetic, biodegradable substance used to make sutures). Any firming or plumping you notice is your own, which makes Sculptra® enticing to patients looking to turn back the clock.
What you see when you leave the injector’s office is far different from the results that develop over time. Immediately after receiving Sculptra® injections, you will notice a small amount of plumping due to the saline solution that the poly-L-Lactic acid is suspended in. That initial volume fades in about 24 hours, at which point it takes six to eight weeks (or up to three months) for your body to begin building new collagen. It is then that you’ll start seeing the actual results.
When Do You See the Results of Sculptra®?
Unlike hyaluronic acid-based filler injections that offer immediate results after, in many cases, one appointment, Sculptra® requires multiple sessions. “Most people won’t see the results they want after one treatment,” Dr. Hahn says. Instead, patients come in monthly for up to three months. But all the patience is rewarded. While the effects of HA fillers last six to 12 months, results from Sculptra® can last two to three years.
After an injection appointment, patients are advised to massage their faces according to the five-five-five rule: five times a day for five minutes over the course of five days. This step is crucial, Dr. Hahn shares, as it helps disperse the Sculptra® particles smoothly and evenly under the skin. “If you don't massage, then those particles can clump up in a very finite area,” he cautions. “To have good results, it’s very important to use vigorous massaging to create an overall sense of fullness.”
If it sounds like a lot of pressure, don’t fret. Dr. Green assures us that the massaging process is simple and easily understood by patients.
Who Should Try Sculptra®?
When consulting with patients who are weighing injectable options, Dr. Hahn says he takes a few factors into account:
- The location of the patient’s desired result
- The patient’s degree of volume loss
Sculptra® is unique in that it is the only PLLA-based cosmetic injectable approved by the United States Food and Drug Administration (FDA) to stimulate natural collagen production. It was first approved by the FDA in 2004 to treat facial lipoatrophy (read: fat loss) in people living with HIV. In 2014, Sculptra® Aesthetic gained approval for the correction of shallow to deep nasolabial folds (a.k.a. smile lines) and other facial wrinkles.
Generally speaking, Sculptra® works best in areas without much movement, such as the smile lines, cheeks, jawline, and temples. For that reason, lips and under eyes are best treated with HA fillers. If a patient asks for filler in a Sculptra®-appropriate area, Dr. Hahn’s next step is to determine whether they are experiencing “global” volume loss. As we age, the face gets thinner and begins to look more gaunt or hollow. “Sculptra® will get those patients a much better result of general youthfulness because it can treat the whole face,” he explains.
With hyaluronic acid fillers, one syringe equals one cubic centimeter (cc) of product. With Sculptra®, patients can go as high as 15 cc in one treatment, which allows for a subtle boost in multiple areas of the face. “People who feel like they need rejuvenation of the full face rather than a specific area that they’re concerned about will really benefit [from Sculptra®],” Dr. Hahn says.
But it isn’t just the face. Some providers and patients are opting to use Sculptra® off-label to restore fullness to the body in treatment areas such as the hands, décolleté, chest, hip dips, and buttocks because the collagen stimulant can provide natural-looking, long-term rejuvenation. “Sculptra® injections in the neck and décolletage areas can provide much needed volume restoration,” Dr. Green says. She also likes Sculptra® as a non-surgical alternative to a Brazilian butt lift (BBL).
It should be noted that, if you choose to treat the body with Sculptra®, expect to pay for more product than you would for the face. For example, in Dr. Green’s practice, she uses eight to 12 vials to create a “more voluminous buttocks.” And, speaking of cost, vials of Sculptra® are generally more expensive than HA-based filler, though there is less maintenance involved. You can learn more in our complete guide to the cost of Sculptra®.
What Are the Drawbacks of Sculptra®?
Hyaluronic acid fillers come with an antidote in the form of hyaluronidase, an enzyme that can dissolve unwanted lumps and even nullify the filler entirely. Sculptra® has no such magic eraser, which makes it especially important that patients work with an experienced injector.
Some Sculptra® patients develop nodules under the skin that may be palpable and visible. These lumps form when the product is too heavily concentrated in one area and fails to disperse — either due to the technique of the injector or the patient’s lack of post-appointment massage.
In addition, because Sculptra® relies on the body’s (newly stimulated) ability to create collagen, patients don’t know the exact level of response they’ll get prior to injection. “The vast majority of our patients who get Sculptra® have a response,” Dr. Hahn notes. “Some have a tremendous response and it does wonders for them, and, in others, it may not result in the fullness they were looking for.” That doesn’t mean you’ll never reach your desired results, but it may take a few more treatments than expected.
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