Sculptra Liquid Lift - The newest approach to natural rejuvenation!

Ran Y. Rubinstein, MD
Article by
Manhattan Facial Plastic Surgeon

Natural is in; artificial is out. Sculptra has recently received FDA approval for cosmetic use. It meets the demand for natural and value.

Q. What is Sculptra?
A. Sculptra is a form of polylactic acid known as PLLA. It’s what dissolvable stitches are made of, which have been used in the medical community for 40 years. It also stimulates natural collagen production, thereby helping to slow down the aging process by gravity-proofing skin.

Q. So it’s been used for a long time?
A. Yes, but not for purely cosmetic purposes. Although Sculptra has been used cosmetically in the United States since 2002, it’s only since the end of July that it received this approval from the FDA.

However, the FDA approved the use of Sculptra in 2004 to replace the facial fat loss in HIV patients. And it’s been used in Europe and Canada cosmetically and safely for more than 10 years.

I started using Sculptra in my practice three years ago, and have already used it on hundreds of patients. Because there was FDA approval of the product for use in HIV patients, I could legally use Sculptra as long as I explained to my patients the purpose for which it was approved and how my use was “off label.”

Q. Do you still have to do that?
A. No, because now there’s Sculptra Aesthetic, which provides for its cosmetic use.

Q. So what exactly does Sculptra Aesthetic do?
A. The material is freeze-dried. I add water and inject a solution that is about 99 percent water and 1 percent collagen stimulant. Within 30 minutes, because of the water, the patient has a visual of what his or her face will look like. However, the next day, after the water is absorbed, it looks like nothing was done at all.

What the Sculptra particles do over the ensuing weeks is to stimulate the body to produce its own collagen and restore the natural “fill.”

Eight weeks later, a second treatment is given. At this point, the patient can see signs of natural collagen being produced. A third treatment is typically given eight weeks after that.

What the patient is left with is a pure result using the body’s own collagen. Even the Sculptra particles are ultimately excreted in the urine. There is nothing artificial left behind, and the treatment lasts about two years.

Q. Most of your patients are women, right?
A. Yes, 80 percent of my patients are women between the ages of 30 and 60. But about 20 percent are men, and the subtle changes that Sculptra offers over the course of four months fits them to a T. They want something that doesn’t scream to their co-workers that they just had work done.

Men also want those harsh lines reduced, so they’ll opt for Botox and eye-lift surgeries, as well as back-in fillers.

Q. How long does Sculptra last, compared with other fillers?
A. At two years, the majority of the effects from Sculptra persist. Most of the other fillers such as Restylane or Radiesse have to be repeated every 6-12 months. However, with the other fillers, the results are instantaneous.

So, if a patient needs to look her best for a special occasion that is right around the corner, Sculptra would not be the filler of choice.

Q. What are the risks with Sculptra?
A. As with all injectables, there is a temporary risk of bruising, which can be covered up by make-up – and we have a cosmetologist on staff to assist with that.
The second risk, which affects less than 5 percent of patients, is development of a nonvisible 2-3 millimeter papule, or small bump under the skin, caused by a collagen clump. We advise about the “fives”: Massage the skin for five minutes five times a day for five days after the procedure to avoid this. But even if it happens, it’s not visible and usually disappears.

Finally, with any procedure, there’s always a very small risk of allergic reaction or infection. I’ve never seen either yet with Sculptra.

Q. How do you determine what’s right for a patient?
A. I use what I call my four R’s of rejuvenation, in conjunction with whether someone is open to surgery or not. The R’s address what the patient wants to accomplish; I then offer the options.

The first is “relaxing” muscles that have been overworked at the lip corners or forehead. Botox, for example, is often a quick fix to help soften those lines.
The second R is “refill.” Many patients have lost volume in the face over the years, especially in the cheeks and jawline. I use the analogy of a tablecloth, with the bony structure of the face being the table and the skin, the cloth. As we age, the tablecloth seems to head south. The causes are some bone loss, but primarily because of a decrease in fat in the face.

The traditional approach was the facelift – to pull the tablecloth up. I tell people to look at two familiar faces: Brooke Shields and Melanie Griffith. Brooke added volume to lift the tablecloth; with Melanie’s face, there was an overly aggressive yanking of the tablecloth, resulting in an unnatural look. Not that I don’t perform many facial rejuvenating surgeries, but I believe in striving for a more natural result. Oftentimes, that can be accomplished by combining Sculptra facial volumizing with less-drastic facelifts and eyelifts.

To help pinpoint the rejuvenation needs, I ask patients to bring in photos of themselves from each decade, starting in their 20s and 30s. With the help of computer-simulated imaging, and ultimately fillers alone or in combination with surgery, the goal is to return, more naturally, to those years past.

The third R is “resurface,” which includes the use of lasers and chemical peels to address fine lines.

Finally, last on the list is “redrape” because the tablecloth is really sagging. This is the most dramatic of requests, and surgery will produce the most dramatic results. However, Thermage and lasers can also be used for nonsurgical skin tightening, and fillers help to pull up the cloth.

Q. And how does the cost compare between Sculptra and other products?
A. Because Sculptra lasts longer, it usually works out to be less expensive.
One vial of a Sculptra Aesthetic treatment is $1,100, and is initially done three times, for a total of $3,300 over 4-6 months. I suggest patients return for one follow-up treatment every two years to keep the tablecloth crisp.

Restylane, for example, costs $3,000-$4,000 for equivalent volumes of Sculptra used to refill the face. It lasts for about 6-12 months. However, if it’s only something like the parentheses lines around the mouth that need to be filled, requiring only one or two syringes, then the less-costly temporary fillers might be more economically advantageous.

Because they are cosmetic procedures, insurance typically does not contribute to these costs.

Q. Has the current economic downturn changed patients’ approach to cosmetic procedures?
A. There is definitely a shift away from more invasive surgeries. People are fearful of taking extra time off from work; their job might not be there for them when they return.
However, I also treat a number of people who have lost their jobs and want to retain their competitive edge as they embark on interviews.

Our goal has always been to help people puput their best faces forward.