Sculptra Under the Eyes - a Very Bad Idea?

daileyr on 31 Aug 2010 at 12:00am

Sculptra is a popular cosmetic injectable that is FDA approved for use in patients with facial hollowness due to treatment for HIV infection. It is commonly used off label for adding volume to many areas of the face, such as in the cheeks. Some patients love the results, and see long-lasting improvement. Others encounter side effects that could possibly have been avoided.

Sculptra must be administered by a highly trained physician who understands facial anatomy and expression AND knows how much material to inject with the proper dilution and preparation. Certain areas of the face such as the eyelids, lips, and forehead can be tricky and excellent results without problems can be elusive.

Lumps, bumps, raised areas

Sculptra administered inappropriately can lead to lumps and bumps that are visible to the patient and others. The good news is that Sculptra side effects may be reversible, however, it often requires surgery. While Sculptra is called a "semi-permanent" filler, it can take years for the substance to naturally attenuate (if at all). Unlike hyaluronic acid fillers such as Restylane or Juvederm, Sculptra cannot be readily dissolved. If you don’t like the effect from a hyaluronic acid filler, the substance can be easily removed with an injection of hyaluronidase which dissolves it typically within the hour.

Sculptra removal case study

Highlighted in the slides is a 64 -year old patient I recently treated for Sculptra- related lumps beneath her eyes. She had received Sculptra injections in the tear trough region of both lower eyelids over 2 sessions, once in October 2007, and again in January 2008.

At first she was very happy with her post-treatment appearance. But then in April 2009 she developed large, hard bumps under eyes due to the Sculptra. After undergoing surgery to remove the material, the patient was happy to see the lumps gone.

Before Surgery to Remove Sculptra

Before Sculptra Removal by Surgery

After Surgery

After Sculptra Surgery

The slides indicate the means by which the product is removed and an analysis of it following extraction. The important thing here is that she was able to get her function back as well as an improved aesthetic appearance with correction of the lid problems she got the Sculptra for in the first place.

I don't inject Sculptra into any area of the face however, I have many well trained colleagues who like the results it produces and have many happy patients. At this point, if you are considering a filler for correction of irregularities of the lower eyelids, you might want to start with a hyaluronic acid filler as it’s effects are easily reversible. Find someone who has a great deal of experience in this area. If Sculpta is to be used in this area; experts with this filler suggest that it should be significantly diluted in the lower eyelids.
Be sure to seek out a member of the “core four” trained facial aesthetic specialists: board certified Oculofacial Plastic surgeon (ASOPRS), Facial Plastic surgeon (AAFPRS), Plastic surgeon (ASAPS), or Dermatologist (ASDS) when considering facial fillers. Learn more about ASOPRS
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  Roger Dailey, MD
       Dr Roger Dailey, OHSU
Dr. Dailey is an Oculoplastic Surgeon Oregon Health & Science University in Portland, Oregon.  More about Dr. Dailey

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Comments (4)

Thanks for sharing this case study, Dr. Dailey. The video is very graphic and had I seen it before I got Sculptra, I would have certainly went for the autologous fat transfer, which the body cannot reject. I am now 18 months post one half of a vial of Sculptra injection in the tear trough. Problem-free knock on wood. I am hoping that I am past the "granuloma risk" zone - given especially since I only had a one time small volume injection. Only time will tell - hopefully I will not be calling you up in years time for a granuloma removal surgery!
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This is a VERY TRUE review of the product! This Dr. appears to have a brain. I am shocked that one Dr posted on realself and according to his website uses sculptra and promote its use, actually called it a sugar. Clearly some of these self declared experts forgot their freshmen chemistry basics. This Dr. Dailey seems to have read more then the paid advertisements and those sales reps with degrees in literature selling injectables. Good for you Dr. Dailey and thank you for being smart and honest.
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Thank you for your kind words.
Best,

Roger Dailey, MD, FACS
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Love the new TV commerials!
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