Fat in the face ages by melting away, accumulating inconventiently and descending inappropriately. While I would prefer to fat graft a face which is gaunt, some patients don't want surgery or the downtime required. Sculptra is one solution for these volume depleted faces, although it doesn't make fat. It is multiple repeating units of Lactic acid, which is derived from corn. Mixed with sterile water and local anesthetic, it is ideally injected as a single layer, deep to the skin, where it causes inflammation with the net result of collagen formation.
This process does require time, so we photograph all patients at each visit, so they can document their progress. We also advise them not to panic when the volume seems to be lost, 24 hours after treatment. It definitely doesn't belong in certain zones, i.e the lips, around the eyelids, neck. My experience is limited to cheeks and temples and the incidence of lumps has decreased as the amount of fluid added to Sculptra has increased.
It has historically been expensive, however that may change, as its manufacturer Dermik seeks a larger user base. If a patient realizes how much Hyaluronic acid filler is required to fill deflated cheeks, Sculptra is quite cost effective. Another difference is that once the HAs are dosed, the body starts to break it down. By contrast, Sculptra causes an inflammatory response, which thickens skin progressively with time. The earliest group of non HIV patients are 2-3 years out, without having further treatments, after getting to their desired goal.
I consider it another option in the war against facial aging.
