I had Sculptra injected under my eyes yesterday. Is there anything I can do to ensure no bumps will form? If they do, is therea way to get rid of them?
How to Avoid Sculptra Bumps?
Doctor Answers (25)
Treatment solutions for chronic and persistent infraorbital surface irregularities
Previous authors have adequately explained the common approaches in avoiding surface irregularities that may result from injecting Sculptra (or other materials) too superficially in the periocular regions. I would like to add several solutions and “pearls” by discussing surgical alternatives (usually as a last result) that may be beneficial in treating chronic or long-lasting irregularities.
- Sculptra, or Poly-L-lactic acid, has traditionally been reserved for the deeper lines, grooves, or trough facial regions. Its FDA approval stipulated use in the nasolabial folds that often result from lipoatrophy that is witnessed in immunocompromised patients.
- Most physicians approach the periocular region more carefully than any other facial region because of its thin skin. The focus in this region has been away longer acting fillers. I personally will not inject the infraorbital hollowing or tear trough areas beneath the areas, because I believe there are better and safer options in my hands. Excellent correction has been seen with Restylane, Juvederm, etc., and patients are willing to tolerate two injections per year.
- If Sculptra is injected under the eyes, using a higher volume dilution (roughly 8-10 cc’s per vial), allowing the product to sit for at least 24 hours after mixing the constituent to allow for little residual precipitation or powder, using a small gauge catheter to assure small participate size placement, and placement in a deep level.
- If superficial placement by the injector is suspected (at the time of injection), I believe immediate subsequent injection with normal saline in the region to further dilute the composition, followed by massaging can alleviate the complication. It’s a smarter decision to “void” out the treatment than risk a long-term complication.
HOWEVER, what treatments can be offered if persistent surface irregularities, bumps, or granulomas persist?
In addition to Sculptra, I have personally seen these same complications in patients who were injected with Artefill, silicone, and other materials that are often injected abroad.
- If the patient can tolerate them without significant complaint, don’t offer surgical alternatives.
- I have found that massaging for chronic granulomas usually doesn’t improve the appearance.
- Surgical Approach: In patients who can benefit from additional periocular rejuvenation procedures, i.e. blepharoplasty, then alternatives such as crushed fascial grafts or thin strips of alloderm can be superficially placed at the same time as the cosmetic procedure. Routinely, I’ll make two small stab incisions (along the medial punctum and next to the lateral canthus, take a small tendon passer and pass a thin 25 x 5mm strip of alloderm superficially under the skin to mask the bumps associated with silicone injections.
- Attempting to surgical excise these granulomas is tedious and problematic at best, and significantly high for injury. Conservatively “masking” the bumps is a better and safer option.
I hope these are beneficial to patients and physicians alike.
Avoiding granulomas, lumps with facial fillers. Sculptra - polylactic acid.
Facial fillers have become quite popular in the cosmetic market. The objective of facial filler use is to restore volume to the face in an anatomically and physiologically correct manner to improve aesthetic outcome. The risks to fillers are twofold:
- Distortion of anatomic subunits
- Granulomas or lumps under the skin
Avoiding complications is relatively easy with facial fillers. Recommendations are to avoid undergoing procedures with inexperienced physicians or practitioners; being conservative with volume and intervals of treatment, and finally, maintaining harmony and normal aesthetic proportions. Practically speaking, the risks of Sculptra injections can be minimized by:
- Avoiding areas of thin skin such as the eyelids and lips
- Conservative treatment
- Requesting a lower dilution of injectate
Avoiding Sculptra bumps
don't ever let anyone inject Sculptra into your face.In 2000, at the World Congress of Dermatology in Paris, Pierre Andre reported cystic, nodular, and granulomatous lesions when this agent was used in individuals with normal immune functioning (non-HIV+ patients). Additionally, long-term allergic reactions have since been described, which are very difficult to manage. In another report concerning its aesthetic use in 100 patients with normal immune functioning, 20% of the treated individuals experienced significant adverse reactions. Obviously, this product is not immunologically inert as the manufacturer stated. Foreign body granulomas are being seen with this agent in HIV-positive as well as immunocompetent patients.
While the manufacturer as well as investigators claim this product produces neocollagenesis or new collagen this is not what is seen under the microscope. On biopsy one sees a severe immune reaction to the product.
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Sculptra is risky under the eyes
When preparing Sculptra for injection, I reconstitute the powder with more liquid than the manufacturer's guidelines and I do this at least 24 hours before injecting it, rather than the recommended 2 hours.
Once it has been injected, there's not much you can do as a patient to prevent bumps. As a rule, I do not inject Sculptra under the eyes because of its tendency to form bumps. Due to the thin eyelid skin, the bumps may be visible. If they do form, there's not too much you can do, except try to fill in around the bumps with another filler to make them less noticeable.
In my opinion, Sculptra is better used for deeper, thicker areas like the cheeks. For the under eye area, I prefer a hyaluronic based filler such as Restylane.
Sculptra under eyes is not safe
At this point it is fairly common knowledge that Sculptra should not be injected under the eyes. The problem with it is that the reaction of the body and the resultant scar formation are unpredictable. You can try to approximate and massage, but in the end the patient might still end up with granulomas.
I've had several patients who had their Sculptra done elsewhere, and who had unsightly granulomas, nodules, and sausage-like lumps that we had to excise. It is not a significantly risky procedure, but most commonly we had to do it combined with lower lid blepharoplasty for access and better overall cosmetic result.
I hope you do well with these injections and never need to have surgery, but if you do, you should know that it can be done safely.
Post Sculptra Massage is Vital
The best thing you can do to avoid bumps or irregularities from Sculptra is to massage the injected area for 5 minutes, 5 times a day, for 5 days. Now, this recommendation is the minimum. Don't limit yourself to this regimen if you are able to massage longer or more often. My patients have found that using the backside of a Clarisonic brush is an ideal massage tool.
Sculptra should not be injected above the orbital rims
Sculptra should not be injected above the orbital rims. Advanced Sculptra board-certified physician injectors may place Sculptra near the orbital rim and massage the material into the tear trough portion of the lower eyelids
I have used Sculptra for over 10 years. Have had 2 small graulomas in patients which were no problem to fix. I have Sculptra in my face injected by myself, my nurse, and two other experts. I do not see the issues with the product I keep hearing about. Time will tell I guess.
First of all, make sure you choose a doctor who has been trained to perform Sculptra. Experienced injectors place the Sculptra well below the surface of the skin. When placed deeply, a visible nodule very rarely will occur. In addition if it has not been properly diluted, or is placed into areas that are not ideal for this product you may also see bumps.
After you are injected by the right professional, they will tell you to massage for 5 minutes, 5 times a day for 5 days to help prevent these bumps.
Post-treatment regimen for Sculptra
I do not inject Sculptra Aesthetic in certain areas of the face including above the orbital rims on the cheeks (lower eyelid area), the upper lip, the face or forehead. Areas where the skin are very thin or where facial muscles move often (lips, eyes) are more prone to the rare event of collagen bump formation (collagen papules/nodules). I instruct patients on the 5/5/5 rule following injection--they are to massage the treated areas 5 times a day, for five minutes, for the 5 days following Sculptra treatment.