How to avoid Sculptra bumps?

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.

To review:

• 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.

I have not had any "bumps" from Sculptra injections. If the injections are performed at the appropriate level, granulomas (what most people are calling bumps) do not usually form. If the injections are too superficial, the risk of having "bumps" goes WAY up.

Follow the directions from your provider and look for any other tips from the manufacturer and on sites like this! Massage often for the first 5-10 days (5-10 minutes 5 times daily. . .whatever your doctor says).

If you have injections below your eyes. . .it's always best to err on the "deep" side from an injector standpoint. This will go a long way in reducing complications.

If you do experience "bumps", you can try to mask them with a filler or try to address by other means (more aggressive. . .and with additional risks).

Sculptra has been used safely throughout the entire face, including below the eyes. It's not my favorite choice in this area for the same reasons that others have quoted. . .but it does work.

The key ingredient to having a successful Scupltra results is at the plunger end of the syringe! The injector makes the biggest difference - without question!

I, also, dilute the mixture with more liquid than the originally recommended volume (but now seems to have become the recommended amount) and prepare one day prior to the scheduled injection date (as Scupltra trainers advocate and were recommending in the past. . .but are stronger about it now. . .). This has always worked for me and for the "successful" injectors I have spoken to.

As with any cosmetic procedure, do your research, find the most qualified provider in your area (or travel to someone you trust), follow the pre- and post-treatment guidelines. . .and enjoy your results!

I don't place Sculptra underneath the eyes. But if it was placed there, I would massage, massage, massage... for the first few days to help minimize the risk.

Treating the area underneath the eyes with Sculptra is difficult because the skin is so thin. Even so, your best best is to massage vigorously and frequently, at least 5 minutes, 5 times per day.

Sculptra comes as a powder. The doctor adds the solution and he can add anywhere from 3-10 cc of fluid into the vial. The more fluid that is injected, the easier it is to spread out the powder, which helps to reduce the chance of forming lumps.

Now that it has been injected, you need to massage the areas as much as you can to try to keep the Sculptra powder from forming clumps which can lead to lumps in the skin. So... start massaging!  Keep it up for 1 month. That should really help.