It sounds like you had a positive initial experience with Sculptra, you did not mention if you had one or two vials injected. Typically the improvement a patient gets initially with Sculptra is just due to the volume of fluid in the vial of sculptra that was used to reconstitute the sculptra. That fluid is resorbed and with that the volume decreases but over time the sculptra particles which are left in place stimulate collagen which gives the full look similar to how it looked when it was just the fluid giving the fullness. This improvement takes time and experience has shown that a second or third treatment seperated one to two months apart keeps that collagen stimulation going so that the patient can get best results that peak at 8 months from the first treatment and last about two years. If you have a tight budget and you feel that you already see results from your initial treatment, you would certainly not do any harm in waiting a year to have another treatment done. At the very least the collagen stimulation you get will prevent your hollowness from getting worst with age.
The short answer to your question is "no", 68 is not too old to get results from Sculptra. I treated a patient who was 79 years old and she looked better at age 81 then she did at 79 because of the good results she got from her Sculptra treatments. In your particular case, it sounds as though you had pretty conservative treatment since you had only one treatment followed by another one 12 weeks later, you do not mention how many vials you had at each treatment. It would not be unusual for a patient your age to have two vials, wait one or two months and have two more vials and then a third treatment with one or two vials. Then wait for collagen growth and most patients will peak in their improvement at about 8 months and this improvement will last two years. At two years most patients will come in for another one or two vials to maintain improvement. The number of vials recommended is based on the needs of the patient. Again, in your particular case since you have waited a year, you would be safe to go in for another treatment and should get continued improvement.
While I know that the insert for Sculptra states not to use in patients with history Keloids, I have never heard of or seen personally or in the literature a case of keloid from sculptra injection. I have talked to many physicians who use Sculptra and none has seen a keloid. As you have experienced personally, risk of keloids are greatest on chest and back and it is rare to see one on the face and the needle sticks from sculptra are not traumatic enough to cause keloid. While nodules is a risk of sculptra these nodules are not keloids and can occur in patients without a history of keloids. However, if you are uncomfortable and prefer not to get the treatment, I would think you should be able to get a refund.
Sculptra comes in vials which are then reconstituted with sterile water and lidocaine. The number of vials that need to be injected depends on the amount of hollowness or atrophy that you are trying to correct, Because some patients have a considerable amount of atrophy it may take a total of four vials. However, you can not inject four vials in to the face at once because of risk of nodules. Furthermore, from experience, we know that spreading out the vials over time, for example two in the first treatment session, wait one month and then inject one vial, wait another month and then a third vial gives a nice gradual build up of collagen that peaks around 8 months and lasts at least two years from the first treatment. However, if you have minimal atrophy, you may only need two vials, so you could have your first treatment with one vial and your second treatment a month later with one vial and not need a third treatment. So in answer to your question, no, you do not always need three treatments to have lasting results especially if you are not that bad to begin with.
There is no evidence that Sculptra can cause autoimmune disease. There are rare cases of nodules forming in the areas where sculptra was injected years after the injection but this is very rare and it is not known why this occurs. I have used Sculptra in patients with autoimmune disease and have not seen either any exacerbation of their disease or more complications. These are typically patients who have tried other products, such as hyaluronic acid and were just not getting enough improvement so we used Sculptra without problem.
