Rebecca L. Euwer, MD

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.

We always make sure that the sculptra is reconstituted at least 24 hours before we inject the product in to the patient.  Because we treat a large number of patients with Sculptra, we always have some reconstituted and  we can treat new patients on the same day as consultation with product that has been mixed at least 24 hours prior to treatment.  Follow up with your physician reagarding the lumps and express your concerns.

Sculptra is a biostimulator and works by stimulating the cells in your skin to produce collagen.  The physician can inject sculptra under the skin and over the bone over the entire face (temples, cheeks and chin, not lips) essentially blanketing the entire facial area to stimulate your own collagen which grows over time creating thicker, firmer skin with a more youthful fuller appearance.  The look is very natural since it is your own collagen that is producing the results which  last up to two years and prevent aging.  Radiesse is a filler that has some biostimulating effects but mainly works immediately because it is a thick product that fills the area as oppose to sculptra which is not filling immediately but stimulating the cells to grow collagen over time.  Radiesse last up to one year. I use sculptra to achieve an overall improvement and then Radiesse or hyaluronic acid for fine tuning or spot treatment to touch up areas that could use more correction like nasolabial folds and  marionette lines.  Radiesse is also not used in the lips. Hyaluronic acids like Juvederm and Restylane are used in the lips.  

I agree with Dr Schuster, your eyes are beautiful and you should leave them alone.  Just use make up as you are currently doing and be happy with your naturally beautiful eyes. 

Studies have shown that the results from sculptra peak at eight to ten months.  In my own experience I have found that waiting eight months to take the after pictures is the best time to see the results.  But the good news for the patients is that while the results are gradual once the results have been achieved they last a long time, so you are actually growing younger!

We have treated many patients who are 65 to 79 years old who have had previous face lifts and sunken cheeks.  The results have been excellent and the patients have been very pleased.  We usually start with two vials, wait one month and inject another two vials, then wait another month and inject two vials.  The improvement is gradual and very natural looking.  While patients may see results in two or three months, the results actually peak at 8 to 10 months and last at least two years.  The actual number of vials used depends on the severity of the sunken cheeks but I have found in older patients it takes five to six vials while in younger patients three to four vials is all that is required.  Hope this has been helpful. My last piece of advice for you is to find an experienced physician injector to perform your treatment, it may cost a little more but will be well worth the investment.