Is Sculptra the best treatment for lower face volume loss? In combo, what is the best treatment for overall tightening in combo?

I'm 32 - always been thin but face has gone from heart-shaped, to long & hollow, particularly the lower half. My jawline is also less sharp, & there is overall laxity (minor). I plan to do fat grafting, but first want less a permenant option so I know PS & I are on the same page. Plan is Voluma in mandibular/jaw area - Upper face is fine & don't want more volume there, i.e., no Voluma. Sculptra is best for lower cheeks, yes? What is the BEST treatment for overall tightening to pair w/fillers?

Doctor Answers 4

Sculptra and Skin Tightening

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The best combination for the lower face is a combination of skin tightening with Thermage and lower face injections with Sculptra.  If there is any "double-chin" fat, then Kybella will remove this fat and give a well defined jawline.  Best, Dr. Green

Sculptra works well in combination with skin-tightening devices

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Sculptra provides a nice natural full facial improvement that results in lifting, revolumization, and some tightening as well.  If you are looking for additional treatment of superficial skin laxity, I would recommend pairing the Sculptra with Ultherapy, Fraxel, or any of the radiofrequency skin-tightening devices (TriPolar is used in our office).


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Your question was what is the best method to get overall tightening to pair with fillers- radiofrequency tightening is a great approach that can safely be paired with fillers.  If you are looking for instant definition along the jawline, I do not believe you will get that result with Sculptra.  Sculptra is great for pan filling and forms a scaffold deep in the skin, for new collagen to grow, gradually, over 3 mos or so.  For instant mandible definition, Lyft, Juvederm or Radiesse (longest lasting) are good choices.  Be well. 

Estee Williams, MD
New York Dermatologist
5.0 out of 5 stars 25 reviews

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Is Sculptra the best treatment for lower face volume loss? In combo, what is the best treatment for overall tightening in combo?

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You did not posted pictures to see your concerns. In person consultation for a physical exam is recommended.

Loss of heart shape of the face is due to fat/bone loss at the malar area of the cheeks primarily and descend of the tissues to the lower cheek area. Wasting of the cheeks below the malar bony area also gives a wasted appearance but should be paired in my opinion with augmentation of the malar cheeks because if you only fill the lower portion you will never regain the heart shape youthful look that you are searching (which appears to be your primary goal).

I would be concern if someone is recommending volume replacement to your lower face only to regain the heart shape appearance without some type of malar augmentation by filler/fat or cheek implants as the volume of the bony cheeks is key for this goal of yours. I know that most; if not all; physician would agree with this, it is the tridimensional shape of the face that you are looking for. So, I would recommend some malar augmentation with a filler/fat (or cheek implants) and this could be used also for the jawline and sub-malar area. A considerable amount of material might be needed for this. We are talking 4-6 (or more) syringes of HA or other materials.

HA's are the best in my opinion at this because they can me molded into the area, you can see immediately the improvement, and can be removed if the patient does not like it. The cons is that they might cost a lot and they are temporary. Sculptra on the other hand is multiple injections to see an improvement, the result is permanent, and if the patient does not like it then it is not reversible. Fat grafting is another alternative. It is the most permanent solution, it is non reversible, and if you are too thin then it might be difficult to reach the needed amount.

As you see there is no perfect solution, it is only a mater of explaining to the patient different options and what is available at the particular office that you go. From there is selecting the best option for you at that time.

For skin tightening I would recommend fractional resurfacing (I prefer ActiveFX) or any of the other non-ablative techniques. ActiveFX is the gold standard fractional resurfacing for this. If you gave acne scars, then combine it with the DeepFX. All the other non-ablative methods have their hits and misses since the all are dependent of the operator and still in my opinion can not match the improvement of the skin quality improvements that fractional resurfacing can give with the added skin tightening. 

Hope this helps,
Dr. Gus Diaz

Gustavo A. Diaz, MD
Charlotte Facial Plastic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.