Lumps shortly after Sculptra. What can cause this?

Question

I had 2 vials of Sculptra 12 days ago in my temples. I massaged 5 times a day at least as instructed. Somehow, I still managed to get one and it feels like 2 more are developing. I’ve been massaging the areas firmly, but they won’t go away. All of them are where my hair is so as long as they don’t get big, they are not visible. Should I get more Sculptra treatments? Should I go to this injector again ( a PA working with a dr)?

Jason Emer, MD · Answer

Keep in mind, it will take several weeks for results with Sculptra. If you remain concerned, I would follow up with your injector. Sculptra is a great product for improving facial volume and collagen building, but for best results, I recommend using it in a combination depending on desired results. I combine Sculptra with other fillers, lasers, toxins and skin care to give immediate results. See an expert. Best, Dr. Emer

Thomas J. Lee, MD · Answer

Thank you for your question.  It depends on what the lumps are caused by.  It is not uncommon that collagen growth from the Sculptra can have some irregularities.  I warn all my patients that additional treatments may be necessary, for either more volume or for contour revision.  Uncommonly, if the Sculptra is placed too superficially, the Sculptra can crystallize and create nodules under the skin.  This may require a procedure to have them removed.  At twelve days, your body is producing new collagen where the Sculptra was injected.  Continuous massage can help encourage the new collagen to distribute more evenly.

Shareef Jandali, MD · Answer

Thank you for your question. Typically I recommend that my patients massage 5 times a day for 5 minutes at a time for the first 5 days following treatment. If you feel as though you are having lumps, bumps or any other abnormalities, be sure to follow up with your provider.

Dean P. Kane, MD, FACS · Answer

Dear Strype:

Sculptra is a bio-active “filler” drug which when properly injected stimulates fibroblasts to make collagen (elastin and other structural molecules). It can produce firming and tightening of the tissues surrounding the injection.

The drug itself comes as a powder and must me re-constituted into a liquid before injection. The manufacturer recommends no less than 2 days before use and up to 14 days before use to allow it to “dissolve”. 
The injection of any product can produce lumps through the process of injury and healing (even with a needle)1.       As a suspension though, Sculptra can concentrate into tiny droplets and over stimulate the cells to produce more collagen than desired and therefore a “collagen granule”.

2.       Some injectors are concerned that these are not lumps of collagen but “granulomas” of inflammatory white cells and cellular debris.

3.       Injury to a blood vessel may create a small collection of blood called a hematoma or firmness as a bruise.

Pro-active massage is the best way to reduce the concern of this Sculptra side-effect; ie., evenly distribute the drug into its tiniest particles. Other remediating options are based on the talent and skills of your injector:

1.       Xylocaine / Marcaine intra-lesional injection to break-up the clump and allow for further hydration and mechanical massage.

2.       Use of very dilute intra-lesional steroid (Kenalog) to reduce the collagen making response.
 
Return to your injector for his / her recommendations. I wish you the best!

Michele S. Green, MD · Answer

I love Scuptra but it takes the correct dilution to avoid lumps.  Two vials sound like a lot in just the temple area. I would submit photos to evaluate the area.  Massaging is very important but so is the proper dilution.  I would wait a few weeks to see the result before deciding to continue.  Best, Dr. Green

Heather Lawson, DO · Answer

Hello,
If it has only been 12 days since you had your procedure of Sculptra, it is unlikely that these lumps are Sculptra nodules. Of course, nodules are a complication from this procedure, they usually form a few weeks after the procedure and are more common after repeated treatments. I would recommend going back to your injector. They can reevaluate your lumps and decide what the most appropriate treatment would be for the issue you described. Hope everything works out well. Dr. Lawson

Kriston Kent, MD, MPH · Answer

Thanks for the question. Sculptra is a collagen stimulating
treatment which uses a dissolvable substance to stimulate collagen production
during its removal from the body. Ultimately, the injected product will be
removed and replaced by new collagen. If too much product ends up in one place,
then the new collagen can leave a "lump". In your case, it is
extremely unlikely that you have developed lumps of new collagen in just 12
days. Therefore, it is more likely that your body is reacting quite vigorously
to the injected product. It is unclear what the ultimate outcome might be for
you at this time. It would probably be a good idea to visit your treating
physician to get their input into the need for any interim medical attention to
your lumps. Best of luck.

Liliana Manrique, MD · Answer

Polylactic Acid, Sculptra, is a great filler for volume loss. Sculptra is disolved in DW and It is injected in very small amounts creating a mesh. I will advise to go back to the physician for an evaluation. Dr. LM.

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