Can I use collagenase injection to dissolve Sculptra(or new collagen)?

Collagenase injections are approved for use in contractions of dupuytren's.  These injection are not predictable for use in the face and should be avoided; likely the result would be worse than present.  Some patients have a vigorous response to sculptra creating volume with as little as 1-2 treatments.  Most patients require 3-4 vials for full correction.   I would advise patience as all volume with decrease over time.  Seek out an expert injector in your area to follow up with periodically.

Its very rare for a single vial to cause this much irritation/lumps.  Sculptra results for a first time treatment are not typically evident for 6-8 weeks.  Sculptra is subtle and takes many treatments to change facial shape/contour. Please review your before and after photos with your physician to decide on the best next step.  There are very few treatments that work to reverse these nodules.  Best, Dr. Emer.

Collagenase should not be injected into the face as it can destroy the integrity of vascular structures, i.e. arteries, arteriles, capillaries, veins, venules and capillaries. It is FDA approved for Depuytren's contractures. Dr Karamanoukian

I've been injecting Sculptra for years since its first FDA approval for HIV positive patients, before the approval for cosmetic volume enhancement. It's unusual to get too much volume from one vial of Sculptra. I suspect that you may have an imbalance in your facial volume. Placing Sculptra in the "cheeks, smile lines and also lower face," may not be what you need. Most people lose volume in the mid-face and that's where the volume needs to be replenished, not the lower face, which often looks relatively too full compared with the loss of volume of the mid-face. Smile lines are best address with fillers, not Sculptra, or the correct placement of Sculptra in the mid-face or outer cheeks to give the appearance of lifting. Mid-face Sculptra can achieve better balance and harmony to the face overall, and the appearance of a lifting. I would not attempt any type of collegenase, because I think you'll get unintended consequences. See someone with a lot of Sculptra experience who will discuss your facial balance and harmony, which might mean Sculptra placed in a different location, or fillers, such as Juvéderm Voluma for mid-face balance with the rest of the face.

This is a bit unusual. One vial usually can't cause that much volume. I suspect more that the proportions of the filling are not correct. I have no experience with collagenase but it would work, but I suspect that you would be trading in one problem for another. It will probably destroy collagen you want to. Give it time is the best advice at this point. Then consider filling around the face to bring things into proportion. I lecture and train doctors on Sculptra and in good hands, it shouldn't lead to over filling.

I am sorry to hear of your experience.  Sculptra is not a "volumizer" but rather a collagen stimulator.  In general, it is difficult to "overfill" with this particular product.  Unfortunately, collagenase would not be helpful.  You may consider a steroid injection to "fine tune" the areas that not in balance with your face.  If you feel nodules or lumps, you may consider a combination of Kenalog and florouracil and hyaluronidase injection to feather the area.  A third option is to restore facial balance by correcting or enhancing the upper 2/3 of the face.  Please see a experienced dermatologist or plastic surgeon in your area, one who specializes in fillers and Sculptra. Best of luck,Suneel Chilukuri, M.D.Houston, TX

Some injections of 5-fluoruracil, Kenalog 10 (cortisone), and local anesthetics combined with needle perforations of any deep or palpable lumps can possibly help change your look.  Not sure who performs this in Dallas, but you can call around.Collagenase is very reactive and very expensive almost 4,000 dollars for a 1/2 cc)  Used in the hand it really swells and bruises in treating Dupuytren contracture.  It would be difficult in the face and would have to be extensively diluted, but is not completely out of the question.  I think it is best to start with the simpler and less expensive option.Best wishes and good luck.

Thank you for your question.  Technically there is no way to reverse Sculptra.  Your options are to wait another couple of months and see if the sculptra settles in, you can try collagenese but it unlikely to do anything and some people do get a reaction to it, or small aliquots of 5-fluoruracil combined with some form of radiofrequency may improve the Sculptra.  Another option even though it sounds counterintuitive is you can often times add more filler in other locations to balance out the overcorrection, remember the face should have the upside down triangle look not square look, so by adding filer to your mid face/temples you may be able to restore that look.  This is an advanced technique so I advise you follow up with a board certified Dermatologist.  Regards, Dr. Matt Elias