Does Sculptra Need to Be Diluted Before It is Injected into my Face?

I read a comment by someone who complained because Sculptra was injected under her eye undiluted.  I don't understand this.  Wouldn't it be a rip off if someone diluted your filler injection? 

Doctor Answers 13

Sculptra is "reconstituted"

Sculptra (injectable poly-L lactic acid, made by Dermik) comes to the doctor in little bottles with a freeze-dried, powdery substance inside the bottle. In order to inject it into your face, sterile water has to be added to the vial to reconstitute it, returning it to a liquid state from a solid (i.e. powder).

The amount of sterile water that is added varies slightly, depending on the preference of the injector, but is usually 3 to 5 mL (based on the manufacturer's guidelines). Some may reconstitute with more than 5 mL, which could yield more subtle, less effective results. If it's too concentrated, you may increase your risk for nodules or bumps.

Once the liquid solution is prepared, it has to sit for at least 2 and up to 24 hours. It is no longer good 72 hours after it has been reconstituted, which is why it is packaged and shipped as a freeze-dried material.

Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 40 reviews

Dilution of Sculptra is now standardized by Sanofi-Aventis

Sculptra is increasingly popular for its use as Liquid FaceLift ever since its cosmetic indication approved by the FDA. It has taken few years of trials and few errors for advanced physician injectors and Sanofi-Aventis to standardize dilution of Sculptra where nodularities can be minimized. 6cc of sterile water is typically reconstituted 48-72 hours prior to injection followed by 2cc of 1% lidocaine with or without epinephrine, depending on the preference of your board-certified dermatologist or plastic surgeon.

William Ting, MD
Bay Area Dermatologic Surgeon
4.8 out of 5 stars 12 reviews

Ideal Sculptra dilution

Sculptra comes freeze dried unlike other fillers so it has to be diluted with sterile water prior to injection. Standard protocol has been to dilute it with 5 cc of water. Many injectors have been diluting Sculptra to a greater extend as they have found it to be equally effective and at the same time the incidence of papules (non visible small bumps due to clumping of collagen) has decreased. This does not diminish your results as long as the correct amount is placed under the eyes.

Ran Y. Rubinstein, MD
Manhattan Facial Plastic Surgeon
4.8 out of 5 stars 153 reviews

Sculptra dilution

The reason physicians dilute Sculptra is that it comes in a solid form and we need to evenly disperse the Sculptra to the areas that you are looking to volumize.  I typically use a 9cc (9ml) dilution per vial in the face to allow for a fairly diffuse and homogenous distribution of the Sculptra in the face.  As long as you are paying for and getting a full vial, then I wouldn't focus as much on the amount of water they are adding to dilute the sculptra.

Young R. Cho, MD, PhD
Houston Plastic Surgeon
4.8 out of 5 stars 38 reviews

Is Sculptra diluted and why?

Sculptra (PLLA) is manufactured & arrives in the offices of qualified physicians in the form of a powder contained in a vial.  It must be diluted with water in order to be able to be injected. Early on, the dilution ratio (how much water was added) sometimes seemed to lead to hard clumps or nodules that could be felt & seen.  Today, the dilution ratio (more water) is improved and the formation of clumps has not been an issue in our practice. The primary benefit of Sculptra is the gradual stimulation of a patient's own collagen, and that collagen ideally is spread out & lasts from 18-24 months.    So by  properly diluting the product powder, the results are even better & safer. 

Donn R. Chatham, MD
Louisville Facial Plastic Surgeon
5.0 out of 5 stars 69 reviews

In the bottle from the manufacturer, Sculptra is a powder and is unsuitable for injection...

it must be mixed with in the US its mostly sterile water or sterile saline (salt water) combined with xylocaine...the exact amounts vary with the doctor and his/her experience and training...must not be too concentrated or it can cause small nodules...and sculptra is not meant for the tissue immediately under the eyes and should not be used in this location...but its great for the cheekbone area...and to the side of the eyes

Ken Landow, MD
Las Vegas Dermatologist
4.6 out of 5 stars 9 reviews

Preparing Sculptra

Sculptra (injectable poly-L lactic acid, made by Dermik) is similar to a self "dissolving" suture called Vicryl. It comes in  bottles as a freeze-dried, white powder. It then has to be put into a suspension by adding  sterile water usually a few days ahead of time and sometimes 1-2 cc's of lidocaine so it doesn't hurt as much when injected. The liquid is gently  added to the vial which is gently swirled to reconstitute it and not create bubbles.. The amount of sterile water that is added varies slightly, depending on the preference of the injector, but is usually 3 to 7 cc's in my experience

Larry S. Nichter, MD, MS, FACS
Orange County Plastic Surgeon
4.9 out of 5 stars 157 reviews

Sculptra and dilution

Sculptra is a material that comes as a dry powder. It is mixed with lidocaine and normal saline to "dilute" it. Otherwise it would be in solid form and we wouldnt be able to inject it. If it is diluted in a concentrated form, as you can image the sculptra would be concentrated and create more lumps and bumps. In a dilute form this risk is minimized. 

Chris Thiagarajah, MD
Denver Oculoplastic Surgeon
4.9 out of 5 stars 9 reviews

Dilution may vary somewhat

Sculptra is an excellent treament for skin rejuvenation, restoring lost collagen in a gradual and natural way, in experienced hands. It is also a potent volumizing agent for correcting facial hollows and sunken cheeks. The dilution may vary from 7:1 to 9:1 in most cases. Meticulous injection technique at the proper level and frequent post injection massage help to ensure even dissipation of product and uniform results without nodule or papule formation in my experience. It is NOT to be used in thin skin areas such as the eyelid and lips because of the high risk of these very problems occurring; papules in these areas are difficult to treat and may take years to resolve. Seek out experienced injectors for this treatment.

Harrison C. Putman III, MD
Peoria Facial Plastic Surgeon
4.7 out of 5 stars 13 reviews

Sculptra Dilution Explained

Sculptra arrives in a bottle as a fine powder and is mixed with sterile water the day before injection. Since you can't inject powder, this is the only way Sculptra is used.

Premixing allows the powder to disperse evenly, but even immediately prior to injection we will gently keep the mixed solution "moving" to be sure the placement is as even as possible.

The dilution ratio, even if it varies, does not mean you are getting less of the product since patients are charged by vial as opposed to by syringe as with filler. Some doctors may add an anesthetic to the mixture and that could lead to more syringes per vial, but still, the amount of Sculptra in the vial is the amount you will receive and pay for.

There are standard ratios of dilution for products like Botox and Dysport where conceivably a dishonest injector could over dilute, but fillers come in prefilled syringes of specific amounts. There is no need to mix anything as the filler in injected directly from the prefilled syringe which is prepackaged by the manufacturer.

If anyone were to be concerned, they could ask the physician to not remove the filler syringe from the package until they were ready to inject.

This is not practical with Sculptra as it takes a number of hours for the mixture to properly reconstitute.

Rebecca Fitzgerald, MD
Los Angeles Dermatologic Surgeon
4.1 out of 5 stars 22 reviews

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.