Incorrect Dilution of Sculptra?

Hi 50 Not,

It is difficult to make any judgements about when the vials were reconstituted.  What I personally will avoid is using a needle that is larger than a 25 gauge needle to inject.  I believe that the clogging of the needle is actually another safety against injecting globules of undiluted Sculptra particles.  It is sometimes frustrating when the needle clogs, but I would not recommend injecting with larger gauge needles.  There are ways to help dissolve hard nodules if need be.  Discuss your concerns with your plastic surgeon.  Good luck and be well.

Dr. P

Thank you for your question. The nodules may have to be excised if they are a result of the Sculptra.  You may have to ask when the product was reconstituted, and the size of needle used.  We use 25ga BD needles, and rarely have problems with plugging.  If I use a 22ga, I never have an issue.  They have to be burped prior to injecting, and usually are trouble free..   I hope this helps!

I would like to echo the other remarks about refraining from using a needle larger than 25 gauge when injecting Sculptra.  Sculptra is not easy to inject and needle clogging is just a part of the procedure.  This helps to make sure that the injection is performed in suspension and not in poorly suspended clumps.  My practice protocol is to reconstitute the Sculptra with sterile water and lidocaine 7 days prior to injection and to inject the suspension in a deep plane.  Hard nodules after injection are clearly not normal and should be discussed with your Physician.

You should ask the physician if there are any changes in his routine for your most recent treatment.  Have him look at your bumps. Dilution can affect the frequency of nodules as can the doctor’s technique.

Nodules are a possible risk when injecting Sculptra, however, with careful preparation and injection technique, they can often be avoided.  When Sculptra first came out, physicians were trained to use dilutions of 4 mL.  However, this low volume tends to promote nodules.  Most physicians now dilute to a volume between 6-9 mL.  In thinner skinned areas, such as hands and chest, even more dilute formulations are recommended.  When injecting the face, the injections should be placed deeply.  Sculptra should not be injected around the eyes or mouth, as these areas will form nodules.  Massaging after treatments is helpful, as well.  As always, treatments should be performed by a board certified dermatologist or plastic surgeon with cosmetic experience.     

Sculptra is a fine powder that is reconstituted with saline and lidocaine prior to injection. I have found that reconstituting the product at least 2 days prior to the injection and placing it in our warmer make the injections easier.  I always use a 25 g needle and would avoid using a larger needle.  Lumps can happen if too much of the product is placed in one position or if it is injected into the superficial muscles around the lower eyelids.  Following these protocols are helpful to avoid problems.  

Sculptra is the most difficult material to use. It requires years of experience, careful attention to detail and a doctor who cares about your well being. Humbly, you must see your doctors about the issues you are having.

A significant reduction of the frequency of nodules from Sculptra injections has been achieved with higher reconstitution volume (I use an 8 ml per vial dilution), a longer time between reconstitution and injection (36-48 hours rather than 2-12 hours), injections into the deeper tissue, and post injection massage. In a recent study, 8.5% of patients injected with Sculptra experienced formation of nodules. All nodules could be felt but were not visible. The onset of nodule formation from the time of injection can vary. Early nodules appear one to three months after treatment and most spontaneously disappear. I suggest you return to your plastic surgeon and discuss your concerns.