Dear Garden City4489:Contemporary techniques in Sculptra use have provide significant improvements in the rejuvenation of facial aging. Originally considered a filler, Sculptra has been found to have a bio-stimulatory effect on the cells which produce the structural molecules in the skin and soft tissues. When injected in its currently thinner dilutions, changes to the dermal and epidermal skin and underlying fat occur which are more firming with mild filling than as compared to maximizing volume and projection with hyaluronic acid fillers. As it is a liquid suspension and not a gel, Sculptra has the ability to coalesce in particular areas along the lateral brow and forehead and occasionally the corners of the mouth. This will concentrate the product and over-stimulate collagen production and therefore nodule formation. It is easy to reverse a nodule formation when the patient senses a crackle or minute particle formation. But if left alone to increase in size, a tiny pin-head grain can develop a pea-sized nodule. Interestingly, biopsy of these nodules find collagen and not a foreign-body granuloma. Options to reverse this over-stimulation of collagen formation include:local anesthetic injection with vigorous massage,kenalog or other steroid injection if performed during the development processexcision of the nodule if it has been ignored until the above options can't help. Sculptra is a wonderful adjunct to facial rejuvenation but like any other option there are trade-offs. I instruct my patients to make a non-emergency appointment to evaluate and treat a tiny issue before it becomes a bigger problem. It is much easier to massage and spread the fluid into a thin, uniform layer rather than allow it to pool and form a nodule. While the current mantra is to massage 5 minutes, 5 times a day for 5 days; more is better in this case with particular emphasis on areas where larger volumes were injected. Consult with a well experienced Sculptra Plastic Surgeon or Dermatology Injector. I hope this has helped. All the best!
