Am I good candidate for Sculptra or should I just get fillers? (Photo)

Question

Hello! I'm very self conscious about how hallow my face looks. I just turned 30, I don't smoke, drink or do drugs and I want a more full face and i'm debating if Sculptra is right for me or fillers is best? What are the complications from Sculptra and how common are the risks?

Jonathan Kulbersh, MD · Answer

Either Sculptra or HA fillers could give you a very nice result. Fillers offer immediate gratification in that you see the results almost right after your procedure. Those improvements typically last 6-18 months, depending on the filler used and how quickly your body metabolizes the hyaluronic acid. Sculptra works by triggering your body to produce more collagen, creating the most natural and longest-lasting results in most cases. However, you will not see your improvement for a few weeks or even months. You will also likely need a series of injections to produce an optimal outcome. My advice is to schedule a consultation with a very experienced and qualified injector. By examining you in person and discussing your concerns and goals in greater detail, your injector will be able to determine the best treatment plan for you.

Harold J. Kaplan, MD · Answer

Hello Adventurous.  Yes, Sculptra is an excellent option for you and for anyone with very thin features.  It is an excellent product for naturally contouring the face with your own collagen.  In your situation, we would caution you to use Sculptra to add softening and volume, but without changing the shape of the face.  You have a long, thin facial structure and this is your particular facial anatomy.  Trying to make a face like yours too round will lead to a very unnatural appearance.  Vest of luck.

Rebecca Fitzgerald, MD · Answer

We're lucky to have such a wide variety of fillers which can be "mixed and matched" to contour and shape the face.

Sculptra is a collagen stimulator, so the end results are your own natural collagen. This makes Sculptra ideal for a global treatment in most areas if the face.

When used along with gel fillers - which rely upon hyaluronic acid to hold water and created the desired increase in volume for projection or lifting of folds and wrinkles - Sculptra can become a scaffolding of sorts.

More often than not, a combination is used when the desire is to achieve a fuller face, as not every filler solves every issue at hand. As such, Sculptra is not used in the lips or in the higher mobile areas.

Longevity:
Those fillers that are placed in high mobility areas of the face (such as Juvederm Volbella or Restylane Kysse, among other) don't last as long as those that are meant to create a projection, such as Juvederm Voluma, Restylane Lyft and the new RHA2.  The range is around 6 months to 2 years depending on the filler. Occasional touchups keep the effects at peak performance.

Sculptra will typically last longer, though if you are in a hurry, realize that results are not immediate and require a series of visits to create the "build".

Whichever injectables are chosen, the critical factor is injector skill and experience.

Michael A. Persky, MD · Answer

Hi Adventurous,

You are an excellent patient for Sculptra treatment by an expert injector.  I believe that I can help you achieve your facial aesthetic goals with one or two sessions of Sculptra injections spaced over a 2 to 3 month period.  I have been treating hundreds of patients like you with Sculptra over the past ten years without complications or problems.  The most common adverse event, though I find it quite rare in my patients, may be a small bruise that resolves within a few days.  Sculptra injections on the face require advanced injection techniques, the rate of complications is related to the injector, not the product.  It is very. important that you choose your Sculptra injecting physician very carefully based on their experience with the product, their skill, knowledge, and most importantly their natural artistic vision. Please call my office at your convenience to schedule your consultation and appointment for your Sculptra treatment.  I look forward to meeting with you and helping you achieve and maintain your aesthetic goals for many years to come.  Happy and healthy Thanksgiving.  
Michael A. Persky, MD

Gerald Minniti, MD, FACS · Answer

Although a majority of practitioners prefer hyaluronic gel fillers best because they can be reversed, Sculptra is a great alternative that actually is different in the kind of results you get. HA fillers have a large 'elastic modulus', or in layman's terms, a lot of lifting power. They can create definition and volume. Sculptra is a product that stimulates collagen production and provides a softer volumization. You already have cheek definition, you need to blend and fill the lower areas (buccal region) to give your face volume and softness. Sculptra is not permanent, unlike Bellafill, and eventually over 12 to 18 months dissipates. When done correctly, Sculptra will be smooth and not lumpy, a reputation it gained 2 decades ago from use in HIV positive men with facial fat wasting. Understanding why it got lumpy allowed for better techniques that almost insure a smooth result.  Be aware of practitioners who want to over treat you with a all sorts of things you don't need.

Jason Emer, MD · Answer

you are a really good candidate for sculptra but I use this as a "base" for collagen production with dermarolling at home weekly (see link), morpheus, and threads in the office. fillers can be used to give you structure on top or layered with sculptra and over time you will need less fillers as the sculptra builds.

at home peels like cosmelan, enlighten and aerify along with dermarolling (MTS roller with anteage MD ampules weekly, see linkt) should be started now to prevent further aging.

For facial rejuvenation,  I would suggest a combination approach of 
1) skin care with products and PRP/microneedling
2) PDT light therapy few times a month with growth factors
3) laser treatments like clear and brilliant regularly and a few times a year Fraxel/halo Viva, Co2/Erbium
4) Sculptra injections a few times a year for collagen production with fillers like juvederm/restylane/belotero/radiesse/bellafill
5) thermage/ultherapy for yearly skin tightening with or without PDO or cone based instalift threads for lifting
6) botox every 2-3 months to stop movement lines and prevent lines at rest
7) deep microneedling RF like Fractora/morpheus8 for tightening of the skin
8) Vascular laser like vbeam/excel V or BBL forever young treatment every quarter (3-4 months)

Best, Dr. Emer.

Michael A. Zadeh, MD, FACS · Answer

Thank you for your question and pictures. You do appear to be a good candidate for Sculptra which will help naturally volumize your face. Usually multiple sessions are required and results take time. Sometimes it can be combined with fillers. The main risk is that of nodule formation and for this reason I would recommend you see an experienced physician. Hope this helps!

Dmitriy Schwarzburg, MD · Answer

I would recommend fillers with hyaluronic acid for the facial features. The results can be very precise. Sculptra unlike other fillers increases volume as it induces collagen production. So the solution itself is not the one that produces the added volume. The process relies on the body's natural collagen production.

Dean P. Kane, MD, FACS · Answer

Dear Adventurous368010, 
Thanks for sharing your photos. The illustrate your concern regarding hollow under the eyes. Your facial features are beautiful and exotic. A fuller mid-upper cheek, ie the “apple” may help you achieve your desires. 
•	Sculptra is a bio-active injectable which stimulates collagen formation, firming and a bit of filling. Since you don’t have wrinkles with only a hint of a tear-trough, I believe other fillers are your better choice. I have found the risks of nodule formation exceedingly low and easy to resolve, even around the eye or mouth). 
•	A properly selected hyaluronic acid gel filler or calcium hydroxylapatite filler by a technically well experienced injector is a 15 to 30 minute procedure with minimal risk and 1plus years duration.
•	Fat is a wonderful filler but it has its limitations. That is, you need fat to harvest, an average of 30% survives so you many need more sessions, it will cost more. 
Please consult with a Board Certified Plastic Surgeon with great skills and experience in these techniques. 
All the best!

Leonard Grossman, MD · Answer

You have an amazing bone structure and with that fact alone it should be quite easy to treat your face making you look a lot softer. my recommendation to patients like yourself is to use your own fat to perform a fat grafting procedure which will create almost any result you wish in a natural and practically permanent way. Sculpture can be used in a face but it cannot be placed anywhere near your eyelids which creates a problem. That is exactly the reason why I prefer fat. I hope this helps and good luck from New York City plastic surgery

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