Does Sculptra in face carry same risk of blocking lymphatic drainage as fillers in face do?

Question

I recently had to have all of my filler dissolved due to lymph blockage which was causing malar bags, discoloration, and swelling. Since Sculptra works through a different mechanism does it still carry the same risk?

Anna Chacon, MD, FAAD · Answer

Sculptra (poly-L-lactic acid) and traditional hyaluronic acid (HA) fillers work through different mechanisms, and this can influence their risk profiles, including potential impacts on lymphatic drainage.

Mechanism of Action
- Hyaluronic Acid Fillers: These provide immediate volume by physically filling the space where they are injected. They attract water, which can sometimes exacerbate issues like swelling.
- Sculptra: This is a biostimulatory agent that works by stimulating your body to produce its own collagen over time. It doesn't provide immediate volume but gradually improves the skin's structure and volume as collagen builds up.

Risks Related to Lymphatic Drainage
- Hyaluronic Acid Fillers: Because HA fillers add immediate volume and attract water, they can sometimes impede lymphatic drainage, especially if injected inappropriately or in excessive amounts. This can lead to issues like malar edema (swelling in the malar region) and the formation of malar bags.
- Sculptra: While Sculptra is less likely to cause immediate volume-related problems, it can still potentially impact lymphatic drainage, albeit through a different mechanism. As it stimulates collagen production, there could be a risk of fibrosis or nodules if not injected correctly, which might affect lymphatic flow indirectly.

Comparative Risk
- Volume and Swelling: Since Sculptra doesn't attract water in the same way as HA fillers, it might pose a lower immediate risk of causing swelling or malar bags. However, improper injection technique or overuse could still lead to complications.
- Long-Term Effects: Because Sculptra works over time and leads to new tissue formation, any issues related to lymphatic drainage might emerge gradually. Proper injection technique and appropriate patient selection are crucial to minimize these risks.

Recommendations
1. Consultation: Discuss your specific concerns and medical history with a board-certified dermatologist or plastic surgeon who has extensive experience with both HA fillers and Sculptra.
2. Technique: Ensure that the practitioner uses proper injection techniques and understands the nuances of Sculptra to minimize the risk of complications.
3. Gradual Approach: Sculptra treatments are typically done in a series of sessions. This gradual approach can help monitor the body's response and adjust treatment as needed.

Conclusion
While Sculptra may carry a different risk profile compared to HA fillers, it is not entirely free from risks related to lymphatic drainage. Careful consideration, proper technique, and professional expertise are essential to minimize any potential complications. Always ensure that your treatments are administered by a qualified and experienced practitioner.

Michael A. Persky, MD · Answer

Hello nyc,
As with every aesthetic facial treatment, your result will rest upon the expertise of the physician you choose.  Fillers and Sculptra are not commodities like buying a gallon of milk, rather they are tools used artistically and scientifically by experts (and unfortuantely novices trained in a weekend course as well.). As long as an expert injects you with Sculptra, it should not result in malar bags, I have never seen this in any of my patients.  Good luck and be well.

Michael A. Persky, MD
Encino, CA

Leonard Grossman, MD · Answer

Hyaluronic acid fillers should be injected around the eyes just like sculptra should never be injected around the eyes. Injectable products do not cause blockages in the lymph duct. It is a fallacy and an excuse, used by poor execution and poor Product election. It is the action of the muscles around the eye that caused shifting of gelatinous hyaluronic acid product. As a rule, any filler of choice that is to be used in a face, should be injected with a tiny cannula and not a needle. 
The best filler one can use in the face is fat mixed with your own stem cells. Graphing or fat transfer in the right hand produces fantastic Natural and practically permanent results without any form of under eye bags. I hope this helps and good luck from Leonard Grossman MD Organic Plastic Surgery

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