Dear iloveladies: Sculptra is a wonderful bio-stimulatory filler when fully understood by the injector and used in the well selected patient! Unlike hyaluronic acid (HA) gels which are very smooth, homogeneous and attract water to produce a volumetric expansion, Sculptra is different! The Sculptra molecule (poly-L-lactic acid) does not easily mix with water or xylocaine liquid. It must be prepared in anticipation of its injection no less than 48 hours in advance. It forms a suspension and upon injection must be massaged to distribute the molecules evenly or a micro-clump of these molecules will over stimulate the fibroblast to form more localized collagen and other structural molecules. The idea is to induce more structure to the fibrous network of tissue under and in the skin than attract water. Like any injection, do not confuse a lump of inflammatory changes with a true, spicule / granule / nodule of collagen. It generally takes 3 weeks or more (following 4 or more series of Sculptra injections in very thin skinned individuals, in my experience) to form a collagen clump. I have explored this concern and believe it is collagen and not a granuloma). Options to reduce such a spicule / granule / nodule of collagen depend on timing following its injection. Spicules can usually be massaged out Granules (the size of a sugar crystal and up to a half size of rice) can be “dissolved” with: 1 to several direct injections with xylocaine and deep massage, 2 to 4 weeks apart or Very dilute Kenalog (steroid) injections 6 weeks apart. Larger nodules, ie a longer period of time “percolating along” to develop larger quantities of collage may need excision and fat grafting. I have tried valiantly to find information on the use of: collagenase to enzymatically breakdown the nodule without atrophy of the surrounding tissues (using steroid), and 5FU to reduce fibroblast production of the structural molecules, but Unfortunately, I find no local experience and the manufacturers of these medications (probably because of this off-label use) will not respond. To date, I am pleased with the above options particularly when treated early. Use a talented and skillful Sculptra injector with great experience to discuss the benefits and limitations of this injectable “filler”. All the best.