Why do Sculptra and Thermage have different results even though they both work by increasing collagen production?

Question

Sculptra is supposed to restore volume by stimulating collagen production. Thermage is supposed to tighten skin by stimulating collagen production. Why do they have different effects if the underlying reason for each of the effects is the same?

Rebecca Fitzgerald, MD · Answer

The "holy grail" outcome of many cosmetic dermatology procedures is the production of collagen.  Where and how much new collagen you hope to gain are the keys to treatment choice.Collagen production that is created outside the body's natural inclination to do so is primarily achieved through the process of some kind of controlled "injury" or an induced response to the introduction of an agent (like Sculpta). Although that might be a confusing concept, it's actually fairly simple.The body reacts to injury with a cascade response, the end result nearly always some level of new collagen deposition in the skin.  (Ex: Elevated scars are the result of the body's natural wound repair system.)Sculptra:We use Sculptra to trigger a response to increase volume, so you'll see this injectable almost entirely used for facial volume replacement. Although the injection of the suspension fluid is not an actual injury, the Sculptra micro-particles trigger an inflammatory response that ultimately increases the amount of collagen in the areas treated. Thermage:Heat-producing devices such as Thermage depend on heating tissue up to specific temperature levels to achieve new collagen production. From the Journal of Clinical and Aesthetic Dermatology: "As a result of the deep delivered energy into the skin, collagen remodeling through a controlled wound healing response occurs over time with associated neocollagenesis. This collagen remodeling also yields the desired tissue tightening that is seen with these devices."Both Sculptra injections and Thermage are delivered in a highly controlled process to assure a smooth result, whether for tightening or volume creation.

Monica Boen, MD · Answer

Excellent question. The difference is in how the two procedures stimulate collagen production. Sculptra contains poly-L-lactic acid, which promotes collagen production by initiating an inflammatory response within the dermal structure. This leads to more fullness when the collagen is produced. Thermage delivers heat via radiofrequency energy to the underlying dermal layers, which constricts tissue while triggering collagen production for a tightening effect. You can have these treatments separately or you can combine them to achieve even more dramatic results. Make sure you work with a board-certified cosmetic dermatologist no matter which treatment plan you choose to ensure an optimal outcome.

Gerald Minniti, MD, FACS · Answer

Hello,Sculptra causes increased volume by addition of new collagen around the poly-L-lactate crystals below the level of the skin. Thermage stimulates both collagen production and subtraction in the skin, otherwise known as 're-modeling'. Best of luck!

Jason Emer, MD · Answer

Although both boost collagen, they’re very different. Sculptra is a filler that creates volume whereas Thermage use radiofrequency to heat the skin and tighten it over time. If you’re interested in either procedure, I recommend a formal evaluation with your doctor. See an expert. Best, Dr. Emer

Vibha Gambhir, MD · Answer

Hi. This is a great question! The similarity between the two treatments is that both stimulate your body to produce collagen however there are a few differences. First, is the method of treatment. Sculptra is a liquid stimulant that is injected into the area and treatment takes about 5 minutes. Thermage is a machine using Radio Frequency heat placed deep in the dermis to stimulate collagen production and will take 45min-1hr. Second difference is frequency. Thermage is repeated once yearly while Sculptra is a series of monthly treatments usually anywhere from 3-8 treatments depending on the amount used per treatment. And finally there is a difference in placement. Sculptra is mainly used for the temples and cheeks. Thermage treats the entire face and neck. In our practice we combine the two treatments to achieve optimal results. I hope this information was helpful!

Shaun Patel, MD · Answer

A lot of our procedures in aesthetic medicine work by stimulating collagen production. Thermage is a radiofrequency based treatment that bulk heats the skin thereby stimulating collagen production which then results in skin tightening. Sculptra is injectable PLLA. It works by inciting an inflammatory reaction where injected. This inflammatory reaction stimulates collagen production as well. Thermage tightens skin while Sculptra corrects volume loss.

Dean P. Kane, MD, FACS · Answer

Dear sa6aT9in191:Great question! Collagen is the main structural molecule and protein in the fibers of the skin and its connective tissues. There are 28 or more different types of collagen made into a triple spiral helix in the body's tissues. From conception until about the age of 30, your genes govern the production of collagen for growth (and repair). After the age of 30, collagen is formed to repair injury through a process called inflammation. Inflammation does not necessarily mean red, hot infection. It is the process of healing and structural growth. Inflammation can be stimulated to form "scar" or collagen from injury. Other stimulants of collagen induction include: heat through the skin from lasers, radio-frequency, ultrasound, ThermiTight and other energy forms. Each has its pro's and con's. Sculptra is unique in that "injury" is bypassed by injecting a cell messenger to stimulate the fibroblast to make collagen. Neither of these collagen inducing options forms "volume" per se. Each time heat affects collagen directly, it:  tighten the protein then stimulate more lumpy collagen formation during the fibroblastic phase of inflammation and then remodels into a smoother, stronger but different collagen molecule. Sculptra leaves behind a fibroblast stimulator particle called poly-L-lactic acid which provides phases 2 and 3 above for prolonged stimulus for up to a year.Both, therefore stimulate firming or tightening but not really volume formation (unless you define tissue contraction into a smaller volume as "filling"; I don't).I hope this was helpful. Always consult with a Board Certified, skilled Plastic Surgeon to see what is best for you.

Leonard Grossman, MD · Answer

Sculptra is a filler which through the inflammatory process of the body's immune system induces a reaction that creates SCAR tissue also known as collagen. Thermage on the other hand creates an injury to the skin which through radio frequency tightens some of the collagen fibers. Thermage does not create new collagen. Good luck from New York City

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