I Am Considering Sculptra, my Question is What Happen if the Body Doesn't Produce Collagen? Are There Cases Related to That?
Doctor Answers 13
Sculptra and collagen production
Scupltra does not produce Collagen!
The filler Sculptra® was at one time considered an important agent in managing facial fat loss in HIV+ patients. Prior to FDA approval, it was used in a clandestine manner. In clinical trials evaluating this agent for correction of fat loss in HIV+ patients although the study patients were for the most part satisfied, up to 50% of the injected individuals developed some degree of lumpiness in the treated areas. Furthermore, these lumps are often far from invisible. Nevertheless, Sculptra® received rapid track compassionate release approval from the FDA for use in patients with HIV. The panelists on the General and Plastic Surgery Device panel were strongly unanimous in limiting approval only for patients with HIV. At the FDA hearing, not one histologic slide showing the fate of Sculptra upon implantation was shown. Again, how can an agent gain approval without scientific data supporting its application?
According to the European literature the consequences of Sculptra® in the normal host has been very problematic (foreign body granulomas, infections, etc.). I have biopsied many patients after Sculptra and what I find is no collagen production but rather a reaction similar to that surrounding a thorn in your foot.
Nevertheless, the lay press, medical conferences and internet began to promote this substance for soft tissue augmentation in HIV negative patients. Prospective studies for the use of this agent in individuals with normal immune functioning have been completed in the United States and now it is approved for use in everyone. But please don't go anywhere near it
In 2000, at the World Congress of Dermatology in Paris, Pierre Andre reported cystic, nodular, and granulomatous lesions when this agent was used in individuals with normal immune functioning (non-HIV+ patients). Additionally, long-term allergic reactions have since been described, which are very difficult to manage. In another report concerning its aesthetic use in 100 patients with normal immune functioning, 20% of the treated individuals experienced significant adverse reactions. Obviously, this product is not immunologically inert as the manufacturer stated. Foreign body granulomas are being seen with this agent in HIV-positive as well as immunocompetent patients.
While the manufacturer as well as investigators claim this product produces neocollagenesis or new collagen this is not what is seen under the microscope. On biopsy one sees a severe immune reaction to the product as described. As the father of the the field of soft tissue augmentation I would have to call Sculptra a bad seed!
Arnold W. Klein, MD
Professor of Medicine and Dermatology
Klein Chair in Dermatology UCLA
Consultant to the General and Plastic Surgery Devices Panel of the FDA firstname.lastname@example.org
"The Most Innovative & Famous Cosmetic Dermatologist in the World!”
- Beverly Hills Times Magazine, Spring 2011 Beauty Issuel
The body will produce collagen from the Sculptra
The body does produce collagen. As long as there is the possibility of the body healing, which everybody has, the body will produce collagen from the Sculptra. How much it produces, however, depends on age, sun damage, and how much collagen loss needs to be corrected. The older you are, the less collagen is produced with each treatment. The younger you are, the more collagen is produced with each treatment.
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Little to no response to sculptra in a few patients
Sculptra has been used with great success in my practice for the last five years. As a general rule, the younger the patient (40's, 50's), the greater the response. Another factor I have noticed is the less sun damaged the skin, the greater the response to Sculptra. The few patients that have had little to no response have been those with thin skin secondary to excessive sun exposure and some patients in their late 60's and early 70's.
A small number of patients do not respond as robustly to Sculptra injection
My personal experience is that a small number of people will not have as robust a response to Sculptra injection. This is probably fewer than 2-3%. Every patient I've injected has had a response but a small number do not achieve the results that they, and I, had envisioned. The upside is other filler options exist (hyaluronic acid) that do not require your body to synthesize lots of collagen to have a good effect.
Stephen Weber MD, FACS
Sculptra is very reliable at creating facial volume
Sculptra is a very reliable stimulator of facial volume by creating the formation of new collagen. It does need to be placed carefully and skillfully to achieve the best results.
A consultation and discussion of goals is important with a treatment plan for how many vials over what number of sessions should be done before starting the sessions.
The technique for placing it has evolved over the years since it was first made available in the United States. It is very important to see a physician who is experienced and has kept up with the latest trends of how to inject it. I think the rather low Worth It Rating of 59% at RealSelf reflects that not all physicians are as skilled at its use. This is truly a home run treatment for the right patient in the hands of a skilled doctor.
Will Sculptra work for facial volume restoration
Sculptra (poly-L-lactic acid) was initially approved in the US for restoration of lipoatrophy in HIV positive patients. The results of safety and efficacy studies showed that a great majority of these patients benefitted from Sculptra injections. So considering that patients with a chronic illness had a good response to Sculptra for the most part, it is rare to have a healthy person not respond to Sculptra injections.
Sculptra works by stimulating collagen formation as the particles of poly-L-lactic acid degrade, so it does depend on the body's ability to make new collagen. There are rare genetic disorders of collagen synthesis that would interfere with new collagen deposition in response to Sculptra, but these are usually seen or diagnosed in childhood or adolescence.
There are also certain nutritional deficiencies that would interfere with new collagen formation, like vitamin C deficiency (as seen in the disease scurvy, rare nowadays), low levels of protein precursors (amino acids) in the body, and others. People who are on severe restrictive diets would probably not get an optimal result with Sculptra.
There is also a way of increasing collagen breakdown that would interfere with the final results of Sculptra as well, and that is ultraviolet light exposure. UV light activates enzymes in the skin, called metalloproteinases that break down collagen fibers. So if Sculptra is inducing new collagen formation but ultraviolet light is inducing collagen breakdown at the same time, the end result will be less collagen in the skin.
It is important to remember that Sculptra is normally injected on a three session schedule, separated approximately 4-6 weeks apart. After each injection session, there will be transient swelling for several days. Visible results of Sculptra revolumization of facial skin initially appear approximately one month after the second injection. After three injection sessions, the results of Sculptra facial volume restoration usually last 2-2 1/2 years.
Does Sculptra work in Everyone?
This question has been studied and it was shown that all patients will respond and make new collagen. There are other factors to consider of course, such as age, amount of volume loss, health, etc but you can be assured that your body will be stimulated make new collagen.
Sculptra reliably improves facial volume.
I have been treating patients with Sculptra for many years and I have yet to find someone who does not respond. After hundreds of treatments I am confident that results can be expected. If there is not enough volume then additional treatments need to be done. My typical patient is happy with a total for 3 treatments (ususally 4 vials in three visits over 3 months). Occassionally additional treatments are appropriate.
There are patients who do respond poorly to Sculpra
- Patients who are trying to loose weight
- Patients who are exceedingly gaunt will need relatively more product
- Patients who become "sick" especially those with HIV who are not doing well
- Patients who excercise a great deal will also need relatively more product.
My present routine is to give a great more Sculptra at the earlier sessions (usually three or more ampules so the results come more quickly and without the discomfort of many sessions. In experienced hands this is safe and we have never had a problem of overfill. Larger gaunt faces or HIV patients have had as much as five ampules at an initial treatment.