Of course, an examination of the need for volume replacement would need to be assessed. I have been using Sculptra for about 6-7 years. There are several issues of concern:
1. In my opinion, one vial of sculptra is usually not nearly enough to fill the cheeks;
2. One syringe of Perlane is not nearly enough for the cheeks either. The obvious strategy is to have the Perlane give the immediate fill effect and while this dissipates over the next 9 months (normal duration of Perlane), this gives enough time for the Sculptra to take effect;
3. Sculptra MUST be used in at least 2 if not 3 sessions in fairly large volumes, certainly more than one vial for two cheeks on most occasions. One must wait about SIX MONTHS (not weeks) after the LAST injection before one can expect any reasonable results. Waiting four days just means that the sterile water and lidocaine have been reabsorbed and the one syringe (1.0 cc) of Perlane is just not enough to make enough difference. Patience is required while the Sculptra takes effect. It is a SLOW and controlled process;
4. Bottom line suggestion (again, need an exam to confirm) - need more Perlane (or Juvederm Ultra Plus), probably another syringe for the short term effect (first 6 months). As this dissipates, the Sculptra should be beginning to have effect. Sculptra should be given in session 2 six weeks after session one, usually with more volume, and session 3 six weeks after session 2 with a slight decrease in volume need again. I would try to buy the Sculptra on a 1cc basis rather than a vial (7cc) basis. Only get what you need--no more and no less.
I hope this was helpful.