Distorted Facial Shape After Jawline Sculptra Injections

I had my first (and last) experience with Sculptra 48 hours ago. Despite my very specific, repeated, clear, request for the plastic surgeon to please only inject just under my cheeks (where I was bothered by the sunken appearance), he injected into my jaw line, around my chin and jowls as well. I specifically said I had no issues with my chin, and only wanted my sunken cheeks filled in.

After a series of injections consisting of 2 vials (1 vial each side) I looked in the mirror and was horrified to have the "acorn in my mouth" look. Is there anything that he did wrong, or is it standard practice to inject in the chin or jaw line area as well? My face shape has gone from oval to square, and all I can see is the bottom half of my face looking like I walked out of a dentist office. To make matters worse, the left face appears far more injected the right (very puffy/post-dental Novacaine look), so the assymetry makes it even more noticable than it may have been otherwise.

I'm concerned that long after the Sculptra is gone, the new collagen will just replace the same area and will continue to distort the shape of my face completely. How can I get this fixed? Please help.

Doctor Answers 10

Sculptra results will resolve in a few days

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Dear Live,

Your face will return to your pre-injection state within the next two days as the water from the solution is absorbed. Then, over the next 8-10 weeks, you will form collagen in response to the Sculptra particles that are left behind. This collagen response is almost never to the full volume that was injected with the water. So, expect a much more subtle effect when all is said and done.

Sometimes injection, toward the jawline is done to "feather" the treatment. I don't know if this is the case for you or not. Consider a visit to a another plastic surgeon that injects Sculptra if you feel that your prior injector did not listen to your concerns. Good luck!

Sculptura will reduce in profile with time

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Thanks for the question.

There really isn't any "standard injection" pattern for Sculptura (or any other filler for that matter). The injection areas and volume has to be specifically tailored for each patient's particular facial shape and for each patient's concern.

Sculptura will reduce in profile with time. You may be seeing post-injection swelling right now, and will likely have a better idea of your post-injection contour in about a week. The effects of Sculptura itself will fade over the next 6 months to year.

Express your concerns to your plastic surgeon.

I hope this helps.

Massage areas with Sculptra and be patient

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What you see now has little relation to the final effect.

Sculptra is unique in that it is a "stimulatory" filler that creates its effect by causing your tissues to rebuild collagen. The initial swelling and any distortion diappears within several days. However it should be massaged for five days - for five minutes- five times daily to smooth out any lumpyness. We remind our patients 5x5x5. With that program we have never had irregularities in three years of experience in many patients.

We often inject in areas that patients would not expect in order to get the effect they really wish.

In addition, most patients will need more than one sessions so that any issues can be resolved during a subsequent treatment when we better understand how they will usually respond to Sculptra.

In summary, massage and be patient.

Dr. Mayl

Nathan Mayl, MD (retired)
Fort Lauderdale Plastic Surgeon

Sculptra results not permanent

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The description of the results are not consistant with the amount used and I believe that you have a lot of swelling and may be you had bleeding in the deep tissue .Do not worry and let the swelling to resolve and then discuss your concerns with your doctor.

Sculptra Issues

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Early on, since Sculptra is a large volume of injectable product, it can create dramatic swelling for some patients.  It is difficult to determine which areas are swelling and which areas are Sculptra.  Patients should continue to massage the products afterwards and keep close tabs with their injector.  

Sculptra was originally used for patients with HIV lipodystrophy and is made up of poly-L-lactic acid.  Sculptra has the potential for lasting longer than some other fillers, but it has some significant side effect

-Nodules and Granulomas- Can occur with use of Sculptra.  Knowledge of Sculptra and facial anatomy as well as mixing constitution have resulted in decreased incidence of nodules occurring.  

-Infection- Since Sculptra is replaced ultimately by your body's response to it its incidence of infection is very low

-Overly filled appearance- In some patients the response to Sculptra can be vigorous and patients can note an overly full look to the area injected.  Since Sculptra is not reversible, patients must wait for this product to dissipate which can be years.

Overall, in properly trained hands with an experienced injector, Sculptra can add significant amounts of volume to patients and is a useful filler.

Anil R. Shah, MD
Chicago Facial Plastic Surgeon
4.8 out of 5 stars 171 reviews

Sculptra success is all based on placement and massage.

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Well over 90% of the Sculptra emulsion injected into your skin is sterile water, so the results immediately after injections look very puffy.  What is important for even collagen production after Sculptra injections is regular massaging of the treated areas to disperse particles out evenly into the dermal tissues to create smooth collagen response throughout the treated area.  We stress the 5-5-5 rule to ensure even predictable results.

Steven Swengel, MD
Los Gatos Dermatologic Surgeon
5.0 out of 5 stars 12 reviews

Sculptra injections: What to do/expect in the first few days out?

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Sculptra takes weeks to show its effect. 

When it is initially injected, the sculptra is mixed with sterile water.  The fullness you see immediately after injection is this fluid, which gets absorbed, and swelling.

Sculptra is a little malleable when first injected.  You and your doctor decide where to address.  Then you must massage 5 minutes, 5 times a day, for 5 days.

If you see fullness in an area you don't want, it could be swelling or it could be product.  I would urge you to see your doctor, as they know how much they injected and where. Usually though it is swelling.


Lauren Greenberg, MD
Palo Alto Plastic Surgeon

Sculptra injections

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Be patient. It is way too early to see anything. Often, a series of treatments would be needed to get the desired effect from Sculptra. I don't understand why the jawline was injected if that is not what you wanted. Perhaps it is just dependent swelling after the procedure? Give it some time to resolve.

48 hours after sculptra

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I would give it a tincture of time for the swelling to go down. The change from two vials of sculptra is subtle so I think that it would create a small change. Going forward your surgeon can alter the treatment and what you need.

Chris Thiagarajah, MD
Denver Oculoplastic Surgeon

Massage key to smooth Sculptra results

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Hopefully, your physician Sculptra injector would have performed vigorous massaging right after Sculptra injection and also provided explicit instruction for you to do the same at home, e.g. rules of 5's (massage for at least 5 minutes, 5x/day for 5 days). There should not be nodularity 48 hours after Sculptra injection with good Sculptra injection techniques and consistent massaging.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.