Why does sculptra form granulomas under the eyes but not in the cheeks?

Scultpra can be placed under the eyes, but specifically above the periosteum or bone convering. Any scultpra that is superficial to this area will show up as granulomas or lumps. In the cheeks, the scultpra is placed deep to the dermal layer and isn't felt.

The skin under the eyes is very thin, especially compared to the thicker skin of the cheeks.  All injectable fillers can cause bumps under the eyes due to the thin skin not being able to hide any irregularities.  These bumps are usually not granulomas, but papules and nodules.  I do not recommend using Sculptra under the eyes because it can cause bumps in that area due to the thin skin.  I would recommend using a hyaluronic acid filler under the eyes.  

Sculptra is a wonderful product.  You can get natural filling especially in the mid face and jowls for up to two years.  However, one of the potential side effects is granulomas.  That is why Sculptra is contraindicated under the eye area where the skin is so thin.  Sculptra is a deeper injection and not a superficial one.  Please consult a board certified dermatologist with a great deal of cosmetic dermatologist experience.

It is possible for Sculptra
to form nodules anywhere it is injected if proper aftercare is not done. Recommended
aftercare is to massage the area 5 times a day for 5 minutes for 5 days after
treatment. In the cheeks Sculptra is injected deeply so nodules aren’t likely
with proper aftercare. The area under the eye is very thin and does not get
injected as deeply, however Sculptra injections in the area are not advised. I
like to inject diluted Restylane in the undereye hollows. Consult with a Board
Certified Dermatologist to see what treatment is best for you.