Since I do not inject Sculptra, I will leave the cost consideration replies to my colleagues.
I would like to address your last paragraph which particularly galls me.
It is true that dermatology residencies have been the hardest ones to obtain for at least the past fifteen years. However, not due to what you perceive as unfathomable riches. In fact, there are many specialties whose average physician makes far more money than the average dermatologist (Speaking of salaries are you as irked by how much our sport "heroes" make. Gilbert Arenas, a basketball player, makes nearly as much money for playing ONE game as I make in a year. And Gilbert is no Tiger Woods!).
Most prospective dermatologists enter the field because it is the only area which covers nearly the whole panoply of medicine. No other specialty provides the variety to include surgery, medicine (and nearly all its subspecialties such as endocrinology, rheumatology, internal disease), pathology, pediatrics, geriatrics, allergy, vascular disease, genetics, gynecology etc. Plus, as you have noted there is the cosmetic aspect. I am sure you can acknowledge that my specialty has been at the forefront in this area (lasers, chemical peels, dermabrasion, Botox, fillers, hair transplants, tumescent liposuction etc.).
The skin is a fascinating organ with its glandular structures, cellular proliferation, neuro-endocrine, receptors; the science of it is of unending appeal.
It is a joyous specialty and most polls show dermatologists to be the happiest in their field. Incidentally, physicians are a greatly demoralized group; polls show the satisfaction rating has dropped from 95% when I began practice to less than 50% today. Government interference with its CLIA, HIPAA, I Pledge, malpractice, HMO's, shrinking reimbursements, more demanding patients, and prospects do not look good).
Every day the average dermatologists sees a number of interesting, challenging cases (besides the humdrum). Eg: today I saw a patient who had seen his family physician, an orthopedic surgeon and a hand surgeon due to a trigger finger, and carpel tunnel syndrome. Finally, he ended up with a rheumatologist who referred him to dermatology (a retired colleague). On presentation he had a number of small papules in his arm pits (Praise the Lord he did not end up in a mall spa which you seem to regard as some sort of cosmetic savior. His small bumps would have ended up in the trash.) It turns out he had papular amyloidosis (a type of protein which can deposit in the skin). Further work up led to the diagnosis of multiple myeloma, a cancer of the plasma cell. He is doing very well with chemo.
Also today a young lady with Darier's Disease (genetic disorder of faulty keratin formation) is flaring badly and has not responded to the usual treatment. We may try Photodynamic therapy (PDT) or Botox each of which have been used, but studies are very limited. Will be interesting to see if they give her surcease.
The point is every day presents its challenges and fascinating cases.
Since I am sounding in parts like I am answering an essay for a residency application (Why do You Want to Become a Dermatologist?), I will speak to the other fallacious comment. That somehow society will be better served if entrepreneurs and giant corporations are allowed to deliver what you perceive to be better and cheaper care. It is true that the care will be cheaper (with its fake Botox and fillers, cheaper machines) but I can assure you no better. Where the only motive is profit, patients should beware.
I am sure I am not alone among physicians on this site in seeing an increasing number of botched procedures, missed diagnoses, and shoddy medical practice by people who have no right practicing medicine. In fact many are practicing medicine without a license. Many of these medi spas would have already been shut down if the medical boards were adequately staffed. Time was when I would see spa induced problem problem every few months, now I see them about every other week. Not necessarily harming patients (although I have seen three laser burns, scarring from a poorly applied peel, a generalized herpetic infection and a bacterial infection), but needlessly expensive treatments (laser for psoriasis without trying even topicals): freezing and lasering granuloma annulare, repeated useless peels for syringomas, etc.,
Entrepreneurs and CEO's have a different set of ethics. Believe me, they will hire the token physician who is willing to sell out his license (I will be kind here) allowing himself to be the "medical director "and permitting lay people to practice on the unwary patient who has stumbled in after succumbing to the ads of the shallow but slick PR people. If somehow you think you will see less rather than more granulomas from Sculptra when these poorly trained people are let loose you have another think coming. .
I personally believe events will be going in the other direction. More supervision. More restrictions. The general public after hearing stories of woe and experiencing mall cosmetic medicine, will demand more supervision of these places not less.
Although you may be making a big investment in Sculptra, I believe
Sculptra is one of the best long-term volumizers as it stimulates
collagen and this newly formed collagen can last for years before
breaking down. That doesn't mean that you won't lose volume in your
face during this time, because the aging process hasn't stopped. The
cost really is driven by how much you need. Someone in their 20-30s may
only need a vial or two and spend 800-1600 in our practice. I would
consider adding a vial or two for every decade of life thereafter in
subsequent treatments. Sculptra works well for perimeter volumizing and
for softening any asymmetry that we may have in our face.
Fillers and other volumizers such as Sculptra require significant artisitc talent by the physician injecting the agent. Would you compare the cost of an original oil painting by a master artist with the total costs of the paint and canvas used in producing the end result? There is a need of understanding the anatomy of the subject which does not come from a cosmetic course but years of medical study. Sculptra can have nodules develop and to some extent this is technique-dependent. Continued studies are important for the physician to utilize in delivering the best result to their patients. The dilution of the Sculptra, the size of the needle, the depth of insertion, the massage, the appreciation for the three dimensionality of the facial contours and the secondary lifting of other areas by supporting primary areas are some of the important concepts than must be learned by the physician injecting the Sculptra. You are paying for the service and the art more than the product. With good luck the cost of the service may continue to decline.
Sculptra Is Not Expensive
I can certainly sense your frustration with the cost issues of Sculptra. I will give you my philosophy.
I inject Sculptra myself to all patients.
I charge $800 for a vial of Sculptra. I spend about 30minutes with the patient.
I charge $600 for Juvederm but that lasts only six months or so. I charge $800 for a syringe of Radiesse.
I find Sculptra to be very rewarding for the patient as it is natural and long lasting (two to three years)
However the risks of improper injection are great. The lumps and large nodules can be quite disfiguring. You should chose the doctor very carefully.
I would advise you to consult with a few different physicians who inject Sculptra and then go ahead with the one you feel most comfortable with.
On a side note; I am a facial plastic surgeon and I can tell you that most physicians including dermatologists truly care about their patients and are not out to get your money.
Smile, it can make one look a lot prettier than Sculptra can.
So let's see, one vial is $350. Than the mixture with saline/water/lidocaine is $50. Plus the syringes, needles, alcohol, gauze, needles, etc supplies add another $50. Than we cannot forget about the overhead as rent, electric, water, phones, employees, insurances, equalling $150.
So the total out of pocket is around $600/ vial. Than the MD fee is between $400 to $600. Thus, the total expense to the patient is $2,000 to $2,400. Seems fair, but if you can find a qualified injector for less than go right ahead.
Remember, it takes 3 to 4 sessions every three weeks to obtain a chance of improvement. Plan on spending $4 to $6 K.
Go ask the manufacturer to lower their fees, please!
Regards and good hunting
Perhaps you should shop the market a bit
You are close to the present cost of Sculptra.
However, the price charged to the patient is entirely set by the practice.
In our practice we typically charge $1800 for two vials of Sculptra Aesthetic. I am a trainer for Sculptra and have done many patients both on and off label since Sculptra was released in the U.S. Patients who need more than two ampules pay less for each additional ampule depending on the number needed so the average cost per ampule continues to drop.
In addition patients who are being treated for HIV facial atrophy are frequently eligible to get Sculptra through a special program based on need. These patients will often be provided Sculptra at either no or reduced cost depending on their incomes. In addition we also drop what we charge to do the injection depending on financial status and need.