How to Avoid Sculptra Bumps?

Facial fillers have become quite popular in the cosmetic market. The objective of facial filler use is to restore volume to the face in an anatomically and physiologically correct manner to improve aesthetic outcome. The risks to fillers are twofold:

Distortion of anatomic subunits
Granulomas or lumps under the skin

Avoiding complications is relatively easy with facial fillers. Recommendations are to avoid undergoing procedures with inexperienced physicians or practitioners; being conservative with volume and intervals of treatment, and finally, maintaining harmony and normal aesthetic proportions. Practically speaking, the risks of Sculptra injections can be minimized by:

Avoiding areas of thin skin such as the eyelids and lips
Conservative treatment
Requesting a lower dilution of injectate

Hello,
There appears to be a variety of answers across a large spectrum.  In all things - we believe in balanced feedback.  With that said, we have been using Sculptra for facial volume for over five years without any negative or adverse side effects.  There is always a potential for a negative occurrence with any medical procedure, and benefits vs. risks vs. experience of injector are all factors in minimizing this.  
Specific to your question - we do NOT use Sculptra near the eyes and believe a smooth gel filler (ex:  Restylane) is a much better, safer, and predictable product.  However, if you have already been injected with Sculptra, the best answer is to follow the instructions your injector gave you.  For example, we follow the recipe of 2-2-2.  Massaging the injected area twice daily, for two minutes, for two weeks.  This process helps to ensure that the particles will stay in the intended proximity of each other.  

Sculptra should be adequately reconstituted with an adequate volume and time to dissolve the product.  Once reconstituted it should be evenly distributed.  I prefer using a microcannula for sculptra delivery.

Sculptra is not something that I typically use close to the eyes. I will use it to volumize the cheeks or temple areas primarily, or any other area with significant volume deficiency.
Product mixing and injection techniques have changed over the past few years in order to reduce the incidence of nodule and granuloma formation.
Also, post-injection, patients are advised to massage the affected areas several times per day for several days post-treatment. If nodules develop, it may simply take time to for them to resolve, while some may require steroid injections or even surgical excision. Nodule formation is quite rare, and is not something I have even seen in my practice. Always see an expert physician injector.
All the best,

To reduce the risk of Sculptra nodules, your provider should pre-mix the solution and allow it to sit for 48 hours in order to maximize it becoming dissolved.   Sculptra is a hydrophobic substance which means it doen't like to dissolve in water, and so this time for dissolution is ideal in order for it to not be "clumpy."  The areas  around the lips and the eyes are not to be injected due to the way the circular muscles around these areas has a very high risk of nodules.  It is thought that their contraction, which is similar to the motion of a camera lens, results in concentration of Sulptra in a few areas and therefore causes nodules because there is too much collagen being created in one area.  Following these steps properly is essential for the best outcome.   Also, the plane of injection is NOT in the dermis, but rather where the skin of the dermis meets the fat, known as the "subdermal plane".  Finally, after the treatment, massaging the injected areas for 5 minutes, 5 times a day for 5 days will help to ensure even dispersion.  
Hope you found this answer helpful.  All the best!

Sculptra is not typically thought of as an appropriate product to be placed under the eyes due to the increased risk of visible and/or palpable granuloma and nodule formation. That being said, once placed, the only thing that can be done to attempt to decrease the chance of nodule formation is regular massage (usually massage for 5 minutes 5 times per day for 5 days, the so-called “5-5-5 rule”) but even this is not a guarantee.

The thin skin under the eyes is more prone to having an uneven "bumpy" result.  In my practice, I avoid sculptra under the eyes; I prefer a hyaluronic acid filler (juvederm or restylane) for this area.

Q: How can you avoid Sculptra bumps?  A: Find a Doc who injects a great deal of Sculptra and does not get bumps!Seriously, bumps are worthy of concern and discussion.  They were far more common in the early days of Sculptra.  Dilutions were concentrated, massage was not performed, injections were too superficial.  Years ago I created a few of them and have treated them caused by others.  But under ideal circumstances Sculptra has NO MORE problem with bumps than any other filler.  We inject Sculptra almost every clinic day.  95% of our patients have no bumps whatsoever.  The most common bumps (about 5%) are completely non-visible, non-tender, and so small (picture half a grain of uncooked white rice) that we have to point them out to the patient.  A "bump check" is routinely performed at six weeks.  With a few days of proper massage, they usually disappear completely.   First let's define bumps and how they can occur.  Sculptra works by stimulating the body to form its own collagen.  The goal is to create diffuse collagen that is soft, smooth and disperse, not a dense bundle that is palpable or even potentially visible.  Sculptra as injected is a watery suspension of tiny parcels of corn sugar.  Think of it like grass seed.  Each seed forms some collagen.  The idea is to spread the Sculptra seeds like grass on a fairway, not like a dump truck.  If Sculptra is only injected deep enough in tiny strands or filaments (know as threading), or deep just above bone in precise aliquots about the size of a contact lens (known as depot), and the patient massages the area twice a day for two weeks, you do not need to worry about bumps.  Dilution helps, but it does not make up for poor technique.The periorbital area (around the eyes) is by far the trickiest area.  There is no margin of error.  Sculptra is FDA off-label for the periorbital area as is, for example, Botox for horizontal forehead lines.  Eyelid skin is thin, and the slightest irregularity tends to be horribly bothersome.  Many Docs get good results in this area with a variety of fillers (implants, Radiesse, Juvederm).  But bruising is common here, and repeat injections can be an expensive hassle.  We have seen more periorbital bulges from HA than from any other filler.   A mediocre injector is prone to poor placement and over correction.  We inject the periorbital area daily with Sculptra and include it in most of our blepharoplasty.  But it is recommended that the are only be addressed conservatively after years of Sculptra injection experience.

Sculptra is what is a biostimulating filler.  When selected for in the right patient, it can be a wonderful product.  Avoiding bumps, nodules and granulomas in Sculptra is dependent on several factors:

1. Location- Avoid skin thinned area such as periorbital or perioral areas.  Sculptra tends to clump around the sphincteric muscles here and can lead to issues.

2. Constitution- I recommend diluting the product more than manufacturer recommendations.

3. Massage- Early massage is helpful for prevention of bumps and nodule formation

 

The reconstitution and injection technique plays the largest role in minimizing the formation of Sculptra nodules.  Injecting into areas of thin skin such as under the eyes does carry a higher risk of bumps.  The manufacturer recommends massaging the area for 5 minutes, 5 times a day x 5 days to help evenly distribute the product.  If nodules do form, there are a number of things your treatment provider can do to lessen their appearance.  

There is a very high risk for using Sculptra underneath the eye area.  I do not recommend using Sculptra underneath the eyes.