How to Avoid Sculptra Bumps?

I had Sculptra injected under my eyes yesterday.  Is there anything I can do to ensure no bumps will form?  If they do, is therea way to get rid of them?

Doctor Answers 31

Treatment solutions for chronic and persistent infraorbital surface irregularities

Previous authors have adequately explained the common approaches in avoiding surface irregularities that may result from injecting Sculptra (or other materials) too superficially in the periocular regions. I would like to add several solutions and “pearls” by discussing surgical alternatives (usually as a last result) that may be beneficial in treating chronic or long-lasting irregularities.

To review:

  • Sculptra, or Poly-L-lactic acid, has traditionally been reserved for the deeper lines, grooves, or trough facial regions. Its FDA approval stipulated use in the nasolabial folds that often result from lipoatrophy that is witnessed in immunocompromised patients.
  • Most physicians approach the periocular region more carefully than any other facial region because of its thin skin. The focus in this region has been away longer acting fillers. I personally will not inject the infraorbital hollowing or tear trough areas beneath the areas, because I believe there are better and safer options in my hands. Excellent correction has been seen with Restylane, Juvederm, etc., and patients are willing to tolerate two injections per year.
  • If Sculptra is injected under the eyes, using a higher volume dilution (roughly 8-10 cc’s per vial), allowing the product to sit for at least 24 hours after mixing the constituent to allow for little residual precipitation or powder, using a small gauge catheter to assure small participate size placement, and placement in a deep level.
  • If superficial placement by the injector is suspected (at the time of injection), I believe immediate subsequent injection with normal saline in the region to further dilute the composition, followed by massaging can alleviate the complication. It’s a smarter decision to “void” out the treatment than risk a long-term complication.

HOWEVER, what treatments can be offered if persistent surface irregularities, bumps, or granulomas persist?

In addition to Sculptra, I have personally seen these same complications in patients who were injected with Artefill, silicone, and other materials that are often injected abroad.

  • If the patient can tolerate them without significant complaint, don’t offer surgical alternatives.
  • I have found that massaging for chronic granulomas usually doesn’t improve the appearance.
  • Surgical Approach: In patients who can benefit from additional periocular rejuvenation procedures, i.e. blepharoplasty, then alternatives such as crushed fascial grafts or thin strips of alloderm can be superficially placed at the same time as the cosmetic procedure. Routinely, I’ll make two small stab incisions (along the medial punctum and next to the lateral canthus, take a small tendon passer and pass a thin 25 x 5mm strip of alloderm superficially under the skin to mask the bumps associated with silicone injections.
  • Attempting to surgical excise these granulomas is tedious and problematic at best, and significantly high for injury. Conservatively “masking” the bumps is a better and safer option.

I hope these are beneficial to patients and physicians alike.


Los Angeles Plastic Surgeon
3.9 out of 5 stars 17 reviews

Treatment solutions for chronic and persistent infraorbital surface irregularities

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

Previous authors have adequately explained the common approaches in avoiding surface irregularities that may result from injecting Sculptra (or other materials) too superficially in the periocular regions. I would like to add several solutions and “pearls” by discussing surgical alternatives (usually as a last result) that may be beneficial in treating chronic or long-lasting irregularities.

To review:

  • Sculptra, or Poly-L-lactic acid, has traditionally been reserved for the deeper lines, grooves, or trough facial regions. Its FDA approval stipulated use in the nasolabial folds that often result from lipoatrophy that is witnessed in immunocompromised patients.
  • Most physicians approach the periocular region more carefully than any other facial region because of its thin skin. The focus in this region has been away longer acting fillers. I personally will not inject the infraorbital hollowing or tear trough areas beneath the areas, because I believe there are better and safer options in my hands. Excellent correction has been seen with Restylane, Juvederm, etc., and patients are willing to tolerate two injections per year.
  • If Sculptra is injected under the eyes, using a higher volume dilution (roughly 8-10 cc’s per vial), allowing the product to sit for at least 24 hours after mixing the constituent to allow for little residual precipitation or powder, using a small gauge catheter to assure small participate size placement, and placement in a deep level.
  • If superficial placement by the injector is suspected (at the time of injection), I believe immediate subsequent injection with normal saline in the region to further dilute the composition, followed by massaging can alleviate the complication. It’s a smarter decision to “void” out the treatment than risk a long-term complication.

HOWEVER, what treatments can be offered if persistent surface irregularities, bumps, or granulomas persist?

In addition to Sculptra, I have personally seen these same complications in patients who were injected with Artefill, silicone, and other materials that are often injected abroad.

  • If the patient can tolerate them without significant complaint, don’t offer surgical alternatives.
  • I have found that massaging for chronic granulomas usually doesn’t improve the appearance.
  • Surgical Approach: In patients who can benefit from additional periocular rejuvenation procedures, i.e. blepharoplasty, then alternatives such as crushed fascial grafts or thin strips of alloderm can be superficially placed at the same time as the cosmetic procedure. Routinely, I’ll make two small stab incisions (along the medial punctum and next to the lateral canthus, take a small tendon passer and pass a thin 25 x 5mm strip of alloderm superficially under the skin to mask the bumps associated with silicone injections.
  • Attempting to surgical excise these granulomas is tedious and problematic at best, and significantly high for injury. Conservatively “masking” the bumps is a better and safer option.

I hope these are beneficial to patients and physicians alike.


Los Angeles Plastic Surgeon

Avoiding Sculptra bumps

don't ever let anyone inject Sculptra into your face.In 2000, at the World Congress of Dermatology in Paris, Pierre Andre reported cystic, nodular, and granulomatous lesions when this agent was used in individuals with normal immune functioning (non-HIV+ patients). Additionally, long-term allergic reactions have since been described, which are very difficult to manage. In another report concerning its aesthetic use in 100 patients with normal immune functioning, 20% of the treated individuals experienced significant adverse reactions. Obviously, this product is not immunologically inert as the manufacturer stated. Foreign body granulomas are being seen with this agent in HIV-positive as well as immunocompetent patients.

While the manufacturer as well as investigators claim this product produces neocollagenesis or new collagen this is not what is seen under the microscope. On biopsy one sees a severe immune reaction to the product.

 

Arnold W. Klein, MD (in memoriam)
Beverly Hills Dermatologic Surgeon
4.8 out of 5 stars 5 reviews

Avoiding Sculptra bumps

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

don't ever let anyone inject Sculptra into your face.In 2000, at the World Congress of Dermatology in Paris, Pierre Andre reported cystic, nodular, and granulomatous lesions when this agent was used in individuals with normal immune functioning (non-HIV+ patients). Additionally, long-term allergic reactions have since been described, which are very difficult to manage. In another report concerning its aesthetic use in 100 patients with normal immune functioning, 20% of the treated individuals experienced significant adverse reactions. Obviously, this product is not immunologically inert as the manufacturer stated. Foreign body granulomas are being seen with this agent in HIV-positive as well as immunocompetent patients.

While the manufacturer as well as investigators claim this product produces neocollagenesis or new collagen this is not what is seen under the microscope. On biopsy one sees a severe immune reaction to the product.

 

Arnold W. Klein, MD (in memoriam)
Beverly Hills Dermatologic Surgeon

Avoiding granulomas, lumps with facial fillers. Sculptra - polylactic acid.

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

Avoiding granulomas, lumps with facial fillers. Sculptra - polylactic acid.

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

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

Sculptra is risky under the eyes

When preparing Sculptra for injection, I reconstitute the powder with more liquid than the manufacturer's guidelines and I do this at least 24 hours before injecting it, rather than the recommended 2 hours.

Once it has been injected, there's not much you can do as a patient to prevent bumps. As a rule, I do not inject Sculptra under the eyes because of its tendency to form bumps. Due to the thin eyelid skin, the bumps may be visible. If they do form, there's not too much you can do, except try to fill in around the bumps with another filler to make them less noticeable.

In my opinion, Sculptra is better used for deeper, thicker areas like the cheeks. For the under eye area, I prefer a hyaluronic based filler such as Restylane.

Jonathan Hoenig, MD
Beverly Hills Oculoplastic Surgeon
5.0 out of 5 stars 40 reviews

Sculptra is risky under the eyes

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When preparing Sculptra for injection, I reconstitute the powder with more liquid than the manufacturer's guidelines and I do this at least 24 hours before injecting it, rather than the recommended 2 hours.

Once it has been injected, there's not much you can do as a patient to prevent bumps. As a rule, I do not inject Sculptra under the eyes because of its tendency to form bumps. Due to the thin eyelid skin, the bumps may be visible. If they do form, there's not too much you can do, except try to fill in around the bumps with another filler to make them less noticeable.

In my opinion, Sculptra is better used for deeper, thicker areas like the cheeks. For the under eye area, I prefer a hyaluronic based filler such as Restylane.

Jonathan Hoenig, MD
Beverly Hills Oculoplastic Surgeon

Sculptra under eyes is not safe

At this point it is fairly common knowledge that Sculptra should not be injected under the eyes. The problem with it is that the reaction of the body and the resultant scar formation are unpredictable. You can try to approximate and massage, but in the end the patient might still end up with granulomas.

I've had several patients who had their Sculptra done elsewhere, and who had unsightly granulomas, nodules, and sausage-like lumps that we had to excise. It is not a significantly risky procedure, but most commonly we had to do it combined with lower lid blepharoplasty for access and better overall cosmetic result.

I hope you do well with these injections and never need to have surgery, but if you do, you should know that it can be done safely.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

Sculptra under eyes is not safe

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

At this point it is fairly common knowledge that Sculptra should not be injected under the eyes. The problem with it is that the reaction of the body and the resultant scar formation are unpredictable. You can try to approximate and massage, but in the end the patient might still end up with granulomas.

I've had several patients who had their Sculptra done elsewhere, and who had unsightly granulomas, nodules, and sausage-like lumps that we had to excise. It is not a significantly risky procedure, but most commonly we had to do it combined with lower lid blepharoplasty for access and better overall cosmetic result.

I hope you do well with these injections and never need to have surgery, but if you do, you should know that it can be done safely.

Stella Desyatnikova, MD
Seattle Facial Plastic Surgeon

Sculptra Experts

I have used Sculptra for over 10 years. Have had 2 small graulomas in patients which were no problem to fix. I have Sculptra in my face injected by myself, my nurse, and two other experts. I do not see the issues with the product I keep hearing about.    Time will tell I guess.

James Apesos, MD
Dayton Plastic Surgeon
4.2 out of 5 stars 14 reviews

Sculptra Experts

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

I have used Sculptra for over 10 years. Have had 2 small graulomas in patients which were no problem to fix. I have Sculptra in my face injected by myself, my nurse, and two other experts. I do not see the issues with the product I keep hearing about.    Time will tell I guess.

James Apesos, MD
Dayton Plastic Surgeon

Post Sculptra Massage is Vital

The best thing you can do to avoid bumps or irregularities from Sculptra is to massage the injected area for 5 minutes, 5 times a day, for 5 days.  Now, this recommendation is the minimum.  Don't limit yourself to this regimen if you are able to massage longer or more often.  My patients have found that using the backside of a Clarisonic brush is an ideal massage tool. 

Daniel J. Leeman, MD
Austin Facial Plastic Surgeon
3.4 out of 5 stars 5 reviews

Post Sculptra Massage is Vital

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The best thing you can do to avoid bumps or irregularities from Sculptra is to massage the injected area for 5 minutes, 5 times a day, for 5 days.  Now, this recommendation is the minimum.  Don't limit yourself to this regimen if you are able to massage longer or more often.  My patients have found that using the backside of a Clarisonic brush is an ideal massage tool. 

Daniel J. Leeman, MD
Austin Facial Plastic Surgeon

Sculptra should not be injected above the orbital rims

Sculptra should not be injected above the orbital rims. Advanced Sculptra board-certified physician injectors may place Sculptra near the orbital rim and massage the material into the tear trough portion of the lower eyelids

Sculptra should not be injected above the orbital rims

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Sculptra should not be injected above the orbital rims. Advanced Sculptra board-certified physician injectors may place Sculptra near the orbital rim and massage the material into the tear trough portion of the lower eyelids

How To Avoid Sculptra Bumps?

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.

Thomas Funcik, MD
Mount Pleasant Facial Plastic Surgeon
3.9 out of 5 stars 10 reviews

How To Avoid Sculptra Bumps?

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}
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.

Thomas Funcik, MD
Mount Pleasant Facial Plastic Surgeon
3.9 out of 5 stars 10 reviews

Good luck!

First of all, make sure you choose a doctor who has been trained to perform Sculptra. Experienced injectors place the Sculptra well below the surface of the skin.  When placed deeply, a visible nodule very rarely will occur. In addition if it has not been properly diluted, or is placed into areas that are not ideal for this product you may also see bumps.
After you are injected by the right professional, they will tell you to massage for 5 minutes, 5 times a day for 5 days to help prevent these bumps. 

Yael Halaas, MD
Manhattan Facial Plastic Surgeon
4.8 out of 5 stars 43 reviews

Good luck!

{{ voteCount >= 0 ? '+' + (voteCount + 1) : (voteCount + 1) }}

First of all, make sure you choose a doctor who has been trained to perform Sculptra. Experienced injectors place the Sculptra well below the surface of the skin.  When placed deeply, a visible nodule very rarely will occur. In addition if it has not been properly diluted, or is placed into areas that are not ideal for this product you may also see bumps.
After you are injected by the right professional, they will tell you to massage for 5 minutes, 5 times a day for 5 days to help prevent these bumps. 

Yael Halaas, MD
Manhattan Facial Plastic Surgeon
4.8 out of 5 stars 43 reviews

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.