Sculptra is a good choice for fat wasting secondary to HIV and the antiretroviral agents used to treat HIV. In my experience, it takes multiple vials to get a good result. I usually inject 2 vials at a time at about 6 to 8 week intervals. Some patients require 6 to 8 vials to get a good result, dependent on the degree of fat wasting.
Sculptra is a different product that the hyaluronic acid products which cause immediate changes. Sculptra is a wonderful product, but takes several injections and a natural buildup of your collagen in response to these treatments to see the great changes. The earilest from the first treatment is usually minimium of 6 weeks. It is a natural change that occurs slowly, but it also breaks down more slowly than other products, giving you more long lasting effects! From your photo, Sculptra would be a great match for you! Unfortunately it cannot be used around the eyes as this is very thin skin and could cause small lumps and bumps under the skin.
Sculptra is a stimulating agent, and when it is injected it will cause some temporary improvement. After a week or so, this temporary improvement goes away as the water which was injected to deliver the Sculptra is absorbed. It can take several Sculptra treatments until a noticeable change is seen. In reality, there probably is some minor improvement but because it happens so gradually, it may be measurable but not noticeable. It's possible that you might not notice a change until after a third treatment. It is not unusual to have one side be more sunken than the other, and this can be evened out with the treatments. Sculptra should not be used around the eyes, as the skin is very thin there and visible lumps can develop. So, I would not recommend using it to treat crow's feet. Botox or some other fillers may help with crow's feet.
You are an ideal candidate for Sculptra, but it takes time to get to a good correction. Typically 3 sessions are needed but I have had some patients that required up to 6 sessions.
Sculptra takes time and the results are gradual. I have had many patients that feel the same as you after their first treatment. However, my patients are always happy they continued with the treatment.
The best option for crow's feet is Botox or Dysport.
Stick with the treatments. You'll be happy you did.
Sculptra is designed to give a significant response only after several sessions. It has been said that one may expect a small response after the first treatment, but it may not be noticeable to the patient. After the second treatment, a much greater response is seen, and after the third, and even greater response to the same volume injected as previously will be seen. It may take 3 to 6 months to see the final response.
While this can be frustrating, there is a big upside: these volumetric enhancement is typically evenly distributed about the face, very natural in effect, and very long-lasting, two years or more of enhanced volume to the face.
It is obvious you and maybe your doctor injector do not fully understand the collagen stimulation effect from "sculptra". It takes months and many, up to 4 to 6 visits to obtain a satisfactory results. Thus with ONLY 1 injection session I would expect minimal responses.
The simple answer to your question is that a patient with HIV associated lipodystrophy is going to require 2-3 more sessions to gain a satisfactory result. I always inform my patients that they will be underwhelmed after the 1st treatment session, and be much happier 4 weeks after the 2nd or 3rd treatment. Try to be patient and follow through and you are likely to be much more pleased.