There are many fillers that are available for use in the face. Sculptra is FDA approved for use in HIV patients with facial wasting. It is performed off-label for other areas in the face. Sculptra is made of poly-l-lactic acid, a substance that is reactive, or irritating to human tissues. The human body sometimes walls off the substance, particularly when it is placed close to the surface or under thin skin such as that of the lower eyelids. I have seen many permanent problems that have resulted when Sculptra is used in the tear trough area or lower eyelids. The problems are usually related to firm lumps below the eyes. These lumps must often be surgically removed when they do not dissolve. Many patients are happy with Sculptra. The satisfaction rate on RealSelf at the time of this post was 58%, not overwhelmingly high but not a disaster. The main complaints seem to center on long-term lumpiness. For under eye hollowness, and for hollowness around the face, we prefer using LiveFill, untraumatized tissue obtained from the patient's own tissues, which is then inserted into areas of hollowness. In skilled hands, fat injection is a fine filler, although uneven take still nags this procedure. For temporary filling, we prefer hyaluronic acid products such as Juvederm, Restylane, Perlane or Prevelle (all different hyaluronic acid formulations) depending on the patient and the area requiring augmentation. The complication rate from these fillers, which last from 4 months to 12 months, depending on the patient and the location, is very low. The chance of a permanent complication from these substances is almost nonexistent. Because of the relatively high complication rate we have seen from Sculptra, we don't use Sculptra in our practice, and do not recommend it around the eyes or in the tear trough area.