Radiesse is a good alternative
Radiesse is a filler that both acts as a filler and a collagen stimulator. It has the advantages of immediate correction like a filler but also offers collagen stimulation like Sculptra. I use it extensively along the jawline and along the marionette lines, as well as the cheeks and under the lateral brow. It can be diluted to get the consistency you need in any area so that you can inject it deep for support or superficial to fill in lines. I find it last much longer than the hyaluronic acid fillers and is a much sturdier product.
Fat Transfer is a Good Option
For those with signicant fat loss in the face, fat transfer is a good option.
Fat Transfer, also known as Fat Injections or Fat Grafting, is the technique of moving fat from one area of the body to another to improve contour, correct defects, or enhance features.
Unlike Sculptra, which lasts up to 2 years, the results of fat transfer may be permanent, especially when placing fat under the eyes and in the cheeks or temples. It does not tend to last week in the naso-labial folds (lines from nose to mouth) or in the lips, due to the amount of movement in that area.
I've been doing fat transfer for 8 years, and the majority of my patients have just one treatment. Occasionally, they do come back for a touch-up treatment about a year later, especially in those with HIV-induced lipodystrophy.
The benefit of fat transfer is that it is your own body's material (fat) that is being injected. The drawback is that it is technique-dependent and does require surgery (in my practice, a minor surgical procedure with local anesthesia and oral sedation).
Sculptra is a volumizer, but not all fillers are
Sculptra and Radiesse restore volume to the cheeks and mid face. This helps to pull hanging skin folds at the nose and mouth back up in a very satisfying way.
The other fillers are much better at treating the symptoms by filling in lines and wrinkles, but are not actually addressing the cause of the problem in the first place.
Don't get me wrong, I like most of the fillers out there and they all have their purpose, but when I get a patient who is willing to listen to my best advice, I fill the mid face first - and they typically end up much happier.
As Dr. Hoenig mentioned, fat transfer is a permanent...
As Dr. Hoenig mentioned, fat transfer is a permanent option for filling the face.
For patients who are looking for a temporary solution, injectible fillers such as hyaluronic acid and others can be used. Though these last anywhere from 3 months to a year, it can allow a patient to see if they like the look before undergoing a more permanent alternative such as fat transfer.
Sculptra alternatives include radiesse, HA fillers (Juvederm, Restylane)
Radiesse and HA fillers are frequently used to treat marionette lines, nasolabial folds and cheeks. They have the advantage of immediate correction, but their effect does not last as long as Sculptra.
There are several options for the marionette region. Juvederm, Perlane, Restylane and Radiesse are all reasonable options for filling in the marionette region. I often combine Sculptra with one of the above fillers. The fillers above are used to fill the area and soften the marionette shadows. I add Sculptra to further soften the area and give the corrected result more longevity.
Alternatives to Sculpra Injections
Sculptra injections are ideal for replacing lost facial volume when the goal is for natural, long lasting results, and when the patient is willing to wait 4 to 6 months for final results and undergo 3 treatments spaced 6 to 8 weeks apart. There is no downtime. With proper technique, and post treatment care, the complication rate is very low and comparable to other filler injections.
Patients seeking alternative products are usually either looking for even longer lasting results, such as with fat injections, or want instant results, where products like Restylane, Juvederm, Juvederm Voluma and Radiesse would be used.
Fat transfer is a surgical procedure and performed in the operating room under sedation. There is 7 to 10 days of downtime. Results are not always consistent from patient to patient and only one third to half the fat injected takes and remains for a long period of time. This often necessitates a second boost treatment after 6 months. One has to be careful not to gain much weight as the face will also gain weight, sometimes dramatically, where the fat has been injected.
Other fillers are very appealing because the results are instant. With Juvederm Voluma's recent FDA approval, we now have the option of injecting patients one time with a product that can last up to two years, in a single treatment safely and naturally.
The most important factor is not what product is used but more so where, how much, and the technique used to inject the products. When done properly, all products will have a youthful volumization to the face.
Sculptra, Juvederm, Restylane all do well with marionette lines.
Marionette lines can be treated in several ways. I favor Sculptra or the hyaluronic acid products.
Sculptra: lasts 2 or 3 years and takes several treatments for initial result
Juvederm: lasts a year, one treatment
Restylane: lasts 18 months when a touch up is done at 6 months.
Perlane: same as Restylane
I find that I can provide my patients with choice and great results. The product used is tailored to my patients needs and desires.
Fat injections are a great option for permanent filling
Fat injections are the best option as an alternative to Sculptra injections. I even consider fat injections first before Sculptra. Nothing is better than using your own tissues for plastic surgery purposes. You have essentially no risk for reactions, no risk for cancer, no toxicity from your own tissues. Sculptra is made up of suture material. It is a foreign substance that is essentially broken down into carbon dioxide and glucose and ultimately carbon dioxide and water.
Other ways of filling is through silicone iimplants. The problem areas for implants and Sculptra is the periorbital area. Implants are also hard to use for the buccal area where there is no bone for the implant to rest on. It is here that Sculptra can be used and Fat injections.
In the rapidly evolving world of fillers, there are more and more alternatives to Sculptra. Patients should consider an injector with multiple alternatives to provide appropriate filler. Some alternatives include: