Can you look overdone with Sculptra?

Question

Hi Doctors. I’ve only ever had hyaluronic acid fillers but have been reading about Sculptra. I understand it can’t be dissolved like HA fillers. How do you control the results? Can it cause the generation of too much collagen and produce an overdone look? I’ve had preauricular area HA filler and found it made my face look wider (not the goal). Would Sculptra be likely to do the same? Hoping for a bit of a lift for nasolabials, marionettes, eyebrows. Not bulk. Thank-you!

Dean P. Kane, MD, FACS · Answer

Dear Ginger_Snap123,
Thanks for this question.
Sculptra is a unique loner in its field. Sculptra consist of Poly- L-Lactic Acid, which is a synthetic polymer that has been used in human body since 1960 promoting collagen formation and as medical suture material from 1970. It directly stimulates the cell-healing macrophages and fibroblasts to produce collagen and other fiber forming molecules of bone and the compartment walls and structural foundations of fat and dermis. Sculptra therefore uses the natural immune system to create lost structure and tightening in tissue healing.

As we age, collagen is said to diminish 1% per year from our body after age 30. This allows all tissues made of fibrous molecules to weaken, sag, wrinkle and atrophy (lose volume). Injury will restimulate collagen loss with a REPAIR requirement but the body will not RESTORE collagen loss without a stimulant and here is where Sculptra excels.

Sculptra belongs to a FDA classification of fillers. All other fillers such as Radiesse®, (Calcium hydroxylapatite ) and Bellafill® (polymethylmethacrylate (PMMA) collagen) which replace lost volume (equal to that injected) AND minimally create collagen synthesis repair but not to the degree of PLLA.

In the same FDA Filler class is a volume filler with water attracting properties called hyaluronic acid (HA). It is natural to the human and part of the structural fibrous network throughout the human body. It is what makes the skin and tissues spongy and somewhat elastic. Generally, the volume injected expands by “magnetically” holding onto water. Each manufacturer has “sliced and diced” the HA molecule and re-linked it to fool the natural breakdown enzymes in the body to degrade it much slower than human natural collagen; therefore HA filler lasts longer. Depending on each product’s characteristics, a given weight of HA filler will attract more water or stiffen itself to project higher or become more elastic to act softer and snap back.

With all that said, volume filler can be “overdone” and project outwardly too fully if too much is injected; yes, it can be dissolved with the natural enzyme, hyaluronidase.  Sculptra taking 6 to 12 weeks to gently stimulate the collagen repair system will thicken the collagen foundations and firm or contract to tighten the skin and soft tissues.

I use analogy of a aging beach ball. As it ages, it loses air and the shell becomes weaker. Like a volume filler, you will need to replace more than the lost air lost air to project the thinner, weakened shell. It will need more volume and therefore become larger than it was originally to tighten the surface.

Stimulating the shell (as with Sculptra) to thicken and become firmer will tighten the shell around the reduced volume of air inside the aged beach ball; ie. a firmer, tighter facial appearance. (Sculptra due to its immune stimulating properties will also up-regulate dermal and epidermal rejuvenation providing a smoother textured skin as well.) As a completion of my analogy, if too much volume is lost in the beach ball and the skin is too lax or thin without natural rebound, the excess shell can be excised sewing the edges together,  just like a facelift.

The caveat to Sculptra is that it is a particle suspension. When it is injected under the skin, it may coalesce into a lump which can overstimulate collagen production into a nodule. Like too much HA filler making a lump, a Sculptra lump can easily be dispersed early in its cycle to provide a nodule free firming and tightening.
Both volume and collagen-stimulating fillers have their virtues and liabilities. Choose a very qualified, creative, skilled and talented Board Certified Plastic Surgeon, Facial ENT or Dermatologist to consult with and perform your injectables.
I hope this long winded explanation is helpful. All the best!

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