NEWSSeptember 21, 2021

Is Sculptra a new filler?

By Megan Davies, MSN, FNP-BC and Medical Director for RN’s in Arizona

Is Sculptra a new filler? I get this question often. Sculptra often gets lumped into the category of fillers, but Sculptra actually is not a filler. So, what is it then? Sculptra is a bio-stimulator. It comes as a powder that we then mix with water. Fillers on the other hand are a gel. The way we inject Sculptra may seem similar to filler to the client but there are definitely some key differences.

As we age, we start producing less collagen. Collagen helps form the framework that supports healthy cells and tissues. Sculptra addresses the actual cause of facial aging, it does not just mask the symptom as fillers do. This is why it has been called the “401K for your face” and others make claims that you will “age in reverse”.

It sounds so amazing and really is so amazing that clients joke with us about bathing in it….and a few of our clients have come just short of that. We have treated everywhere from face, neck, chest, arms, hands, legs, stomach, and buttocks. If aging is a concern, we can probably treat it with Sculptra.

So why wouldn’t this just completely replace fillers? Well first there are a few areas that we do not inject with Sculptra due to the risk of nodules which are the lips and under eyes. So, if enhancement is desired in those areas we recommend fillers. Also, Sculptra is subtle, so some people want immediate results and in those cases, fillers would be a better option. Another scenario is that if the deficit is significant enough often Sculptra alone will not be enough. For example, a client who is a candidate for a chin implant and has always had what is referred to as microgenia or a “weak chin” may not be able to achieve their results with Sculptra alone and will need a combination of filler and Sculptra if they are wanting to stick with the non-surgical options. Temples are another area that I think can benefit from Sculptra, but I often find I must add filler there as well to achieve optimal results.

Now that I’ve told you that I often need to combine filler and Sculptra you may be back to thinking you may want filler, but let me explain why I believe both are the best combination. As soon as you get injected with filler you have immediate results, which is amazing because who doesn’t want instant gratification, however you are already on the down slope-meaning you are already losing the effect of filler. Sculptra on the other hand is on the up and up- it is going to get better over the following months. By injecting filler and Sculptra in combination you will look good now and years later. The other reason that Sculptra does not replace filler is that Sculptra is the product that also works on skin quality and texture. I love walking into the room after 2-3 sessions of Sculptra and just saying “wow” when I see my clients-we call it the “Sculptra glow”.

So yes, you saw right- you need multiple sessions. How many sessions depends on a few factors. How well are you aging? Sometimes it’s not necessarily aging, it’s just that you are depleted of fat because you are working out a lot- (unfair right)? How old you are is another factor as well as do you already have filler or are you just starting your injectable journey? The general rule is a vial per decade of life over the series of treatments. This is a general rule (for the reasons that I mentioned prior such as working out a lot). The series of sessions are usually spaced out every 3-6 weeks.

Let’s take the example of one of our 53-year-old clients named “Lisa”. Lisa has had filler most recently in her cheeks and lips but still needs more of a refresh. Lisa uses medical-grade skin care at home and does a PiXel 8 RF session 1-2 times a year along with a chemical peel at separate appointments. Most people guess Lisa is in her early 40s. Lisa started out with 2 vials at her first appointment and then a month later receive 2 vials again. A month after her second session she may receive 1 more vial. Sculptra will most likely reduce her need for maintenance treatments with cheek filler, which if she never received Sculptra she would consistently need to re-treat.

So we haven’t discussed how long Sculptra works yet. Would you love if I told you it lasts four years!!?? Yes - most of us that have been injecting long enough can tell you that it lasts that long. Aging unfortunately continues to occur but this will slow it down substantially. The Sculptra website states that it lasts 25 months because that was when the study ended. Sometimes a multi-year study is a challenge for various reasons, especially when the company wants to get the product to market and get a return on their investment. So, companies will often cut studies short to get the product to market. What is important to know that at 25 months Sculptra was still on the upslope.

The other commonly asked question is when will I see results? I always tell people do not get Sculptra if you can only commit to one session. The first session can result in the person appearing a little swollen because of all the water that was injected. The swelling then goes down over the next few days and over a few weeks the collagen starts building. When you come back for your second session we may or may not see much. At the third appointment we are seeing amazing results. This is a reminder that the general guideline for how much product is needed is general. Some offices will even do 3 vials at a first session so that the client only needs to do 2 sessions, however this can deter people from getting their next treatment due to the swelling and may not be the best option. I always tell clients even if you can’t get back as soon as 6 weeks for the next session that’s okay, it’s still in there, but you do need to come back. Just in the way grass doesn’t grow in a day this takes time too!!

Some bad things you may have seen online about Sculptra include issues with nodules. The way Sculptra is FDA approved lends its way to causing nodules. So don’t be afraid to ask your injector how they learned to inject Sculptra. Training with some of the top injectors of Sculptra in the state and country such as Bernice Cohen, Shino Bay and JD McCoy are good signs. How many trainings has the injector done related to Sculptra? Have they had issues and how did they handle it? Who is their medical director? All are good questions to ask.

DHH Med Spa Scottsdale has been offering trainings in Sculptra for seasoned injectors and I have combined so many pearls of wisdom that I have learned from training with so many great injectors that many injectors have told me they have left feeling confident that they can now competently inject Sculptra. Other injectors have been trained but are having trouble integrating it into their practice and want to come to our training program to gain more confidence. It is a product that does take a few trainings to really gain confidence in order to treat patients. We do not train brand new injectors on this product as we feel strongly that someone should become experienced with neuromodulators and dermal fillers before moving on to this product. This is a more advanced procedure and should be treated as such.

I wanted this blog to focus on facial treatments, but I will quickly comment on body areas. For many body areas Sculptra is great to work on skin laxity or crepiness. With body sometimes using the “rule of hand” can be helpful to determine how many vials are needed, but just like facial areas this can be a generalization. The rule of hand generalization is a number per session and really you would use the palm of your hand for the surface area. I don’t love this rule and do not often use it but it can be helpful for someone unsure and just starting on body areas. I often do a single vial on hands (both), neck or chest but have done more on some clients. The single vial for both hands totally goes against what I’ve just told you but I also realize that putting that much fluid in a hand can look totally crazy. I have done a vial per hand however before where it didn’t look crazy so it just depends on the person and how much volume loss they have.

For arms I can use anywhere from 1-4 vials a session and it is usually to work on crepiness. For legs I’ve treated this area for sagging above the knees but also deformities post liposuction. This again has significant variables from 1-6 vials. Stomachs can be a great area to treat and can result in tightening. I’ve had many clients now come to me post cool-sculpting where they have a deformity they we are able to treat with Sculptra. I usually just need 1-2 vials a session here. Sometimes if it is just lines in the abdomen that are the concern, I’ve been able to use the micro-droplet technique with Dysport or Botox and soften the lines that are commonly caused from repetitive movements.

Perhaps the greatest area of variability is the buttocks and hip dips. Getting a non-surgical butt lift is an optimal use of Sculptra. The latest trend we are seeing are clients want to round out those hip dips on their butt cheeks. These are two separate areas for treatment, so if you need to treat both you can’t use half the amount and expect full results. You do not however have to treat both if only one is the concern. The reason we are treating the area plays a factor in determining how much product we need. I’ve treated old hormone pellet indents or have added some volume to only one side after a Brazilian butt lift or fat transfer and in those cases sometimes only 1 vial is necessary. If someone really wants significant lift or volume, surgery is most likely going to be cheaper.

However, there are many reasons people desire a non-surgical option such as having less downtime, less risk, being able to gradually add until they achieve the desired effect. There is often sticker shock at how many vials will be needed for butt lifts but remember these are products that were designed and packaged to treat a face. The amount of product needed to add volume or do a butt lift can be anywhere from 4-30 vials. For that reason, we always recommend a consult first. Typically, in our office we treat with 8-10 vials a session. We do find that many body areas respond quicker than the face and may only require 2 sessions when adequately treated. We do frequently see with the booty that that is an area that although it is adequately treated clients keep wanting just a little bit more. I do believe that this is a product in many celebrity booties and how they can claim they didn’t have buttocks implants because it won’t show up on an x-ray.

I hope this blog has answered many of your questions about Sculptra. If you are a nurse/physician injector hoping to add this to your practice, feel free to reach out to us regarding our next training. If you are a potential client, feel free to browse our before and after photos on social media. Our office is one of the top offices in Arizona for Sculptra Aesthetic face and non-surgical butt lift treatments and also voted Best Botox in the valley by AZ Foothills magazine so rest-assured you are in good hands.

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