Episode 10: Sculptra

This episode will take a deeper dive into Sculptra which is a biostimulatory.
We will discuss:
1.  What a biostimulatory is
2.  How Sculptra differs from fillers
3.  Where Sculptra is injected
4.  What to expect from the collagen stimulation 
5.  What a treatment consists of

At the end of this 18 minutes episode, we hope that you have a better understanding as to when and why we choose Sculptra and fillers.

Enjoy!

Thank you for your listenership!

Transcript

Hi everyone. I hope you're well. Thank you for joining us on another episode of Just Laser iT and all things cosmetic. We're up here again with Link and Kane and Kane of course. How are you doing tonight? 

I'm doing great. You know, one of these days we need to video this so everybody can see link just laying at our feet, hanging out with us.

Well, what we're going to do today is  we're actually going to go back and review a topic that we briefly went through with fillers, and that's biostimulators and preferentially. We're going to talk about Sculptra today, and we really want to take a deeper dive into Sculptra and talk about what it is, what type of patient we use this for, when we use it over fillers, what kind of the differences are between the two of them, and then finally what to expect during treatment and post-treatment as well.

How does that sound?

Sculptra is:

PLLA (Poly L Lactic Acid) which is basically an alpha hydroxy acid.

It's a polymer of an alpha hydroxy acid that comes to us as powder in a bottle and we reconstitute it with sterile water and lidocaine.

So, by the time we're ready to inject it into patients, it almost looks like this milky liquid. So that's kind of what the actual logistics of sculptor is.

And so what we do with this is these little tiny granules, which they're small. I mean Kane, these little powder granules are about an average of about 50 microns in size, really teeny tiny.

But as we inject it, and the primary area that I love to inject is the lateral part of the face. You could almost think about Sculptra as building collagen. That's what the intent is. It's not a true filler, but rather it stimulates collagen. And so, when we inject it, we place it in, we do it with a, with a cannula.

I'll talk a little bit more about how we do it and you disperse it around and you want to really lay the seed. Remember we talked about that in that initial podcast: that Sculptra is the seed to build a collagen in these areas,

Let's back up for a minute because I think a lot of times Sculptra just kind of thrown into the mix of a filler. And, and when you talk about the seed, there's a very clear difference between Sculptra and filler. Filler is that immediate result you fill and you see the fill while Sculptra is not immediate.

So dive into that metaphor or analogy about the seed a little bit more just to kind of set everybody's expectations.

Sure. So, remember we talked about filler being the sod, it's your instant grass and Sculptra is your seed that stimulates a collagen. Your filler, your hyaluronic acid is a space occupying gel. So, when you have volume loss in a certain area, your filler is wonderful for that, and I love filler for areas that are very mobile, so around the mouth area, deep, you know, nasal labial, fold, marionette lines because it really, it moves with you as, as you emote.

Sculptra is composed of little, tiny granules create a little bit of an inflammatory response that builds collagen. 

So it's basically giving the structure back the integrity or the scaffolding back to the face. And so Kane when we talk about collagen we always think about just the skin, right? We talk about the collagen, how we lose it in the skin. Sculptra is actually injected subdermally, and so there is important collagen even in these fibrous bands that are under the skin, that, that, that kind of anchor, anchor the tissue up a little bit, so it actually builds collagen there as well as a skin as well as giving a little volume replacement as well.

So with Sculptra, you're really stimulating your own natural collagen production. 

Correct. 

When fillers first came about it was FDA cleared for the nasal labial fold, and then it got an indication for cheeks, the lips, the chin, the jawline.

We're really trying to use filler to build structure back when in reality, one of the best ways to bring our structure back is with our own collagen. So, there's still a place for filler. I don't want to ever just say that there's not a place for filler.

But when it comes to that lateral loss, when we lose volume kind of in that posterior part of our jawline, or the area in front of our ear, the preauricular area, or just in our midface or in our temple area. That's where I like Sculptra, and I think that sculptor's kind of making a resurgence.

Why are those areas preferable versus the other areas around the mouth and chin or the, that you mentioned with filler. Why do you prefer those particular areas for Sculptra?

There's a line of ligaments that runs on the side of our face, essentially. Think about it that way. And the, the areas that are more for structure are these lateral areas. That's where I want to get that scaffold of the collagen back.

What do you mean when you say structure?

We want structure in those lateral areas. 

You want to be able to have filled in. Otherwise, all the mobile area that's in front of these line of ligaments kind of descends inferiorly and centrally. If you look at a face and you see these heavy nasal labial fold, it's because, the fat pads are kind of descending downward and inward, and if we place that structure back laterally, it's almost as if we're anchoring back up that tissue.

So, it gives a really nice rejuvenation to the face.

Does it provide a little bit of a lift as well, or is that, maybe that's too strong of a word?

It gives you that structure back, which does, in essence look like a lift. I mean, you're definitely more rejuvenated in those areas, which, which just anchors tissue up a little bit better.

Sculptra been around since 2004. It was actually used for HIV lipo atrophy patients. Do you remember the years where you would see that really sunken look to the face and, and Sculptra was, was utilized there and had some really beautiful effects.

The aesthetic world said, well, wait a minute. We need to use it in the, in the aesthetic arena. And that's where it came to be. And so it's been around for a while, but then when fillers really kind of came into the forefront of aesthetics. All of a sudden things could be done and they were very immediate.

You didn't have to wait for those results. And so fillers became very popular and superseded Sculptra for a while. But now that we know that we need structure back and we're getting these FDA clearances for fillers, well that's a lot of syringes of filler in the face. And I think. That sometimes we need to not chase everything with a filler, but when collagen's lost, we need to bring that collagen back.

Filler certainly has a place and it's wonderful, but if given the choice for me I would have my natural collagen stimulated 

What issues: 

Lets discuss nodules, what a nodule really is, is a collection of collagen. So it the reason why when we inject Sculptra and we inject it deep and laterally and we tell patients to massage five times a day, for five minutes, for five days, is we really want to disperse the product. So areas around the mouth that have these circular muscle. Sometimes these little granules could get deposited in a greater density there. And could create a little nodule, but that's, that's kind of been circumvented with how we dilute or reconstitute the sculptor. It used to be that four or five ccs were used to reconstitute the s sculptor, and that's not utilized anymore.

Now it's more like eight ccs with a couple of extra milliliters of lidocaine. So just the reconstitution method and the areas that we inject can help minimize those type of risks. And of course, the massage.

So it sounds like it's fairly rare, but is it, is it like a big deal if it happens?

Well, it could be if it was very visible, but it does dissipate and there are ways to kind of d dissolve it a little bit more.

But typically it's, it's felt more than it's seen. And you see it less and less again with technique of injection where you're placing it and really educating the patient on massage and of course the reconstitution of the, of the sculpture.

I've seen a lot of the before and after’s of, of patients with Sculptra, and you can certainly see you know, where it's, I guess to my eye it kind of lifts a little bit, but it also seems to just improve the quality of the skin.

Am I imagining that?

You're exactly right, it does improve the collagen of the dermis. And so you do get this glow, this Sculptra glow that occurs and you know, we're talking about the face, but that's not the only area where Sculptra 's used. One of the other key areas that sculptors use in is in the buttock area. 

You can also smoothen over a little bit of the laxity that's there. And sometimes some of the cellulite. You subscize the cellulite and then inject Sculptra. It's also used in the anterior thighs and the medial aspect of the thighs to help with that crepey skin.

It's used in the arms. Crepey skin. It's used in the chest. The one area that I don't use it are the hands. I just prefer filler there. 

Okay, so just to kind of reset the expectations when it comes to Sculptra is it's not instant, right?

It is a process. It takes time. How much time would you say before you can start to see.

It does take several sessions to, to be able to really see it, but you start to see collagen at about six weeks. You're beginning that process of visually seeing it. 

On label for the face is : 2 bottles every month for 3 sessions. 

I don't do that. I do one bottle at a time, because remember, we're reconstituting it with about eight ccs and we're putting anywhere from two to four ccs of some additional numbing in there. And So you, that's a lot of volume for the face.

And so if I'm doing two bottles, that's quite a lot of volume for that particular one to two days.  I do one bottle at a time. I bring them back at four weeks. I do a second bottle. I bring them back in six to weeks, to eight weeks, we do a third bottle and we kind of march along slowly like that.

You know, some men, I will say that if someone has a lot of volume loss, I won't hesitate doing two bottles at a time.

But I would say that's probably 5% of my patients. The majority are one at a time. Now, when I do the buttock area, it's definitely a bottle per the buttock area, and sometimes it's even four bottles at a time, depending on what they're trying to achieve.

But it's really from an expectations perspective. Yeah. It's going to take six weeks to really start to see a change, and then that change would typically last.

And that change will augment. I mean, that's just the beginning part of the change. And then you'll see more and more of that change and it can last up to 25 months. Now, I tell patients that once you get to goal, if you say, okay, I'm there and I took me three bottles or four bottles, then I tell them, once a year or a year and a half, come in for a bottle to maintain that result.

So, you're not going from, from looking great to, to nothing at 25 months and then starting the process over again.

Once you get to where you want to go, you kind of plateau for a while, and then, and then after maybe a year and a half or two you, it'll, it'll be coming back down and in the meantime you could supplement that with a, an additional bottle.

Correct. And it's so much fun to see. I mean, just the other day we had a patient that we had started sculpture in 2017 and we only did four bottles. She's a 65-year-old patient. Now we only did four bottles over a six year span, and we brought up her photo in 2023 and we compared it to her 2017.

Well, she didn’t look worse and she actually looked better than she did in 2017. So, she basically maintained her aging over that over six years with four bottles of sculpt. Wow

 I mean just, for me, just the thought of stimulating my own natural collagen is, is a benefit like I, that I, I like the sound of that, where it's kind of my own body naturally producing what I need.

Absolutely. And it's interesting, I almost feel like there is a resurgence in, in coming back to a natural look. People are turning more to, to lasers potentially instead of fillers. And again, I'm not poo-pooing fillers.

I think that what's happened is every aesthetic. Was thought to be dealt with, with a filler, whether it was a wrinkle or any other lift. And I think fillers are so wonderful for filling in areas of lost volume, but, but they're not the things to utilize when you're chasing lines and wrinkles.

They're not what you want to utilize when you're really trying to get a lift. That's when we turn to energy-based devices. PDOs or even some sculpture.

Yeah, I mean, there's just a lot of awareness about fillers.

I mean, I'm not sure there's a lot of awareness about Sculptra of the bio stimulator. So, it's something that I think is, is really appealing to me.

So again, how do you, how do you prepare for it? Well, it's probably a good idea to minimize aspirin, ibuprofen about 10 days prior to minimize bruising.

And then I always plan it accordingly because while we use micro cannula deeply into the tissue for = Sculptra injection, you know, you have to insert a needle to get into, into the tissue. So sometimes there could be a little bleeding and a little tiny bruise that could potentially occur. So just kind of give yourself a grace period prior. Don't do it prior to a big party or anything like that for one to two days, you might appear to be a little more filled, because remember, there's about 10 ccs of, of the actual volume that is presented to the face, and you'll absorb that over one to two days. So maybe don't do it right before some, you know, family photos or whatnot. Just give yourself a little grace period for him.

Okay. So it's relatively safe. It takes about six weeks to start to see the results and then those results will continue to develop. But while you're stimulating those results, you'll be checking in to gauge whether an additional bottle is needed or not.

And then once you reach your goal, you can expect that to last upwards, to close to two years. 

Correct. And then, then after you've achieved your goals with Sculptra, oftentimes you need less filler around the mouth and the marionette zone because there is a little tiny touch of a pole.

Right. Okay. 

That's kind of it. Very simplistic, easy. Takes about 25 to 30 minutes to do. It's, it's not hard at all.

Well, I, I like the sound of it.

Okay, good. Good. Well, I hope you all have a wonderful night tonight, and thank you again for, for tuning in.

All right. Thanks everybody. Appreciate you.

you. Bye-Bye.