Q: Dr. Eppley, you have written that the collagen stimulated by the Sculptra injections disappears once the Sculptra crystals are all gone. Since the effects of Sculptra last on average 2 years, your implication is that the crystals remain on the face for up to 2 years. However, in almost every piece of literature/opinions, I have read that the actual Sculptra dissolves entirely within a few months, leaving behind new collagen. If this is true, then logically this collagen would dissipate no quicker than regular (non-Sculptra stimulated) collagen. Is what I have read incorrect? Are you saying that Sculptra stimulated collagen dissipates faster than our natural collagen? I hope that your theory is correct because I received 2 treatments 2 years ago. I am 26 and underweight and my face is fuller than ever. It’s very upsetting to me. I’m hoping that it’s true that there are still crystals inside my face and that’s why it’s still overstuffed.
A: Any discussion I have ever had on Sculptra is based on the known chemistry of its poly-lactic acid (PLA) particles…which are the crystals to which we both refer. PLA is a very slowly resorbing polymer that often can take up to a year or longer. Most commonly they persist for 9 to 15 months based on the variable resorption patterns amongst different patients although particle resorption may take longer than that in some individuals. The effect of Sculptra comes from the laying down of scar (collagen) around the particles. As the particles are eventually resorbed, the collagen produced will eventually go away as well in most patients. This collagen resorption follows by months after the particles are resorbed. It may also be possible in a few patients that the collagen scar effect may not dissipate although this is very uncommon.
Dr. Barry Eppley
Q: Dr. Eppley, I am inquiring about how to get rid of some injectable filler I had placed. I had two rounds of Sulptra to my cheeks and upper face last year that produced a subtle but pleasant change. I then went in a third time for lines around my mouth and was injected with a 1/2 vial of Sculptra into my lower cheeks and in front of my ears. The creation of volume started at just three weeks and has continued into this 6th week. I just wanted a couple lines filled near my mouth and specifically told her no more volume, but I realize there was either a miscommunication or she hasn’t had someone react so strongly on the 3rd vial. I know that most doctors say that Sculptra is irreversible and I might just have to wait two years, but a few others have suggested collagenase, 5FU and Kenalog injections to reduce it. One even suggested Ulthera therapy. I’m confused, but if there is something I can safely try, I really don’t want to go two years waiting for it to wear off.
A: The effects of Sculptra are magnified each time you use it as the body is reacting to the polymer crystals that are being implanted. So much like an immune response, each exposure to it (as well as the volume placed) can create an even more profound effect. Its effects are created by the scar/collagen reaction to the implanted material. The volume effect goes away when the polymer crystals finally dissolve and the scar tissue created by them eventually wears off…a period of between 18 and 24 months. In very rare cases, the volume effect does not go away.
Since it is very likely that time will solve the problem, you don’t want to do anything that may have its own adverse effects. For this reason, injectable steroids (Kenalog) would be excluded no matter how dilute. Collagenase is an option but is a small percentage of patients they can develop a reaction to the enzyme. 5FU has really known side effects although it is less effective than either steroids or collagenase. External skin tightening therapies such as Ulthera or Exilis can have some facial slimming effects because of the radiofrequency heat they produce which could cause the reactive subcutaneous scar tissue to dissipate. They are well known to cause fat absorption at high energies or repeated treatments.
The safest options in my opinion would be 5FU injections combined with Exilis. It may require more one treatment but conservative improvement with no downsides would be a prudent approach.
Dr. Barry Eppley
Q: Dr. Eppley, Why is Sculptra not permanent although it stimulates the growth of the body´s own tissue? Is there a certain percentage of the augmentation effect, that can be considered permanent?
A: Sculptra creates its collagen effect through the implantation of small polmyer crystals known as PLA. This is a well known slowly dissolving polymer material. Its implantation causes collagen tissue to form around it as a reaction to the implanted material. This scar tissue will only persist as long as the PLA crystals persist. Once they are broken down and absorbed, the surrounding collagen tissue fades away. On a much larger scale think of the collagenous capsule that forms around a breast implant. Once the breast implant is removed, the capsule will eventually be largely absorbed. This explains why there is no permanent effect to Sculptra injections. It is long lasting for sure but not permanent unless treatments are eventually repeated.
Dr. Barry Eppley
Q: I have been infected with HIV for 31 years, and have seen every one of my former friends and acquaintances succumb to AIDS. For some reason meds have always become available just in time to save my life. For that I am thankful But my life feels hardly worth living with the disfigurement of facial lipoatrophy and pain of buttock lipoatrophy. My face is so gaunt it is horrible and I have not butt at all!
A: One of the very unique effects of anti-viral medications in the management of HIV/AIDS is their effects on fat wasting or lipoatrophy. While much of the body (but not all) is affected by this fat loss, the face and the buttocks are frequent areas of aesthetic concern.
Facial lipoatrophy can be treated by two potential methods. The non-surgical approach is with the use of Sculptra injections. This is an FDA-approved injectable material that is essentially the placement of crystals or ‘seeds’ of a resorbable polymer that promotes collagen formation. It requires a series of injections over time to get a sustained response. The injections are placed in the cheek and submalar areas where the hollowing is the worst. While there is the possibility of a foreign-body reaction or granulomas with its use, good technique can minimize that risk. This injection material is not permanent and must be repeated every year or so once the desired result is obtained. From a surgical standpoint, cheek or submalar implants can be used which is actually my preferred approach. The procedure is simple, is done from incisions inside the mouth, and the volume obtained is permanent. Once can then use Sculptra to further highlight and feather the result out further into the face if desired.
Unlike the face, there is no good solution for the buttocks. Fat injections are not a good idea as there is no fat to harvest in most HIV patients and it will likely be absorbed anyway even if there was. Buttock implants are a possibility but the pain of recovery and the risk of infection may this procedure unappealing.
Dr. Barry Eppley