Can I do something to avoid bumps from Sculptra Aesthetic?

My brother had some fillers injected in the under eyes area 7 years ago and his results were disappointing. He now has some small bumps that hake him look tired all the time. I don't want to repeat this outcome. What can I do to ensure my results with be smooth and natural? Any massaging maybe? I know the doctor does that during the procedure.


F, 29, Vermont

Sculptra is an FDA-approved injectable which stimulates the body to create its own collagen. It is injected as a diluted solution containing poly-L-lactic acid molecules. Over time, the poly-L-lactic acid molecules are replaced by collagen that the body builds to provide long-lasting benefits. The synthetic molecules dissipate as the patient’s own tissue takes its place. For the treatment to have beautiful, natural results, the injections need to strategically placed to disperse the diluted solution evenly throughout the targeted area.

Unfortunately, nodules, papules, and granulomas were quite common in the early days  solutions, insufficient massage of the treated area after injections, and injections that were placed at a superficial level.

The incidence of small bumps has since decreased because plastic surgeons today better understand the product and how to gain optimal results from its application. The risk of lumps occurring has been minimized as Sculptra providers now know that the solution should be reconstituted several days prior to use and adequately diluted with water.

Excellent injection technique is also essential to gaining beautiful results. A highly competent injector knows that if Sculptra is injected at a very shallow level, lumps are more likely to show. This is especially true of the periorbital or eye area where the skin is very thin and delicate. Irregularities tend to be far more noticeable under the eyes than  other parts of the face.

Injecting Sculptra at the right locations beneath the eyes is critical. The best injectors are conservative in their approach. They understand that it’s better to slightly under-inject and if necessary add more Sculptra in a follow-up consultation, than over-inject and have to try and undo a poor outcome later on.

The periorbital area should only be injected with Sculptra by highly experienced providers. If you decide to proceed with treatment, ensure that a board-certified plastic surgeon administers your injections and not an inexperienced injector working in the same clinic. Check that they have a proven history of producing great results.

Nowadays, few patients experience issues with Sculptra lumps after treatment. The majority of small nodules that do arise in approximately 10% of patients are almost invisible, not tender, and easily dispersed with a few days of proper massage. Many providers recommend the 5-5-5 massage rule. The treated area should be massaged at least five times a day, for five minutes each time, for the first five days following your treatment. Most small lumps go away with time.

Lawrence Broder has 1 Fillers, Laser Resurfacing before & after:

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Sculptra is an injectable that works gradually to encourage the body to produce its own collagen. When injected beneath the skin the body breaks the product down. New collagen is built during this process, rejuvenating the treated area by creating natural facial volume. It is safe and can produce beautiful, natural-looking results when administered by a competent facial plastic surgeon.

I recall there were issues when Sculptra was first used as a volume enhancing injectable to plump the faces of HIV patients. Surgeons mistakenly thought a high concentration of Sculptra in very little fluid was the most effective way to stimulate collagen deposition response in the body. Unfortunately, the over-concentration of Sculptra in a particular area provoked an over-concentration of new collagen in that area. As a result, palpable and visible bumps would form over time.

The procedure for injecting Sculptra in patients has since changed significantly. Not only is Sculptra more diluted now, but it’s also injected at a deeper level so any unevenness in collagen formation isn’t so close to the surface. Regular gentle massage of the injection site for at least five days following treatment is also recommended: this encourages the deposition of collagen as a deep sheet as opposed to focal lumps. Finally, injectors now reconstitute the mixture one or two days prior to injection to ensure adequate hydration of the product.

Sculptra is most commonly used for the nasolabial folds and marionette lines and should only be injected in the under eye area by the most competent of injectors. As the skin beneath the eyes is very thin, it is more prone to show irregularities in texture. Some surgeons prefer to use hyaluronic acid dermal fillers like Juvederm for this sensitive area instead.

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I would not recommend sculptura under the eyes.  I have found that sculptura has a high incidence of this complication and I do not use it.  I would recommend a very thin hyaluronic acid filler for under the eyes, such as juvederm or belotero.  They each have a very low complication profile and can each be reversed by injecting hyaluronidase.

Sculptra is a great product but I do not think it a good choice for under the eyes. I would recommend a thinner hylaronic acid (HA) like restylane silk or belotero

the way to keep sculpta smooth is massage post treatment per the instructions  - we say 5,5,5.   5 minutes, 5 times a day for 5 days

best of luck

JackPeterson MD

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