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Can you use both a filler and Sculptra to create instant and lasting volume?

Yes but the filler should not be another collagen stimulating product. HA fillers are considered safe. No fillers should be put into the same area as the Sculptra at the same time. A period of a few weeks is advised. Treatment of other areas of the face can however be done at the same time.

No studies of interactions of Sculptra with drugs or other substances or implants have been made, however combinations are used in clinical practice.
According to European expert recommendations, we differentiate 2 cases:

1. Treatment of the same area:

a. In case two tissue stimulating methods are used in the SAME area (e.g. ablative treatment, fractionated laser therapy or needling, medium depth or deep peels) the 2nd treatment should be done 4 6 weeks before or after Sculptra treatment.

b. If no tissue stimulating interventions are used in the SAME area, the time period can be shorter (e.g. non ablative treatment, a vascular laser for the treatment of small vessels of the cheek can be done 1 week prior or after Sculptra treatment of the cheek).

2. Treatment of two different areas:

a. If different products are used (dermal fillers, botulinum toxin A), the treatment can be done the same day or spaced out based on the physician own preference and experience. (e.g. BoNT-A in the glabella area, an HA filler for lip volume and Sculptra for jaw line and medium part of the face). 

Can you recommend how far apart first, 2nd and top up Sculptra treatments should be?

Sculptra treatments should ideally be between 4-6 weeks apart but longer gaps can be used if more suitable for the patient. This will not affect the results achieved but will simply delay the final collagen growth time. Top up treatments should be approximately every 2 years but can be done earlier if loss of volume is seen to be occurring before then.

Is there a maximum age that you would recommend Sculptra?

Evidence shows new collagen growth occurs even into late age with Sculptra. However Sculptra results may not be as great with age due to reduced ability for fibroblasts to be stimulated. 

Is it possible to over-volumise with Sculptra? And if so how can this be remedied?

Yes. It is very important not to over treat with Sculptra and to be aware that significant collagen growth will still be seen up to around 9-10 months after each treatment. It is better to wait for the maximum growth before giving further Sculptra. This prevents over volumisation.

What classification is Sculptra? Is it a POM

Sculptra is not a POM. In the UK it is registered as a class 3 medical device 

When you first see your client, how do you visualise the total volumisation that you are looking to achieve?

It is important to ask patients to bring photos of themselves taken about 10 years previously. This gives an idea of their earlier facial volume and their present volume loss. You can then assess how much Sculptra they should need based on approximately 1 bottle/vial per decade of life. E.g. A 50 yr old may need 5 vials of Sculptra if treating the whole face or 2-3 vials if only treating the upper face.

Amount will vary depending on presenting volume loss and patient expectation.

How can you be precise with Sculptra?

With experience you will be able to be more precise about how many vials of Sculptra your patient requires. Keep to the idea of one vial per decade and if unsure then always use less and wait the 9-10 months before you add more.

What aftercare cream do you recommend you clients use to do their massage?

Any massage cream can be used that the patient’s skin is comfortable with. It is important to use some form of cream as it makes the massage much easier and prevents dragging of the skin.

Are there any other Sculptra developments in the pipeline?

Sculptra is now being injected with micro-cannulas which has reduced the number of entry points and possible bruising. Patient satisfaction is extremely high with this technique. If you wish to be trained on the CanuSCULPTmethod, please contact your local Sculptra rep.

What percentage of patients get Granulomas?

Granuloma occurrence is extremely rare with Sculptra 

What is the main cause of nodules, is it injector error?

Nodules are tiny palpable hard lumps that may appear months after the treatment and consist of particles of PLLA surrounded by collagen. Their incidence is approximately 1-3% but this can be greatly reduced with correct dilution, correct injection depth and placement and sufficient post treatment massage. They normally resolve by themselves over time but can be broken down by injection into the lumps if needed.

What is the current advice re depth of injection?

Injections of Sculptra should be placed in the sub-dermal plane or deep into the supra-periostiol area.

When diluting to 9 ml, doesn’t this take longer to see a result?

New collagen growth will still occur at the same rate as lower dilutions as it is still the same total amount of Sculptra being used. However you may require more bottles of Sculptra to achieve the volume required as you will be able to treat a larger area with the higher dilution.

How can I disperse any nodules?

Nodules can be broken into using a small amount of Lidocaine or Normal Saline and using a 21 to 25G needle to break the capsule. The nodule will often then resolve gradually.

What size of cannula is recommended, both length and gauge, when injecting Sculptra via this method?

Micro-cannulas of 25G and 27G by about 37mm are the most popular.

How long does Sculptra last?

Sculptra stimulates growth of new collagen and results will generally last about 2 - 3 years before a smaller amount of Sculptra is required to re-stimulate the collagen. 

What is your advice on aftercare, massage following Sculptra and how to you ensure your clients comply?

I personally ask clients to massage for 5 mins, twice a day (3 times if they can manage it) until they see me next (which is usually 6 weeks). I am sure that this is longer than needed but better more than less.

Where would you use cannulae in preference to a needle?

Cannulae can be used in all areas of the face and should be considered when there is a large or multiple areas to treat. They are excellent for fanning large areas that are in need of dermal thickening.

What is your advice on using Sculptra on people who have had fillers in the past, how long before you can treat with Sculptra?

At least 4 months after HA treatment as long as the treatment had no problems. 

Can you take an educated guess when seeing a client for the first time how well they’ll respond to the stimulation of collagen from Sculptra?

I don’t believe so.

How important is it to buy from a trusted source which will provide a full audit trail and pharmacovigilance support?


By using lidocaine with Sculptra what is the legislation regarding the use of lidocaine as nurse prescribers?

Lidocaine is a prescription drug and so is under the same legislation as any other. Nurse prescribers can prescribe this if they have had training to do so.

What is the best way of dealing with nodules?

Correct placement of product and ensuring clean technique will minimise nodule formation.  Good, regular massage will also help. Early nodules (4-6 weeks post treatment) should continue to be massaged and in most cases will resolve spontaneously. Any symptomatic or visible nodules should be reported to your local rep and advice can be given in individual cases.

What's the panels opinion on cannula size with regards to blocking?

Prevention is similar to the advice for nodules – correct and clean technique. Avoid placing large amounts of Sculptra in the same area repeatedly within short time periods. Granuloma and nodules often have an infective component that can be treated with Doxycycline.

The dilutions of Sculptra are always changing, why is this and will it change again in the future?

In the last few years, there has only been one change, from 5mls to 7mls of WFI. Increasing dilution of the product aims to reduce the chance of nodule formation even further. I don’t imagine that the advice will even change to be more dilute than 7+2 (WFI + lidocaine).