Besides Fat, Which Facial Filler is the Longest Lasting?
Whoever of you answered Sculptra, congratulations. You folks are correct!
Ahem, excuse me. I am wrong. Bellafill is probably the winner here. But I have very good reasons for never having used Bellafill on any of my patients. You see, Belllafill contains polymethyl methacrylate microspheres (PMMA) which is closely related to the cyanoacrylate that Super Glue is made from. PMMA is not biodegradable in our bodies, and can on occasion lead to permanent granuloma (hard lump) formations that must be surgically removed to get rid of them. So let’s just eliminate Bellafill from the competition, shall we?
So, what is Sculptra and why is it used? And does it have any advantages over the more commonly utilized hyaluronic acid containing fillers like the Juvederm or the Restylane family of products?
Sculptra is made up of poly-L-lactic acid (PLLA) which is a biocompatible and biodegradable synthetic material in the alpha hydroxy acid family. Contained within the Sculptra vial is also a bit of carboxymethylcellulose and mannitol. Sculptra is a subcutaneously injected filler that has the beneficial property of stimulating the migration of the body’s fibroblasts to surround the tiny particles of PLLA.
Sculptra is used to thicken skin and therefore give the appearance of a fuller face in the regions where increased volume would be an enhancement. In fact, Sculptra was initially given FDA approval for use in HIV patients with severe facial fat loss (lipoatrophy). This occurred in 2004. Five years later the FDA gave official approval for Sculptra use for people without HIV who were desirous of more facial fullness for purely aesthetic reasons. Studies have consistently shown that after a series of 3-5 Sculptra treatment sessions, there is zero loss of skin thickness after 25 months. In fact, most experts in the field maintain that for practical purposes the volume gained after a series of Sculptra treatments will last for a minimum of 5-10 years! Only fat transfer into the face can boast of greater longevity. That is, of the transplanted fat that survives by establishing a new blood supply source in the new location.
(Remember, I have excluded Bellafill which has what I feel are disqualifying problems with its use.) None of the more commonly used hyaluronic acid fillers will maintain their original volume anything close to 5-10 years.
Obviously then a huge advantage of Sculptra is the extended duration of benefit. Are there disadvantages? Of course there are, otherwise everyone would be using this product, right? First of all, it can be expensive. More than one treatment session is always required. Sometimes two, three, or even up to 5 sessions will be needed to achieve the fullness the patient desires. Granted the sessions will be spaced out over a period of several months, but money spent is money spent, after all.
Secondly, there is homework required. Homework!! What?? Yes, that’s correct. To get the maximum benefit from each Sculptra treatment, the “Rule of Fives” should be followed. Massage the treated areas of the face for five minutes, five times a day, for five days. Rats! However, by doing this the greatest improvement from the treatment will occur, and thereby the patient will get the biggest bang for the buck spent.
Finally, although Sculptra can be used for many unusual appearance needs (filling in areas of traumatic fat atrophy, enlarging buttocks, etc.) it cannot be used to directly address things like vertical lip lines, thin lips, or to provide the so called liquid nose job.
In summary, Sculptra is a grossly under utilized and extremely valuable tool in the aesthetic provider’s armamentarium. Some offices will from time-to-time offer specials on pricing which makes the good bargain that Sculptra actually is even better than usual. Carter MD Aesthetics is promoting just such an offer for the months of September and October 2024. Come see us and get a tremendous value that you will benefit from for years to come!
William A. Carter, M.D.
Carter MD Aesthetics