Poly L- Lactic - Acid: Sculptra Dermal Filler
| Best used: Stimulate dermal collagen, replace volume, improve skin quality | Caution: Nodules with low dilution | Best for: Volume loss, bio stimulation, atrophic scars, rejuvenation |
| Comments: Tried & tested dermal filler for nearly 2 decades | Mode of action: Collagen stimulator, volumizer | Science Score: ***** |
What is PLLA (Sculptra)?
PLLA is a collagen stimulator. It restores the deep, underlying structure of the skin by increasing collagen- subdermal volume, in turn diminishing facial wrinkles. This collagen stimulating dermal filler works with your innate immune system in the deeper layers of your skin to help revitalize production of collagen. This helps restore your skin’s inner structure and volume.
How does PLLA work?
Poly- L- lactic microparticles are absorbed by the skin, in turn stimulating collagen production. Collagen builds the scaffolding of skin, in turn restoring dermal volume. This reverses the aging process and reduces the appearance of wrinkles.
Sculptra stimulates collagen growth which helps to restore facial volume and the look of fullness to wrinkles and lines over time. Hence Sculptra can improve skin laxity & aid in skin tightening.
Lastly PLLA can improve skin quality, reducing the size of pores, as well as providing better light transmission & luminosity.
Why are dermal fillers an integral part of treating skin aging?
Volume. Volume. Volume. Volume replacement is integral to getting natural results. Lasers & chemical peels address the quality of skin, also known as texture. Non-surgical treatments such as radiofrequency, PDO threads & HIFU-Ultherapy address skin tone (improves skin laxity). Volume refers to the replacement of fat & dermal collagen.
Sculptra also stimulates collagen, which improves skin integrity, laxity & increases skin tone. The use of Sculptra is hence extended to a tightening agent. Lastly, it can marginally improve the quality of skin.
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How do dermatologists choose Sculptra over hyaluronic acid dermal fillers?
Sculptra dermal filler is best for improving volume in a larger surface area, as compared to hyaluronic acid dermal fillers. PLLA stimulates your own immune system to produce collagen. HA fillers can improve collagen production, but not to the degree that Sculptra can.
The second aspect of skin rejuvenation is an improvement in skin quality. PLLA or Sculptra has been shown to improve photoaging, fine lines, wrinkles, enlarged pores & aid in the refractive properties of skin (luminosity).
Sculptra can also improve skin laxity via a process called neocollagenesis. This trending term is also called bio stimulation & is the new buzz word for 2023. Essentially it means collagen stimulation via fibrosis. This can lead to variable amounts of skin tightening & lifting. IMO Sculptra is best for volume, then fibrosis & skin quality.
Is the treatment painful?
Treatments are well tolerated as we incorporate lidocaine with Sculptra. This ensures patient comfort levels throughout the procedure.
Jessner TCA peel, one session
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👉This is a medium depth peel. Occasionally I prep with retinoic acid beforehand, but thin skin like this patient, RA is not needed. I scrub with acetone, then coat with 2-4 layers of Jesser. I then have a cup of coffee then come back to finish off with TCA at 35%
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😁Was having a friendly banter with my mentor & close friend @aprofphilipbekhor last night. Peels vs lasers. Why do I like peels? My chill out time. No loud noises apart from the patient's muffled screams 😱😱(joking). Despite the tech of lasers, I still like looking carefully at end points from peels. It is tactile, much like driving a manual car vs an automatic. Sure the latter is easier, but sometimes it’s the challenge to get the downshift perfectly matched, or the epidermis so evenly gray that the entire sheet slides from the dermis. It’s old school cool
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👊🏻Disclaimer: You do need to watch your peel patients more closely cf. NA laser patients, that is fact💯
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#tca #jessner #jessnertca #chemicalpeels #dermatologist #dermatology #drdavinlim #skinrejuvenation
TCA peels are a simple way to rejuvenate skin. This picture is over a decade old, but I still enjoy peels over lasers (more tactile). It’ much like driving a older vintage car, it’s slower to get to your destination but the drive is more enjoyable🚘
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🔬Skin science: TCA can be applied as a superficial, medium (most common) & deep peel. In this case I employed it as a medium depth peel, to the upper papillary dermis. In some cases I combine it with Jessner for deeper penetration
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👉Downtime: 5- 8 days depending on the strength and coats
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😢Pain: Tolerable with topical application of numbing and skin cooling. I do give oral conscious sedation if deeper peeling
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👍🏻Good for: Skin type 1-2+, pigment, freckles, sun damage, solar keratosis, mild to moderate wrinkles, lentigos/ age spots
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👎🏼Not good for: Darker skin, deep wrinkles, melasma
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😎Davin Lim
Dermatologist
Brisbane🇦🇺
#chemcialpeels #TCApeel #jessner #jessnerTCA #skinrejuvenation #skinlightening #skinbrightening #davinlim #dermatology #skinscience
How do we inject Sculptra?
Our most common method of delivery is via a hollow blunt needle called a cannula. This disperses PLLA over a wide area. A needle is best for targeted delivery of soft tissue dermal filers. A cannular provides superior safety levels as compared to needle delivery.
What is the science behind Sculptra & Poly-L-Lactic acid?
Sculptra is made out of poly-L-lactic acid, which is gradually and naturally absorbed by the skin. It assists in rebuilding lost volume. PPLA stimulates collagen production through a series of treatments administered by a clinician.
What are the indications of PLLA?
PLLA is a potent stimulator of dermal collagen. Dermatologists employ this dermal filler to correct-
- Wrinkles & volume loss of the cheeks, temples & neck.
- Skin laxity of the face, neck & décolletage
- Volume loss of the hands
- Atrophic acne scars
- HIV associated lipodystrophy
- Compromised skin quality
How many treatments will I need?
The number of sessions depends on your goals as well as the location & clinical findings. As a guide-
- 40s: 2-3
- 50s: 3-5
- 60s and over: 4-6
When will I see the results?
Results can be seen as early as 2 months; however, the maximal gain is around 3-5 months.
How long does it last?
2-3 years. Hence the requirement for regular top ups every 12 to 24 months. Remember, Sculptra works by increasing your own body to produce collagen. If your immune system is slow to develop collagen, you may require other treatments.
How does Sculptra dermal filler compare with Profhilo?
Both are collagen stimulating fillers that rely on your skin’s immune system to produce collagen. Profhilo is made from hyaluronic acid, whilst Sculptra is made from poly-L- lactic acid. For larger volumes, Sculptra may be more cost effective, whilst Profhilo is used to treat specific areas of laxity including the neck, chest & face.
Profhilo results are immediate, whilst Sculptra results are delayed. Profhilo provides skin hydration to a larger degree than Sculptra.
How does Sculptra compare with polynucleotides- Rejuran?
Sculptra provides a biased volume correction over collagen stimulation. Bio injectables such as Rejuran & Gouri provide more collagen stimulation & less volume changes. Hence of ‘heavy’ faced patients, Rejuran & or Gouri (PCL) are better than volumizers.
What are the side effects of Sculptra?
Fortunately, side effects are uncommon. They include infection, nodules or lumps, uneven bumps & over-correction. Side effects can be mitigated with meticulous delivery of Sculptra & advanced training.
The initial reports of dermal nodules were with a 1 to 3 Sculptra dilution. Now-a-days the dilution is 1 to 9 or 1 to 18, hence side effects are uncommon.
What can be combined with PLLA?
We combine Sculptra with lasers & energy devices. The most popular combination is-
- Laser resurfacing + Sculptra in the same session
- Sculptra + RF devices such as NuEra or Tempsure
- Sculptra+ pico lasers
Lasers improve the quality of the skin more effectively, whilst Sculptra’s role is to stimulate the production of collagen.
Why Sculptra- PLLA over other fillers & treatments?
Collagen creams are cr*p. Pure marketing & BS. The large molecules of collagen do not penetrate to the dermal layer of skin. Better results with vitamin A creams & emollients to improve the skin’s appearance.
Collagen Supplements: are great for joints. They can produce a placebo effect when ingested. Given the fact that they can improve arthritis, knock yourself out.
Hyaluronic acid fillers: can rejuvenate skin, improve volume & reduce wrinkles immediately upon injection to fill in lines, wrinkles and folds.
Davin’s Viewpoint on PLLA or Sculptra
This injectable epitomises the term ‘repurposing’. The first mainstream use was over 20 years ago as a ‘filler’, namely, to replace severe volume loss in HIV positive patients with lipoatrophy. It was good & under the PBS- Medicare. I believe that this is PLLAs true existence – namely volume replacement in patients with moderate to severe atrophy. Sculptra hence is an awesome filler in the true definition of a filler.
Over the past decade it has a resurgence in improving skin quality (pigment, fine lines, pores, skin light reflex & luminosity), however the cost to benefit ratio does not make sense. One vial for one decade is Galderma’s guidelines. A 60-year-old will require a minimum of 5 to 6 vials, at a cost of $1100 to $1390 per vial. That means over $8000 worth of injectables. Compare this with $5 cost price of TCA at 15 to 25% with $3 worth of Jessner. Time & time again the Jessner TCA peel will easily outperform 6 vials of Sculptra. No marketing here, just the facts. Can it improve skin quality? Yes, with a wee bit of imagination. Will one simple laser session (yet alone 8 bucks worth of chemicals) produce far better outcomes? Does a bear shit in the woods?
From 2023 & beyond the buzz word is biostimulator injectable. This means an injection that stimulates collagen skewed towards skin tightening with variable amounts of volume increase. The question is, are there better biostimulators than PLLA? Absolutely, especially if one is to avoid volume. PCL or polycaprolactone comes into mind.
Hence in summary, PLLA is a time tested injectable that provides volume over fibrosis over improvements in skin quality. It still is a useful injectable despite its age.
