Why am I against the use of Sculptra in cosmetic procedures?

Sculptra, a polylactic acid-based product, has been promoted as a popular option as facial filler and for skin rejuvenation. However, my position is firmly against the use of Sculptra in cosmetic procedures, due to several fundamental concerns from my clinical and surgical experience, as well as scientific evidence questioning its efficacy and safety.

1) Low Evidence of Long-Term Efficacy: Clinical studies and systematic reviews have raised significant doubts about the long-term efficacy of Sculptra compared to other facial fillers. Research shows that Sculptra’s results can be inconsistent and generally require multiple sessions to achieve visible results, with little guarantee of durability.

2) Complications and Adverse Effects: There have been reports of serious complications associated with the use of Sculptra, including inflammatory reactions, persistent nodules, irregularities in skin texture and even displacement of the product to unwanted areas. These complications can have a significant impact on the patient’s aesthetic appearance and require additional interventions for correction. And indeed, in my practice as a plastic surgeon, I have often observed multiple subcutaneous accumulations of Sculptra in patients who have previously had procedures with this dermal filler. These accumulations have not shown any firming effect on the skin and, on the contrary, have hindered subsequent processes, such as facelifts, rather than effectively contributing to an improvement in skin quality and firmness. These observations persist even years after the Sculptra procedure.

3) Application Limitations and Associated Risks: In addition to the known complications, Sculptra also has limitations in terms of safe application areas and injection techniques. Lack of precision in the administration of the product can lead to undesired results and increase the risk of adverse effects.

4) Lack of Sufficient Evidence of Long-Term Safety: Although Sculptra has been approved by the US Food and Drug Administration (FDA) for certain cosmetic purposes, there is still a significant lack of long-term safety data to support its continued use. The lack of adequate long-term patient follow-up raises concerns about unknown potential adverse effects in the future.

Based on these considerations, it is my professional opinion that Sculptra is not an ideal option for cometic procedures. Instead, I recommend safer and more proven approaches, such as hyaluronic acid dermal fillers, which offer more predictable results and a better established safety profile.

Bibliographic references:

1. Moyle, G. J., et al. “A Randomized Open-Label Study of Immediate versus Delayed Polylactic Acid Injections for the Cosmetic Management of Facial Lipoatrophy in Persons with HIV Infection.” HIV Medicine 8.5 (2007): 300-306.
2. Vleggaar, D., et al. “Consensus Recommendations on the Use of Poly-L-Lactic Acid for Facial and Nonfacial Volume Loss.” Plastic and Reconstructive Surgery 132.5S (2013): 75S-81S.
3. Duranti, F., et al. “Evaluation of the Safety and Efficacy of Poly-L-Lactic Acid for the Treatment of HIV-Associated Facial Lipoatrophy.” Clinical Interventions in Aging 2.3 (2007): 397-403.
4. Narins, R. S., et al. “A Randomized, Double-Blind, Multicenter Comparison of the Efficacy and Tolerability of Restylane versus Zyplast for the Correction of Nasolabial Folds.” Dermatologic Surgery 28.5 (2002): 317-322.
5. Weinkle, S. H., et al. “A Multicenter, Double-Blind, Randomized, Placebo-Controlled Study to Evaluate the Effectiveness and Safety of Reconstituted Poly-L-Lactic Acid for the Correction of Nasolabial Folds.” Dermatologic Surgery 34.Suppl 1 (2008): S54-S60.