Sculptra®

Sculptra is a very interesting product we have in armamentarium. It is a biostimulator that creates volume and builds structure to lift the face, which we use as a platform for other procedures. I’ve been using Sculptra for the last 13 years. I am been using it since 2010 in a very high volume with a very zealot-like enthusiasm. I use it so much, in fact, that we’re one of the top users in the country. I’ve been invited to the Surgical Advisory Board for the last five years and have been publishing with from around the world on best practices and expanded uses of Sculptra. We find, in our practice, that as a single-modality treatment Sculptra offers us the biggest advances we’ve seen in years, and we’re continue to use it in different uses off the face and as well as the face itself.

What we’re hearing today is the big fear of getting fillers is that you’ll look odd and unusual, because if it’s done well, by definition, you never see it. You walk into a restaurant, you walk into a drinking establishment, and the first thing you see are the large looks of the huge chipmunk cheeks. The way we avoid those looks is by using an artistic touch when we’re doing fillers. Knowing where to put them, how much to put in there, that is the key to avoiding that abnormal look. Once again, we will use pictures from your youth, as well as your pictures at dates throughout the process. We have it on a large computer screen, and we’re referring back and forth to that screen at all times during the placement of fillers.

The goals of our treatment, whether it be surgical or nonsurgical, is to create a look that is natural. We hear that all the time. It’s almost a cliché, “I have natural results.” The point I’m trying to make is that when people see the before-and-after pictures of cases we’ve done, they go, “Oh, my goodness. Everybody will notice if I look that much better.”
The reality is we recognize each other based on what we remember of you from the day before. As long as we don’t lose that intrinsic you, that little piece of you that is characteristic, they’ll look at you and say, “Wow, great haircut! You’ve lost weight. What kind of makeup are you using?” They’re not going to say, “Wow, you look great! Who did your facelift?” because that would be the biggest insult that could possibly happen. What we want to hear is, “Wow, you look great!” and your answer is very simple, “Thank you.”

What is really interesting about studying medicine, we’re starting to look at the psychological impact that it has on individuals. For instance, there was a study done looking at Botox and depression, and just the fact that when you get rid of these frown lines on our face, that people who have clinical depression were more likely to respond to treatment than those who did not have Botox. So, think about it in simple terms, you get up in the morning, you look in the mirror, you have the furrowed lines and you go, “Oh, I still feel bad today.” When those lines are gone, it has a positive impact on yourself and the reflection that you’re seeing in the mirror every morning. So, Oprah Winfrey said it best, “It’s confidence in our mind, body and spirit that make us want to chase that new adventure.” We’re here to help you chase your new adventure by giving you confidence in the way you look, which makes you feel better and makes you ready for your next adventure.

People want to know about the complications and the recovery from fillers. Now when we’re doing the fillers, pain can be an issue. We do lots of things to minimize pain from topical anesthetics to regional blocks. I will use blunt needles. These blunt needles are much less likely to cause pain, and they also give you a better opportunity to avoid bruising. Sometimes we have to use a sharp needle, which can cause bruising, which is the most common problem we see with patients after surgery or injectables. What we’re typically seeing is these bruises go away in a few days and are typically covered with makeup without a problem, when they do occur.

Over the last 10 years, we have seen an explosion of non-surgical options for our patients. We, as plastic surgeons, are the best situated to provide these non-surgical products because we understand the anatomy of the face, including the muscles, and the arteries and where we should be putting these as sculptors. The difficulty is, for the consumers, they’re going, “What’s the difference between all of these?”

We have Botox, which is a neuromodulator and has become a household name, like Kleenex. That paralyzes muscles, doesn’t take up space. We then have fillers. And when it comes to the fillers, we have 11 different fillers. Now, my goodness, how do we choose which one of these fillers do we use? And then, we’re gonna complicate things with bio-stimulators, meaning we inject the substance and your body makes its own collagen. The critical thing to understand between these different products is they all have a job that they do, and we need to decide what job you need to have done. And that’s where our expertise comes in.

For instance, fillers, they take up a space. They can fill a wrinkle or a dent in the face. We will choose the appropriate filler for the appropriate wrinkle. I may use one filler for a wrinkle that’s fine. And I’ll go to a larger wrinkle and use a totally different filler. The complexity of the choices becomes the entry level that we need to have as practitioners to give you the optimal result.

Fillers, neuromodulators and biostimulators, are nothing more than tools, just like knives, lasers, fat injections and surgery. So the tools are what we use as artists to create the optimal picture after a treatment. I will look at your pictures, and what we’re trying to achieve, and then I choose the best tool that will give you the best outcome, depending on what you are willing to go through, as far as time, expense and recovery.

The big concern people have is related to the pain and discomfort. There’s a real needle phobia. We will do everything to alleviate your pain and discomfort by putting a topical anesthetic on, which gives you a numbing affect all parts of your face. We can also do dental blocks, where you feel nothing. The idea that you’re going to suffer through this and put up with the pain is not part of our agenda. Controlling your pain also allows us to control bruising. Understand that when you have pain, your blood pressure goes up. Blood pressure goes up, you increase bruising. However, sometimes bruising occurs despite our best efforts, and it’s a disappointment for all of us. We do have makeup and covers that will help you avoid the signs that you have bruising.

The most common complaint I have in my office from people are lips. Everybody is scared to death of the large lips, and there’s a very simple reason we’re seeing so many odd-looking people out there. There’s a ratio of the upper lip to lower lip that was described by the Egyptians. The upper lip should be half the size of the lower lip. What we’re seeing out there are fillers being placed in the lips by people who are not taking this golden ratio into effect. In other words, they’re putting so much filler in the upper lip, it looks like they were stung by a bee. It attracts attention to them, and it’s a very odd look, and that creates fear. If we can train people to stop injecting the upper lip and add it to the lower lip, we can create beautiful lips. Now the last thing to understand about lips, it’s not the filler that creates bad lips, it’s the person that’s holding the syringe of filler that creates the bad lip.

So when people come to me in consultation, we look at the pictures of where they are. And we’re talking about static time, because remember, life is like a river. When you step in the river and you step out, you don’t step back in the same space, because that water has moved on. And our face is the same way. If we do something to the face today, whether it’s surgical or non-surgical, the aging process, if we’re lucky, will continue to move on.

So there are things that we can do surgically to restore a face, and then we need to think about … how do we maintain what we’ve done? Maintaining our investment, if we will. In those circumstances, we can use non-surgical means such as Sculptra. We can use fillers. We can use Botox, skin care or laser as part of our maintenance program, and vice versa. If someone’s not quite ready for a facelift … they can’t fit it into their schedule. They can’t afford it. It’s too scary. There are small things we can do in preparation for the facelift. In the same vein, we can use neuro-modulators, Botox, fillers, Sculptra, lasers as part of the maintenance program prior to having a facelift.

So the idea is, none of these treatments last forever. There’s nothing that is permanent in life, so we’re trying to treat you at a point in time to make you better today, such that 10 years from now, you’ll still be better than you would’ve been had you done nothing.

Currently, one of the more exciting things that we’re doing is using Sculptra away from the face. We’ve got 10, 14 years of using the face. Most recently, I’ve been injecting it into the chest. We make the face look awesome. The neck looks good, but you move into the chest, we see the wrinkles. We see the lines from sleep. We see the sun damage. What we’re finding is by injecting Sculptra into the chest, and then using some type of imaging device, whether it be a laser, which resurfaces the skin, or lasers that get rid of brown spots. We’re restoring the chest so that your dress is open all the way to your bosom, shows good, healthy, clear skin. This is very exciting, the results we’re seeing with this usage of Sculptra.

When you look at the options that you have in front of you for fillers, we have at least 11 in our practice right now, with more coming before the end of the year. The way we choose the filler is to determine what job do you want done. One filler in one line is optimal, where that same filler in another line is less than optimal. So think about it this way. The fillers come in different consistencies, sometimes it’s thick and it’s hard and it’s firm. And that works great when we’re trying to lift the cheeks, because we’re trying to get lift and elevation with a heavy type of tissue. Other times, we’re talking about the fine lip lines around the lips, the lip lines. Under those circumstance, we want to use a liquidy or very thin, very viscous type filler that will then fill that line without leaving those bumps and irregularities. So the choice of the filler is very, very important. And it’s important that we have all these options available to you at any time in our office. It’s not a default, “Well, this is the one I have. So this is the one I’m going to use.”

At this point in my career, nonsurgical sculpting of the face using fillers, Botox-type products like Dysport, neuromodulators and biostimulators, makes up at least half my practice. I’ll do well over 2,000 faces a year with injections sometimes, but that’s about half of my time. Because of the high volume of usage, I’ve now been invited to participate at the surgical advisory board level and writing papers. We’re publishing papers on the use of biostimulators and fillers. This expertise allows us to be on the forefront, the cutting edge, in the use of fillers to optimize nonsurgical treatment of your face. Nonsurgical means you come to the office, you have your treatment, and you are able to return to your normal activities the next day.

For the last five to six years, I’ve been involved in the industry in the advisory boards for fillers. I’ve been involved in surgical education, and so I’m very well aware of the things people are afraid of. When we look at filler, for instance, there are three reasons people don’t have fillers. We’ve identified 20 million women in America who want to have fillers in 2016. Only 2.6 million people had fillers. There are three reasons that they elect not to have treatment. First and foremost is fear, fear of looking different. That is our expertise, is not presenting or creating someone that is different.

The second fear is fear of pain and discomfort. Pain and discomfort can be overcome with using topical agents. We use vibratory sensors, and we use dental blocks for those who have a real aversion to needles and pain and discomfort. Interestingly, the third pain point that prevents people from having treatment is price, and that is a very low percentage of people who avoid treatment as compared to fear of looking different and fear of pain.