Dr. Dean Kane Q & A 
Q. I did Sculptra 12 months ago on my forehead and this visible lump is still there. Sometimes it is a big massive lump and sometimes is two smaller nodules. I have been massaging it everyday. Does massage help and is there any certain cream I can use when I am massaging to make it go away faster? Does HIFU (high-intensity focused ultrasound) on the lump make it better or worse? Or it will eventually go away in 2-3 years later even I do nothing? Thanks in advance.
A. Sculptra use is injector AND patient dependent. Sculptra is a bio-stimulant of collagen production in thinning tissues. It is particularly useful to firm the skin and resist creasing by causing a slow and gradual stimulus of those cells forming collagen and other structural proteins.
It had in the past developed a reputation of forming collagen lumps or nodules. This has largely resolved with newer techniques of dilution and injection. There are areas where the Sculptra molecule if not properly massaged may coalesce and stimulate a growing mass of collagen.
In my personal experience, the forehead, particularly around the fusion line of the temporalis muscle and the upper outer orbital ridge are areas of nodule formation. This may be due to inadequate dilution, distribution or massage. If found early on, injection of local anesthetic to dilute the area and desensitize the area for deeper scar massage has been very helpful. Other alternatives include the use of dilute Kenalog and massage or collagenase and massage.
The consideration for using creams or HIFU (high intensity focused ultrasound) or other lasers to resolve the lump is not known to me but theoretically, any further injury may make the situation worse by further stimulating an inflammatory response to produce scar (collagen) rather than remove that response.
Please seek the expertise of a Board Certified Plastic Surgeon, ENT Facial Surgeon or Dermatologist well experienced in the use and care of Sculptra therapy.
I hope this has been helpful. All the best!
