Plastic Surgeon Dr. Dean Kane of Baltimore Answers Question Regarding Reversing Sculptra Nodules

Q. Can Sculptra be reversed with ith 5FU and steroids? How many injections does that typically take? Why do some doctors say 5FU/steroids can reverse the effects and others say it’s impossible to reverse? If Sculptra was injected unevenly and I would image collagen breaks down evenly then that would mean that someone’s original face shape prior to Sculptra would never return, right?

A. Sculptra is a wonderful bio-stimulatory filler that when fully understood and used by the injector in  well selected patient! Unlike hyaluronic acid (HA) fillers which are very smooth, homogeneous and attract water to produce a volumetric expansion, Sculptra is different!

The Sculptra molecule (poly-L-lactic acid) does not easily mix with water or xylocaine liquid. It must be prepared in anticipation of its injection no less than 48 hours in advance. It forms a suspension and upon injection must be massaged well and frequently to distribute the molecules evenly or a micro-clump of these molecules will over stimulate the fibroblast to form more localized collagen and other structural molecules. The idea is to induce more structure to the fibrous network of tissue under and in the skin rather than attract water.

Like any injection, do not confuse a lump of inflammatory changes with a true, spicule / granule / nodule of collagen. It generally takes 3 weeks or more (following 4 or more series of Sculptra injections in very thin skinned individuals, in my experience) to form a collagen clump. I have explored this concern and believe it is collagen and not a granuloma). Options to reduce such a spicule / granule / nodule of collagen depend on timing following its injection.

  1. Spicules can usually be massaged out
  2. Granules (the size of a sugar crystal and up to a half size of rice) can be “dissolved” with:
    1. 1 to several direct injections with xylocaine and deep massage, 2 to 4 weeks apart or
    2. Very dilute Kenalog (steroid) injections 6 weeks apart.
  3. Larger nodules, ie a longer period of time “percolating along” to develop larger quantities of collage may need excision and fat grafting.

I have tried valiantly to find information on the use of:

  • collagenase  to enzymatically breakdown the nodule without atrophy of the surrounding tissues (using steroid), and
  • 5FU to reduce fibroblast production of the structural molecules, but

Unfortunately, I find no local experience and the manufacturers of these medications (probably because of this off-label use) will not respond.

To date, I am pleased with the above options particularly when treated early.

Use a talented and skillful Sculptra injector with great experience to discuss the benefits and limitations of this injectable “filler”.

Read more about similar topics:

Sculptra Nodule

This information is not meant as medical advice. It is provided solely for education. Our practice would be pleased to discuss your unique circumstances and needs as they relate to these topics.

Give us a call at  410.602.3322  or email Lauri@DrDeanKane.com and make an appointment soon. We’re located on Reservoir Circle just a block off the Baltimore beltway, convenient to greater Baltimore, Annapolis, the Eastern Shore, Southern Pennsylvania, Delaware and Carroll County.

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