Q. Does Sculptra cause scar tissue? Can sculptra cause scar tissue that causes problems down the road?
A. The simple answer is yes, Sculptra causes scar tissue. You’ve opened up a Pandora’s Box of questions with few answers.
There are 16 types of collagen making up 25 to 35% of all the protein in the human body and the single most abundant protein in the animal kingdom. Type I, II and III collagen make up 80-90 percent of human collagen and found in the skin, bone, blood vessels, gut, intervertebral discs, tendon, cartilage muscle and other areas. Collagen is made by the fibroblast (and other cells) of amino acids in a way that they attract each other forming a triple helix during the non-inflammatory growth and inflammatory repair phases of life.. In all areas, their structure and function are to form fibrils to withstand stretching (eg. drooping, sagging, ptosis, stretching of tissues).
During the process of healing, scar is formed to gather or hold-together the tissues torn apart. Scar is made of collagen.
Sculptra is the name of a molecule of poly-L-lactic acid (PLLA) which induces the fibroblast to make collagen. Approved by the FDA in 2004 for the treatment of facial fat loss, it has a side-effect of making nodules when used or coalesced into high concentrations but has since been re-approved by the FDA to treat wrinkles in a different treatment formula. Sculptra is found to thicken skin via collagen neo-synthesis. Sculptra nodules are found to be nearly 100% collagen and not a foreign body reaction. It is interesting that Sculptra then became categorized as a filler (ie. volumizing) injectable rather than a “bio-stimulant” which it act as.
The following questions arise:
Does Sculptra form scar?
Yes, in a manner of speaking, scar is collagen.
Which of the 16 types of collagen does Sculptra form?
Unknown to me.
Is it only fibroblasts that form collagen?
No. Past studies have found PLLA to induce collagen formation along bone and tendons so it is possible for other cells to produce collagen, callus or scar. Sculptra does not appear to stimulate fat cell production (anecdotal experience).
Are Sculptra induced nodules able to be medically removed or are they always surgically excised?
When miniscule (like a granule of sugar) or small (like a grain of rice), I have found that expanding the concentrated Sculptra nidus of collagen with xylocaine/Marcaine breaks apart and dilutes the nodule such that the patient is able to remodel the mass into smoother, imperceptible micro-accumulation with deep and persistent massage. Larger than a grain of rice and a touch of 5-10% Kenalog with persistent massage with breakdown the “non-inflammatory” produced aggregate (like it does with hypertrophic scarring) with the caveat that adjacent soft tissues may atrophy. Collagenase in theory should be able to break down each of these granules and nodules as it does with Dupuytren’s Contracture cords but the collagenase-producing pharmaceutical company and the Sculptra pharmaceuticals have ignored all my inquiries.
Can Sculptra cause problems down the road, as you asked?
Yes and no. It depends on whether the results you obtained were desired or not. Sculptra in my hands and in my experience has provide options in skin thickening, tissue firming, reduction in wrinkling and skin irregularity that no other option has yet produced. The risk/benefit ratio must be fully discussed with each patient regarding their individual concerns, desired results and willingness to risk the side-effects. At this time, I am unaware of nerve injury, embolization, tissue necrosis, lymph node enlargement or obstruction nor any other adverse events other than nodularity.
I hope this has been helpful. Please consult with a talented, skillful and well experienced Board Certified, Plastic Surgeon, Sculptra injector to review your desires and provide the options for the results you seek. All the best!
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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.
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