face & body, issue 04/2021
In aesthetic surgery there are many ways to reduce wrinkles and rebuild lost volume in the face, neck or décolleté. Various materials and treatments are used for this purpose. Synthetic materials such as hyaluronic acid and botulinum toxin, as well as autologous materials such as the patient's own fat, have been popular with patients for decades to rejuvenate their appearance. Equally popular for wrinkle reduction are minimally invasive procedures, such as vampire lifting, thread lifting or treatment with high-intensity focused ultrasound. The combination of some of these treatments also leads to very good results in wrinkle smoothing and facial tightening.
More and more patients want facial rejuvenation without significant downtime and without the risk of a surgical procedure. Therefore, a facelift is usually preceded by several years during which the patient has undergone various minimally invasive treatments to reduce wrinkles and regain facial volume and skin elasticity.
Since the beginning of the year, I have been using the biostimulator Sculptra® by Galderma in my practice. A biostimulator has the ability to stimulate a specific effect in the tissue — in the case of Sculptra®, for example, tightening and smoothing of the skin through collagen building. Sculptra® is based on the stimulation of collagen type 1. The injectable substance is used to compensate for minor volume deficits in the face in addition to tightening effects. The biostimulator can also be used to tighten the décolleté and neck. Sculptra® can also be used to optimise certain body areas, such as buttock tightening and the treatment of hip dips. The biostimulator is also suitable for body contouring. However, these applications can currently only be carried out with an off-label indication.
What is Sculptra®?
Sculptra® is a PLLA biostimulator. It consists of poly-L-lactic acid, sodium carboxymethylcellulose and mannitol.
PLLA is a biodegradable collagen stimulator that is metabolised naturally in the human body after injection. The treatment thus stimulates fibroblasts and collagen neogenesis gradually, producing a naturally appearing tightening effect. The formation of collagen restores the natural firmness and elasticity of the skin and renews the skin structure. This process forms the structural basis for restoring a more youthful appearance. After treatment, the quality, volume and elasticity of the skin demonstrably improve.
Sculptra® wrinkle treatment is particularly suitable
- for the treatment of deep wrinkles, such as nasolabial folds or marionette lines
- for volume building in sunken cheeks (hollow cheeks) and temples – the so-called liquid lifting of the mid-face
- for the treatment of sunken scars
- for accentuating the chin-jaw line / jawline - so-called liquid lifting of the lower half of the face
How does Sculptra® work?
- Sculptra® works deep in the skin and stimulates natural collagen neogenesis.
- It improves the quality, volume and thickness of the skin.
- By stimulating the production of collagen type 1, Sculptra® can help restore skin quality and volume in ageing skin.
Why is collagen so important for the skin as we age?
The loss of collagen is a key factor in the ageing process. Collagen is a fibrous protein in the deep layer of the skin, the so-called "dermis", which gives the skin structure and helps maintain the shape of the skin. At the same time, collagen supports the function of elastin and hyaluronic acid (HA), thus keeping the skin supple and hydrated. The skin loses approximately 1% of collagen per year. However, a natural and healthy supply of collagen to the skin is the foundation for a youthful appearance. Sculptra® acts on two key components of natural skin ageing: starting around the age of 30, not only does overall collagen production decrease, but collagen is also formed in reduced quality. Sculptra® wrinkle treatment stimulates and builds up the body's own collagen many times over.
The Sculptra Treatment
The Sculptra® solution is injected under the skin in a fan-like pattern through special cannulas. Afterwards, the solution is intensively massaged and distributed at the treated areas. It is particularly important that the patient massages the treated areas 5 times a day for 1 minute for a further 5 days in order to achieve an even distribution of the Sculptra® solution.
Sculptra® treatment cannot achieve an immediate effect. Only in the course of treatment does a gradual visible improvement in the firmness and elasticity of the skin occur over a period of several months. Wrinkles are reduced and the face appears increasingly more youthful and fresh. First naturally looking results appeared 2 months after a second treatment.
By stimulating the body's own natural collagen production, the effect of Sculptra® unfolds gently and gradually. The collagen content in the skin is gradually rebuilt. The final result is clearly visible in a firmer and smoother complexion. Sculptra® demonstrably increases the content of collagen type I by 66% after just three months. This type of collagen is one of the main characteristics of young and elastic skin.
For Sculptra® treatment, the biostimulator is drawn up and mixed with sterile water. In addition, lidocaine can be added immediately before injection to make the injection more comfortable and pain-free for the patient. Thanks to the higher dilution, side effects such as nodule formation, papules or hardening are less likely to occur.
While the fluid of the injected volume is resorbed within a few days, the PLLA particles remain in place. They recruit macrophages, which subsequently fuse into giant cells and in turn attract fibroblasts. The fibroblasts form the collagen that gives the skin new firmness. Nine months after injection, PLLA is absorbed by hydrolysis. Only the newly formed collagen fibres remain, providing an explanation for the long-lasting treatment effect.
For an optimal result of Sculptra® facial tightening, 2-3 build-up treatments at intervals of 4-6 weeks are necessary. The result of the treatment continues to improve for up to one year after the last treatment. The rejuvenating effect then lasts for up to 25 months. Due to the natural ageing process, the skin may lose some of its elasticity again within this time, at which point a refresh treatment is advisable. These refresh treatments serve to re-stimulate collagen and can maintain the natural lifting result over the longer term. Such refresh treatments are recommended approximately every 2 years.
With increasing age, the skin shows greater loss of volume and elasticity. Early wrinkles are also already more pronounced, nasolabial folds and jowls develop. In these cases, Sculptra® is an optimal treatment to compensate for volume loss and restore the firmness and structure of the skin. The treatment with the collagen booster can also counteract skin sagging and drooping without altering facial features. Whether Sculptra® treatment is the appropriate procedure for wrinkle treatment can only be decided on an individual basis. The biostimulator cannot be used in all facial areas. For the smoothing of forehead wrinkles or crow's feet, for example, the biostimulator is not suitable.
(Dr. Karl Schuhmann, source Galderma)
