How to Inject SCULPTRA®: Technical Considerations in Soft-Tissue Contouring

David Fuller

Last Updated On: June 20, 2024

SCULPTRA® is a unique dermal filler composed of poly-l-lactic acid (PLLA). This collagen stimulator inducing new collagen production has gained popularity recently due to its ability to treat multiple areas of the face and body with minimal downtime and few potential side effects. 

However, to achieve the best possible results, it is important to understand the technical considerations to achieve safer, consistent results while minimizing the risks of complications. This article will thus explore the uses of SCULPTRA® as a volumizing agent in the face and the body and provide safe techniques for injecting poly-l-lactic acid.

Key Takeaways

• SCULPTRA® is a unique dermal filler composed of poly-l-lactic acid (PLLA) used to treat various face and body areas.
• It is a non-invasive technique that is preferable to plastic surgery because of fewer side effects, great results, and less downtime.
• Depending on the treated area, different techniques should be used in administering SCULPTRA®.

Which Areas Can Be Treated With SCULPTRA®?

As we have already mentioned, SCULPTRA® can be injected into most areas of the face, including the chin, cheeks, jowls, temples, nasolabial folds, and marionette lines. It is also important to note where not to inject SCULPTRA®, for example, into the peri-orbital area, the lips, or the forehead. SCULPTRA® injections are designed for the deep dermis, not superficial facial areas or mucous membranes.

SCULPTRA® can also be used for body contouring to replenish or add volume. These areas include the midface, temples, chin, cheeks, décolletage, chest, neck, hips, knees, upper arms, and buttocks. Many patients prefer this non-invasive injectable treatment to plastic surgery. Unlike the alternative, SCULPTRA® injections are relatively quick, painless, and involve zero downtime while producing the desired cosmetic results.

SCULPTRA® Injections for the Face 

As mentioned, SCULPTRA® is becoming a more prominent facial treatment to reduce signs of aging. Its unique features allow it to reduce the appearance of fine lines and wrinkles while enhancing the firmness and quality of the skin over time, creating a more youthful appearance over several months.

How to Inject SCULPTRA® in the Face?

There are two types of techniques recommended for injecting SCULPTRA® in the face: threading/tunneling and depot.

The threading or tunneling technique is the most appropriate for the mid and lower face (cheek, preauricular, and malar regions). It should also be administered in a cross-hatching pattern to cover the desired treatment area more evenly and avoid skip areas. When treating these areas, the needle should be inserted into the deep dermis or the junction with the upper subcutaneous layer at a 30-40-degree angle, and then the needle should be injected parallel to the skin. The person administering the treatment should notice a change in tissue resistance as the needle traverses the dermal-subcutaneous junction. SCULPTRA® is injected as the needle is withdrawn, stopping short of the superficial dermal layer.

The depot technique is recommended for other areas, such as the temples or upper zygoma. Regarding the infraorbital area, SCULPTRA® injection should be reduced to small boluses of 0.05ml per injection. The needle is placed below the orbicular oculi muscle, depositing the product just above the periosteum. On the other hand, when treating temples, the needle should be inserted at a 45-degree angle, with the final product placed below the level of the temporalis muscle fascia. A medical professional must use a reflux maneuver before depositing SCULPTRA® to ensure that a blood vessel has not been entered.

SCULPTRA® Injections for the Neck

Aging of the neck can manifest as cutaneous dyschromia, skin laxity, rhytides, loss of the mandibular contour, widening of the cervicomental angle, accumulation of submental fat, and volume loss. 

Certain procedures, such as hyaluronic acid (HA) fillers, calcium hydroxylapatite (CaHA), and poly-l-lactic acid (PLLA), have been shown to provide favorable outcomes in the treatment of horizontal necklines. According to research, these products have demonstrated a more seamless integration into the skin and can be placed superficially with less risk for nodule formation. However, nodules can still occur, which is why it is important how you inject SCULPTRA®.

Medical professionals should inject SCULPTRA® as small aliquots and evenly into the subdermal plane to prevent a nodular appearance to the corrected neckline.

Where to Inject SCULPTRA® in the Neck?

SCULPTRA® filler is injected into the dermal layer of the skin on the neck, where deep wrinkles and high skin laxity are most apparent. If SCULPTRA® is injected too superficially, you will notice the injected area blanch. If this occurs, remove the needle and circularly massage the area. Blanching may represent a vessel occlusion. If normal skin coloring does not return, do not continue with the treatment.

SCULPTRA® Injections for the Chest

Injectable soft tissue fillers are widely used to rejuvenate décolletage and improve skin laxity and texture. The majority of the current literature describes how to inject SCULPTRA® in chest in this way for maximum effect. 

Prior to use, PLLA requires reconstitution in sterile water, which is usually combined with lidocaine with or without epinephrine. It is recommended to use at least 5ml of sterile water for reconstitution 24 to 72 hours before injecting SCULPTRA® into the décolletage area. However, when treating the chest, larger volumes are recommended (10-18ml).

How to Inject SCULPTRA® in the Chest

The product should evenly be injected in a retrograde fanning technique into the subdermal space using a 27-gauge needle within the boundaries of the suprasternal notch superiorly, midclavicular lines laterally, and inferior sternum or 4th ribs inferiorly. You should advise your patient to massage the treated area for five minutes, five times a day, for five days after injection. Three to four treatment sessions one month apart are recommended for optimal results.

SCULPTRA® in the Buttocks

When it comes to buttocks augmentation, SCULPTRA® treatment can be customized to fit the aesthetic goals of the individual. A great candidate for the SCULPTRA®, but lift is an individual looking for a fuller, plumper, curvier, and rounder butt without the risk and downtime associated with traditional plastic surgery. 

Where to Inject SCULPTRA® in the Buttocks?

When SCULPTRA® is injected in the buttocks, it is important to target the area along the top of the butt to help fill sunken areas to help the behind appear rounded and lifted. Since many individuals experience indents on the side of their butts, SCULPTRA® is injected along depressed areas to provide a rounder appearance.

The average number of vials for buttock augmentation is five for each buttock, with most patients needing three treatment sessions. This ultimately equates to 30 vials of SCULPTRA® on average. It is important to note that the number of SCULPTRA® vials will depend on the patient’s anatomy and aesthetic goals, so the number of vials may vary.

Is SCULPTRA® Injected in the Muscles?

SCULPTRA® can be injected near sphincter muscles as long as it is injected deep into the muscle. The patient is then encouraged to massage the injected area to ensure the SCULPTRA® is spread evenly. Remember, never inject in or superficial to any sphincter muscle, as those muscles can move the seedlings away from the intended area.

Conclusion

Since SCULPTRA® is an exceptional dermal filler that can address various cosmetic concerns in multiple areas, it is important to consider the techniques for each targeted site. As the demand for this treatment continues to increase, it is important to stay up-to-date with recommended dosage, techniques, and instructions on how to inject SCULPTRA®.

FAQ

How deep should SCULPTRA® be injected?

SCULPTRA® should be injected into the deep dermis. Superficial injections are ofter associated with increased local adverse events such as nodules and papules.

Where is the best place to inject SCULPTRA®?

The best place to inject SCULPTRA® is along the outer border of the face, from temples to chin. Injections should be inserted along the natural bony contours for the best results.

How do you maximize SCULPTRA® procedure results?

Follow the 5-5-5 rule to ensure the best possible result. Massage the area for 5 minutes, five times a day, for 5 days.

Does SCULPTRA® injection lift?

The SCULPTRA® treatment lifts the skin without surgery or downtime and provides some of the longest-lasting skin rejuvenation results.

Can you inject too much SCULPTRA®?

Yes, it is. Once you have used too much SCULPTRA® vials, it is hard to correct. One possible solution is to remove the product surgically, but this can have some consequences.

How many SCULPTRA® vials should be used per procedure?

Number of SCULPTRA® vials per treatment varies based on the amount of volume patient wishes to be added, and the treated area.

References:

Lam, Samuel M. M.D.; Azizzadeh, Babak M.D.; Graivier, Miles M.D. Injectable Poly-L-Lactic Acid (SCULPTRA®): Technical Considerations in Soft-Tissue Contouring

https://journals.lww.com/plasreconsurg/abstract/2006/09011/injectable_poly_l_lactic_acid__SCULPTRA®__.10.aspx

Sabrina Guillen Fabi, MD Fillers for the Décolletage Area Fillers offer patients an alternative to device-based interventions for chest rejuvenation.o, MD 

https://practicaldermatology.com/articles/2015-sep/fillers-for-the-dcolletage-area

Dr. Michele Green, M.D. SCULPTRA® for Chest Wrinkles & Décolletage

https://www.michelegreenmd.com/SCULPTRA®-for-chest-wrinkles

Jean Carruthers, Alastair Carruthers, Jeffrey S. Dover, Murad Alam, Omer Ibrahim Procedures in Cosmetic Dermatology: Soft Tissue Augmentation

https://books.google.rs/books?hl=en&lr=&id=wGCoEAAAQBAJ&oi=fnd&pg=PA239&dq=SCULPTRA®+chest&ots=cSHUyNafQk&sig=zLanLsn0aaZZJksi3BfJ_wprk3w&redir_esc=y#v=onepage&q=SCULPTRA®%20chest&f=false

The Dermatologist, 2007, A Recommended Approach to Cosmetic Enhancement with SCULPTRA®

https://www.hmpgloballearningnetwork.com/site/thederm/article/7851