Sculptra ChicagoQuestion: If I am interested in understanding how injectable Sculptra (poly-l-lactic acid) might work for me, who do I talk to?

Answer: Probably the most important thing to do is find a physician who has a lot of experience treating the aging face. ABPS (American Board of Plastic Surgeons) Certified Plastic surgeons like myself are trained in the gamete of surgical and non surgical procedures that treat the aging face.

Background and Approach

Throughout my career, and especially since 2003, I have treated patients, over time, to help them approach facial aging in a medically safe way. This is called a longitudinal approach which includes both non surgical treatments as well as surgical treatments.

As we age, we may or may not see the loss of our cheek fullness, but we always see the development of nasolabial folds and jowls. I believe that those signs of aging are best treated after your face has been evaluated comparing it to your youthful photographs. This way we can both better understand how your face has uniquely aged. Usually it is complicated and involves skin, facial fat and bony changes.

Part of the process involves Sculptra. Sculptra is a unique product that I have used as part of a comprehensive approach to treat the aging face off label since 2006 (and on label since 2009). And as you may know from my blog, using injectable Sculptra is a unique non surgical procedure that is used to restore facial volume.

In fact, because of my dedication to the art of Plastic Surgery and to the science of the facial aging, I was compelled to study this unique product in 2006 when it became available for AIDS patients. AIDS patients also loose facial volume due to their disease.

So I was very interested in studying Sculptra in my facial aging patient population because until 2006 – and still to date – there are no other products that work to stimulate your collagen to form more collagen. And more collagen renders your face looking more youthful without as many folds, creases and lines.

The Study

In January 2011, my pilot study of 106 consecutive patients was published in our prestigious Aesthetic/Cosmetic Plastic Surgery Journal, The Aesthetic Surgery Journal which is published by Sage publishing company.

This study represented 4 years of treating and evaluating 106 consecutive patients who were successfully treated with injectable Sculptra for facial aging. This product once injected under a facial crease or fold will stimulate your overlying skin to form thicker collagen so that gradually over 4-6 months your facial aging treated areas will be reversed for 2-3 years.

The strengths of this product are that its effects are gradual and subtle and that they last a long time as compared to fillers. I recommend using Sculptra when a patient shows signs of facial aging that involves loss of soft tissue fullness that results in creases, folds and lines. In combination with an individualized skin care regimen that includes topical Retin A, patients see subtle but clear changes that allow their faces to look more youthful.

Below is the abstract from the January 2011 Aesthetic Plastic Surgery journal published by the Sage Publishing company which outlines the scientific work that Dr. Schierle and I did.


Nonsurgical Rejuvenation of the Aging Face With Injectable Poly-L-Lactic Acid for Restoration of Soft Tissue Volume

Clark Friedrich Schierle, MD, PhD | Laurie A. Casas, MD

Dr. Schierle is Chief Resident in the Division of Plastic Surgery, Northwestern University, Chicago, Illinois

Dr. Casas is Clinical Associate Professor in the Section of Plastic Surgery, University of Chicago Pritzker School of Medicine, Chicago, Illinois


Background: Characteristics of the aging face include soft tissue atrophy, loss of skin elasticity resulting in excess facial skin, and gravitational descent or ptosis of facial soft tissues. Poly-L-lactic acid (PLLA) is a synthetic biodegradable polymer that provides soft tissue augmentation through stimulation of an inflammatory tissue response with subsequent collagen deposition.

Objective: The authors discuss the special considerations inherent in facial aging, describe the mechanism of action and indications for a new PLLA filler under consideration for Food and Drug Administration (FDA) approval (Sculptra Aesthetic, sanofi-aventis US, Bridgewater, New Jersey), and detail the results of a two-year off-label pilot study with the product.

Methods: The senior author (LAC) treated 106 patients with PLLA in an off-label indication, as part of a pilot study while Sculptra Aesthetic was being evaluated for FDA approval for cosmetic indications. All patients were followed up for two years to help develop a protocol for injection technique.

Results: The age range of patients in this series was 40 to 78 years. Three patients were male and 103 were female. Patients received an average injection of 1.6 vials per session, over an average of 2.3 sessions, to achieve volume restoration in the tear trough, midface, malar region, nasolabial folds, prejowl area, mandibular border, and mandibular angle. The authors we achieved 100% follow-up with 99.1% patient satisfaction. The rate of nodule formation was 4.7% at a minimum follow-up of two years.

Conclusions: Because of its unique mechanism of action, PLLA for nonsurgical facial rejuvenation requires meticulous injection technique with special considerations for optimizing outcomes and minimizing adverse events.

injectable poly-L-lactic acid (PLLA) Sculptra nonsurgical facial rejuvenation cosmetic medicine facial volume restoration soft tissue augmentation medical aesthetics soft tissue facial atrophy This article investigates the injection of poly-L-lactic acid in a manner that was off-label at the time of treatment.

In recent years, our understanding of the anatomical changes associated with facial aging has expanded dramatically. It is clear that in addition to excess skin laxity and gravitational descent of the soft tissue envelope, facial aging also results in a loss of soft tissue volume, erosion of critical bony landmarks, and deterioration in skin quality.1-4 Comprehensive treatment of the aging face requires a thorough understanding and skillful application of the full spectrum of surgical and nonsurgical treatments. The authors believe that a longitudinal approach is ideal, including nonsurgical treatments to address skin quality, soft tissue volume loss, and skeletal deficiencies, as well as surgical treatment of skin and soft tissue ptosis.

Injectable poly-L-lactic acid (Sculptra Aesthetic; sanofi-aventis US, Bridgewater, New Jersey) is a synthetic biodegradable polymer that provides soft tissue augmentation through stimulation of an inflammatory tissue response with subsequent collagen deposition. Because of its unique mechanism of action, it behaves entirely differently than both traditional injectable fillers and fat injections. The senior author (LAC) has successfully treated 106 consecutive patients with two years of follow-up in an off-label fashion as part of a pilot study. On July 29, 2009, the Food and Drug Administration (FDA) approved an aesthetic indication for the product and its application has become more widespread as a result. Several critical technical considerations have emerged from our experience that have helped to optimize results while minimizing adverse events; those considerations are outlined here, along with an overview of facial aging and information about the Sculptra product itself.

How can I get more information?

Call now for your complimentary consultation.

You may reach us at the Chicago North Shore suburbs of Glenview (847-657-6884).

Dr. Laurie A. Casas and her team will work with you to develop a treatment plan for your cosmetic and aesthetic wishes.
Author: Dr. Laurie A. Casas, – MD, FACS

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