How Sculptra works, where it works, and how it’s different from fillers [Colleen Phillips, PA-C - Portland, Oregon]

Eva Sheie (00:00):
You're listening to Where Before Meets After.

Colleen Phillips (00:03):
My name is Colleen Phillips. I'm a PA with Portland Plastic Surgery Group and MD Beauty Lab. I have been here for 10 years.

Eva Sheie (00:12):
One of the things you're well known for and also very good at, I believe is Sculptra. Can you tell us what is Sculptra and what do you like about it?

Colleen Phillips (00:21):
Sculptra is a PLLA Poly-L-Lactic Acid. It is the same thing that is one of the dissolvable sutures that we've been using in the operating room for years. When we all know whether it's a heart valve, you're sewing in or closing off the pocket to a breast implant or joint surgery. We all know that dissolvable suture is gone in about six to 12 weeks. Your body dissolves it into CO2 and water. So they've figured out how to get this in a powdered form, reconstitute it with sterile water and a little bit of lidocaine to make it a little more comfortable and inject it under the skin in the face to stimulate collagen and fibrin in that same way. We know we lay down a whole new matrix of fibrin and collagen

Eva Sheie (01:10):
And so what's the purpose of that? Who do you use it for?

Colleen Phillips (01:13):
The purpose that you can go in a couple different layers of the skin to get more of a skin result or to get more volume. So if you're in an area where there's a lot of brown spots and a lot of fine lines and things, you stay a little higher in the reticular dermis and you'll see some more skin changes. Also, when you're really going for volume, you can go deeper in the fat. Some of the latest data in Sculptra has shown that it actually stimulates adipocytes, which is fat cells, so we can get more volume when we place it a little deeper and a little more skin changes when we want that. So in areas of the medial cheek, higher cheek will go a little more superficial, but still be in the backside of the dermis, and when you really want volume, you'll go more in the fat subcutaneous layer.

Eva Sheie (02:06):
Why would someone want more fat in their face?

Colleen Phillips (02:09):
For volume. We have fat, as we age, we lose volume in all ways, and one of them is fat. It descends and it shrinks.

Eva Sheie (02:19):
Why would you choose Sculptra over some of the other fillers and how would they be different?

Colleen Phillips (02:24):
Well, Sculptra is a bio stimulator, so you're actually stimulating your body to do a lot of the same things that we've been using fillers over the years, starting way back with collagen, which I actually injected. Quite a few different things have come along now. The hyaluronic acid fillers are the most popular. It's a very hydrophilic molecule that we're placing into an area where we already have a lot of that. So it's like to like and volumizes.

Eva Sheie (02:53):
And so just like those dissolvable sutures, this material also dissolves? It's gone after some period of time?

Colleen Phillips (02:59):
Yes. It is gone in six to 12 weeks. Yes, and that's when your body then is replacing it with your own fibrin and collagen. We know that from using it as a dissolvable suture that it's gone, but whatever you suture together stays together. It's a viable scar tissue in your body. So that's the data, that's the knowledge that we know. That's what we're doing with it, we're laying down a new matrix of fibrin and collagen, so it improves fine lines, it improves volume, deeper lines, shadows. The face is all about shadows and light, so we're kind of playing with shadows on all different levels, superficial skin lines, all the way down to deeper shadows.

Eva Sheie (03:41):
It might be useful to imagine an actual person who has come to you for Sculptra and just describe what that person is complaining about or looking for when they show up in your chair.

Colleen Phillips (03:53):
People want to age gracefully actually. So that's part of why I think the bio stimulators are so much better that they're on your journey of aging. So you place it, you get a little swollen, you sort of see things that the volume go down a little bit, but then over the next few weeks, it's weeks, months that this is actually happening. So you do a couple treatments a year, just soften things. You'll look at the face, it's a pan facial improvement. You're not even sure quite what this patient has done. Everything looks better. We're nowhere near the tear troughs with Sculptra, but the way we lay it all through the face, the improvement is just pan facial. It's not chasing lines. So it's a very natural tool on your journey of aging. Galderma did studies in 2015 with this, and these people could only do the Sculptra. They did two vials, twice in the first year and then one vial a year for five years, and they took pictures every year. And when you look at these pictures, you really think that picture five years later on, an aging woman is younger than the one taken before she started the Sculptra journey. So it is very much a natural replacement of volume and softening shadows.

Eva Sheie (05:16):
One, might be a funny question, but one thing you said was people want to age gracefully and I wonder what the opposite is. What does it mean to age ungracefully? Have you ever thought about that?

Colleen Phillips (05:27):
Yeah, probably. But to me that means putting 20 syringes of filler in your face every year.

Eva Sheie (05:35):
Yeah.

Colleen Phillips (05:35):
That's ungraceful aging. I mean, yeah, we're all going to age.

Eva Sheie (05:41):
Have you had it yourself?

Colleen Phillips (05:43):
I have. I did it in mid 23, 24.

Eva Sheie (05:49):
What was your own experience?

Colleen Phillips (05:51):
In my opinion, it looks like you put a filter on your camera. The shadows, the lines, everything's just softened and you're kind of looking like, Hmm, I'm not real sure what looks different, but she just looks softer all around, a more youthful appearance.

Eva Sheie (06:10):
What if you were someone who'd lost a lot of weight and then all of a sudden had the famous ozempic face, is Sculptra that was good for that?

Colleen Phillips (06:19):
Yes, that is the perfect candidate for Sculptra. We don't want to go making a bunch of round faces. That is not the goal with Sculptra, you still want to keep your curves. You want to make a beautiful OG curve, you want to soften the temples, strengthen the jawline, soften the marionettes. It's everything all around that improves with Sculptra. And as I've gotten more comfortable with it and everybody we're using it just like cheek filler. If someone just needs a little volume to their cheek, you don't have to do what I call kind of the Sculptra experience of two vials, two to three months later, two vials and then the annual vial to sort of feed the matrix and keep this all alive in there. We're doing just cheeks. We're doing just temples. We're doing just some jawlines and of late we're doing the neck, which is showing some fabulous results.

Eva Sheie (07:14):
The neck?

Colleen Phillips (07:15):
Starting to do the neck, which it's hyper dilute, so we're diluting it even more because of the platysma under, there's a hyperkinetic muscle under there that moves in the same direction all the time, and that is typically makes you a little skeptical with Sculptra because you don't want the muscle to drag the Sculptra together. It kind of wants to be together, Sculptra does, it has an affiliation to itself, so that's part of the whole treatment is you need to do, the patient does a massage five times a day, for five days, for five minutes. That is what helps this product get all around the face so that it's a nice fine layer of it. You're getting improvement everywhere. You can't go over sphincter muscles, around the mouth, around the eye. Because of that reason, we weren't using it in the neck for a long time, but they finally found the right dilution and we're having really great results. So it's one vial, one vial diluted to about 15 ccs.

Eva Sheie (08:20):
How would you know if you're a good candidate for Sculptra?

Colleen Phillips (08:23):
It's more the crepey skin that we start to get all in the very center of our neck and the necklace lines.

Eva Sheie (08:30):
Wait, what's a necklace line?

Colleen Phillips (08:32):
The deeper lines that go in the shape of a necklace, people call 'em cell phone lines. It's typically from having our neck bent a lot. But you can target right in those and really try and popping those out and you still just float it all across the neck and see an improvement.

Eva Sheie (08:51):
Would you see something right away just from the effect of the product going in?

Colleen Phillips (08:57):
Absolutely. Because of the volume, you see a big improvement after the massage, after first injection. It's like, oh my gosh, if it would just stay like that, it would be beautiful, but all that water's going to absorb the sterile water. And then matrix forms in there. It really is about six weeks to two months before you're really starting to see the results.

Eva Sheie (09:20):
And then how long does it last once it's there?

Colleen Phillips (09:23):
If you continue to, that's why I sort of call it feeding the matrix. If you continue to float a little bit in there annually is what the studies have shown, it'll keep it viable. And it's not like just stop these people just in a couple months, go back to the way they were. It would take a year or two years to go back.

Eva Sheie (09:44):
I have never heard of anyone putting other kinds of filler in the neck. That's like not a thing, right?

Colleen Phillips (09:50):
Yeah.

Eva Sheie (09:50):
People don't do that.

Colleen Phillips (09:51):
Like the hyaluronic acids and things? No, because the skin is so thin and the skin on the neck is different than the face. It's why we can insult the face so much with lasers and chemical peels and things, there's a much higher density of what's called sebaceous epidermal units, and that's the stem cells from the hair follicles is how you regenerate all this stuff. So we don't have those in our neck. So if we did a lot of those, the aggressive lasers and chemical peels on the neck, you would scar, because you don't have the ability to regenerate those cells. We all worry about our face and talk about our face all the time, and then all of a sudden, sometime in our late forties, maybe early fifties, all of a sudden it's like, ah, look at my neck. I highly suggest starting the neck sooner. Sculptra in the neck in the early forties, what you can put off is incredible.

Eva Sheie (10:45):
You can use Sculptra in the face and the neck. Is there anywhere else that people use Sculptra?

Colleen Phillips (10:49):
Oh gosh, yeah. People are going all over with Sculptra now. You can do hip dips, the little area behind the trochanteric bone in the side of your bottom where that dips in a little bit. Hip dips, hands, little defects, asymmetries from liposuction, if you get a little defect, you can plump it up with a little Sculptra.

Eva Sheie (11:13):
What's the typical age of someone who would be interested in Sculptra and coming in to see you?

Colleen Phillips (11:19):
I'd say typically fifties-ish. I have even an octogenarian still wanting to do it.

Eva Sheie (11:26):
And it works on her just as well as somebody in their fifties?

Colleen Phillips (11:29):
When I first did the sculpture experience, Galderma gave me five patients to take through the, I picked a 42-year-old and a 78-year-old mother daughter as a couple of my models because I wanted to see the difference. And it is amazing what a 40-year-old will produce crazily, where a 75-year-old, you're seeing them back in a couple months and what do you think? Do you see it? They'll always notice something, but it is definitely slower in being able to produce the fibrin and collagen and getting a result.

Eva Sheie (12:06):
What would happen if you used too much Sculptra?

Colleen Phillips (12:09):
Make round faces?

Eva Sheie (12:10):
Yeah.

Colleen Phillips (12:11):
Yeah. You could make just too full, that's why you really do want to go slow. You don't want to do these every month for a few treatments or anything. You want to put a couple months between because it really shows you how they are. You customize these, everyone is different.

Eva Sheie (12:30):
Okay, so if you were going to give us the elements of a successful Sculptra experience and lay those out along with spacing out the treatments appropriately, what kinds of things would you recommend to somebody considering it?

Colleen Phillips (12:47):
The true rejuvenating treatment with Sculptra is to have two vials done on the first treatment. So you'd come in, have pictures taken, sit with some numbing cream on your face for a little while, come in and do it. It is, it's quite a bit of volume on each side of the face. It's very well tolerated. It amazes me how well tolerated it is. So we get it in, do a massage, usually show you your face, and that is typically your goal. What you see when you're done with that first treatment and you have that volume in, a lot of times that is your goal. And patients are very, very commonly looking at themselves like, oh my gosh, I look like me. I look just like me, but 10 years ago, and then unfortunately you see some of that volume get absorbed, but then they start to see it.

(13:41):
You start to see this. I typically then see them in about two months. We would do another treatment, two, sometimes just one, but typically another two vials. And then I'd see you about three months later, take some pictures, go over things and kind of make a plan. Typically, I see you at one year, but a lot of times these patients are doing tox and seeing Martha and doing different things. And sometimes you'll decide to do another vial just to the cheeks or just to the temples at some point. And again, it's very customizable. Some patients want to do a lot and others just want that little bit of natural softening.

Eva Sheie (14:24):
What would you recommend looking for in an injector then, if you're considering Sculptra?

Colleen Phillips (14:29):
Oh, just connecting with them, talking with them, making sure that you both are on the same page with your expectations. You never want to oversell anything. You'll know if you feel like it's a good connection.

Eva Sheie (14:49):
Can you speak to the cost a little bit? What should we expect for the first treatment roughly and then a subsequent one

Colleen Phillips (14:58):
Roughly, the cost is about $1800 for two vials of Sculptra. Typically, I'd say 90% of the time, that's where we start second treatment. If it is two vials, again, it'd be the same, and then typically one vial a year. If you just come in for one vial to do a little cheek volume, then it's a thousand a vial, $800 for a second.

Eva Sheie (15:23):
And how does that compare to HA fillers?

Colleen Phillips (15:26):
Well, I mean they range 800, 850 for a one syringe of filler. And typically when you're volumizing and doing some fine lines, some etched lines, you're typically doing two to three syringes. So you're up at that same price, if not more. The HA is, again, I feel it's much more dependent on where it's placed when you're deep on the bone in the cheek, I think Voluma will last there two to three years. It doesn't have a lot of opposing factors to break it down, but a half a syringe in the lips, I think you're lucky to get six months, eight months. I mean, we talk, we eat, we kiss, we break this stuff down. So it's hard to say. There are people who spend a lot more money on filler than I think you would on Sculptra and getting little different results. But in my opinion, a more natural aging result. I think filler's more for, in my opinion, more the younger crowd, a little bit of volume, not so much correction, more just enhancing things. Where when you get to true aging patients with etched lines and all the environmental damage and things, it's more complex. So Sculptra fixes a more dynamic category of things than just chasing lines, and that's why I love it. Radiesse is another bio stimulator out there that I should talk about.

Eva Sheie (16:57):
How is Radiesse different from Sculptra?

Colleen Phillips (16:59):
Radiesse is calcium hydroxyapatite, so it's also something that's been used in dental and in surgery for years. It does the same thing, stimulates fibrin and collagen, same way. I like it best in the hands. That's what I use in the hands. I have used it in the neck. People were using Radiesse before Sculptra in the neck, and you can use it in the face just as a filler. I mean Radiesse has been around for years as a filler, using it as a bio stimulator, you're just diluting it.

Eva Sheie (17:32):
It's amazing how these two products have been around for a very, very long time and really haven't changed, have they?

Colleen Phillips (17:39):
Yeah, no, no. It's really just learning the dilution and placement of it.

Eva Sheie (17:44):
How did they discover Sculptra in the first place?

Colleen Phillips (17:47):
That's a good question. I'm not sure how it was discovered, but it was first used back in the early two thousands. The medications for HIV caused very severe lipoatrophy of just cheek fat. It was very specific to just cheek fat. So these poor HIV positive people would have sunken in very irregular looking cheeks, and that's where Sculptra first came in. They were just mixing it with two ccs and putting it all right in the cheeks and getting these great results. So they tried to get it into the cosmetic world back then, but it was very expensive. They thought we had to reconstitute it two days before, and so then if your patient no showed or canceled or something, I mean it didn't take off in the aesthetic world. And then Galderma bought it and I think it was 2014 or 15 and went back to the FDA with these new dilution amounts to spread it across the face and do so much more with it.

Eva Sheie (18:50):
There's a famous cover, I believe, of New York magazine with Madonna's face before she got looking weird. Now that I'm saying that, I wonder if she's had too much Sculptra.

Colleen Phillips (19:00):
I very well could be, especially honestly, we had the people from Galderma that are in the lab, the scientific liaison or whatever, and she said they just in the last few months just realized that it's stimulating adipocytes. That's pretty amazing. And that probably is why there's that worry of making big round faces.

Eva Sheie (19:23):
This magazine cover from New York magazine is from 2008. It's from 2008. And at the time we looked at that and we said, that has to be Sculptra. Nothing else that could do that. It's a little bit

Colleen Phillips (19:39):
Because she didn't have, you know she didn't have just fat grafting or something?

Eva Sheie (19:45):
I don't think so. You tell me what you think. I'll show you.

Colleen Phillips (19:49):
I'll give you an opinion.

Eva Sheie (19:51):
And unfortunately I can't make it bigger than that without it losing its resolution, but

Colleen Phillips (19:56):
Oh wow.

Eva Sheie (19:57):
It was a cover story on New York magazine in '08 about the new face. So there must have been something in the article itself that suggested to us that she had had

Colleen Phillips (20:07):
I got to to find the article.

Eva Sheie (20:08):
Yeah.

Colleen Phillips (20:09):
Well, no, New York,

Eva Sheie (20:11):
I talk about it so often that I think I can buy it from this site and then I'll send it to you.

Colleen Phillips (20:16):
Really?

Eva Sheie (20:16):
Yeah, I think so.

Colleen Phillips (20:16):
The whole article or the whole magazine.

Eva Sheie (20:19):
Yeah, I can buy the whole magazine. $15. Well worth it.

Colleen Phillips (20:23):
Oh my gosh. Oh my gosh.

(20:27):
But look how beautiful her face is.

Eva Sheie (20:28):
Gorgeous. I'm really curious what this article is about, but she looks great there.

Colleen Phillips (20:36):
Yeah, I don't know what happened after.

(20:40):
Just so many, I mean, so many got just overfilled, over toxed. That is not what people want. They want to look beautiful and natural and move.

Eva Sheie (20:54):
So here's my last Sculptra question for you. Tell me what the Sculptra consultation is like and if I can actually have treatment at the same time as the consultation or do you space those out?

Colleen Phillips (21:04):
With Sculptra, I actually like to do a consultation first. I think it's incredibly important to get the expectations and really talk about the fact that this is on your journey of aging. This isn't what you go do before your class reunion because you want to look great or something. Because first off, you're probably going to get bruised on that first treatment. So you really want to make sure you're timing this right in someone's life. We know that just by timing something wrong, you can make them not like something. So I like to consult and really go over what it is going to be about the fact that, then you'd come back, we get a full round of pictures, you numb, we do the treatment. It's about an hour and a half, two hour appointment. Do the massage. Two months later they're back. I think a consultation is really important in this to go over everything.

Eva Sheie (21:55):
Is there anything that would preclude you from having treatment, even if you've already had your consultation, sometimes you can't take Advil or NSAIDs before. What are those things that you'd have to avoid?

Colleen Phillips (22:09):
Obviously if you're on a blood thinner for an important reason, you'd never want to stop that just for something like this. You just need to know that you are probably going to get quite bruised. It's a lot of fanning with a needle and under the skin, so you go slow. You use, there's techniques to use to try and get less, but it's always a risk. Sometimes patient will look like they were in a bar fight and another time they have just two little purple dots. And I wish the crystal ball is out for repair, I can't say how that's going to be, but just scheduling these so that you are prepared for that is a big part of it I think. You do, you have to do the massage five times a day, for five minutes, for five days. So there is a little bit of downtime associated with it and participation from the patient, which is great.

(23:02):
I love when they're involved in it more so. Martha, our aesthetician, can hit these bruises with IPL. It's amazing. I mean, within 24 hours, the darn bruises are almost gone. Professional people, people who worry about that kind of thing or still have a bruise, I always talk with them about that. They massage with Arnica to try and help make those bruises go away quicker. But that is a part of Sculptra, and you'll see differences with needle and versus cannula. I've been injecting for 30 years, so I'm a needle person. That's what I've used. I love it. I know right where my needle is. They're newbies who trained on the cannula right away, and so they feel comfortable with it. But the thing with Sculptra is when you get to the second or third treatment, you can feel the fibrin and collagen that's been laid down in there. The needle feels different. And when you're in there with a cannula, it's easier for a cannula to fishtail a little bit, and you hit up, get up against some fibrin collagen and with a needle in my hands, I feel like I know right where I am, but it probably does increase the risk of bruising.

Eva Sheie (24:15):
I'm thinking of like a Botox, Dysport, Daxxi experience appointment where the first injection, you can't feel it. The second one, you can't really feel it. The third one, the more they go with that same needle, the more you feel it because it gets a little dull each time.

Colleen Phillips (24:32):
That's terrible.

Eva Sheie (24:32):
How do you make this Sculptra comfortable and not like that?

Colleen Phillips (24:37):
Well, for one, the Botox needle is very fine. I mean, we use a 33 gauge needle. It's called the invisible needle. I mean, so it will dull quick. If I've been in someone's forehead, I get a new needle before I go to their eyes, and I think that's, I hope that standard of care. But anyway, with Sculptra, you divide this fluid into three cc syringes with one, it's a 25 gauge needle, so it's a little bit bigger than that. You only go in with that needle once, maybe twice, and then you're using a new syringe, new needle. So it's not like you do all those sticks with the same needle.

Eva Sheie (25:15):
Do you use numbing cream or anything like that?

Colleen Phillips (25:18):
Yeah, yeah, yeah. A lot of people think it's not necessary. I think it does help. Yeah. But it's amazing how well tolerated this is. People are a little more anxious for it because when you think about filler, you think about one CC syringe, and then I tell you, I'm going to put nine ccs on each side of your face. People are like, ah, but it's so well tolerated. And then you'd get a five minute massage at the end. I mean, but that shows you, it helps to show you the pressure and all that, and where we really want you to massage.

Eva Sheie (25:58):
That's great. If someone wants to schedule a consultation or talk more with you about having Sculptra, how should they reach out?

Colleen Phillips (26:06):
They should reach out to MD Beauty Lab and just make a consultation. We'll do a full face evaluation and go from there.

Eva Sheie (26:13):
Sounds great. Thanks for listening. I'm your host, Eva Sheie. Follow the show and submit questions for our experts at wherebeforemeetsafter.com. Where Before Meets After is a production of the Axis.