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Look Better Naked: Learn about injectable fillers Radiesse and Sculptra

Editor’s note: This is the third of a four-part series on injectable fillers. To read the first part on Juvederm Ultra and Ultra-Plus, click HERE. To read the second part on Restylane and Perlane, click HERE.

Radiesse, manufactured by Merz Aesthetics, consists of smooth calcium hydroxylapatite (CaHA) microspheres that are suspended in a water-based gel carrier.

Because of its white color, it cannot be injected too close to the skin surface or it will be seen and it can also be seen on facial and dental X-rays. (Keep that in mind in case you don’t want your partner to know you’ve had fillers injected in your face!)

CaHA stimulates the body to produce new collagen over time, which means results last up to a year or more for many patients after one treatment. CaHA is identical in composition to the mineral portion of bones and teeth, so again it’s basically inert and nothing can readily grow in it. There is virtually no risk of allergic reaction and it does not require sensitivity testing prior to treatment.

Radiesse is an ideal choice to fill moderate to severe wrinkles and folds such as deeper nasolabial folds or marionette lines. I often use it for men because it’s a “tougher” filler that bolsters their thicker skin and deeper folds a little more than some of the hyaluronans. I also ask my Radiesse patients to massage the treated areas gently for a few days after treatment to help the product settle in without lumps. The back of an electric toothbrush works very well for this.

Sculptra first came on the market as a filler exclusively for treating HIV-associated fat wasting in the face (the sunken cheeks look). And we still use it very often for this purpose. Sanofi-Aventis, the manufacturer, offers a program to partially or fully pay for qualified recipients based on income level.

Recently, Sculptra was officially approved for aesthetic use as well (even though we’ve been using it aesthetically for years because it’s so great for restoring lost volume) and the price went down from $1,000 a vial to $800 a vial.
Sculptra is not an overnight miracle. It’s injected in stages, one or two vials at a time for three to six treatments, on average, spaced a couple of months apart. It’s long-lasting, giving you subtle results over time. Officially it can last up to two years. But in my practice, I can still feel it in people’s faces more than three or more years out from injection.

Sculptra is a dissolved solution of Poly-L-lactic acid - a biocompatible, biodegradable synthetic material that has been used by physicians for decades in absorbable suture material. After injection, it gradually creates a reaction on a microscopic level that builds collagen and naturally thickens the areas injected.

Sculptra can be used in the nasolabial folds, marionette lines and chin wrinkles in addition to larger volume loss areas such as the cheeks and temples. Sculptra is particularly well-suited for deep areas that are lacking volume due to fat loss or atrophy of the skull. Yes, as you age, your fat moves and disappears and your skull bones shrink! Have you ever noticed how people’s noses tend to get bigger as they get older? Well the nose isn’t actually growing, but the maxillary bone under and next to it is shrinking, making it appear bigger. We can reverse this with filler.

Like Radiesse, Sculptra can also form lumps, so we ask patients to massage it using a manual pressure technique, for several days after treatment. And in my practice, we mix the Sculptra a week in advance to increase dissolution of the material before injection. It takes a long time to dissolve the powder and it must be dissolved well in order to inject properly.

Darren A. Farnesi, M.D., APC, offers his sound advice and personal knowledge of the industry as a successful doctor with Medical Age Management Inc. He can be reached at (619) 299-0700 or online at his website.