Speaker 1 (00:07):
You're listening to The La Jolla Cosmetic Podcast.

Monique Ramsey (00:14):
Welcome Back everyone to The La Jolla Cosmetic Podcast. I'm your hostess Monique Ramsey, and I want to welcome back Amy. How are you today?

Amy (00:23):
I'm great. Thank you for having me today, Monique.

Monique Ramsey (00:26):
So this episode is called Cheeks and Cheeks because the treatment we're going to talk about today was first used to help fill up the cheeks and fill sunken cheeks. And over the years people have come up with other ways to utilize it and it's become a favorite of injectors everywhere. And now it's also used in the butt cheeks. So we're going to get to that, I promise, because that's kind of interesting. I'm fascinated by this. But first Amy, let's talk about what is Sculptra, and what do you love most about it?

Amy (00:59):
So Sculptra has become one of my favorite products to use. It is a bio stimulator, meaning that it is a product that when it's injected, it stimulates your own collagen to produce. So it's a liquid injectable. We reconstitute it in sterile water. It's made out of a product called PLLA, which stands for poly-L-lactic acid, which is actually a sugar or a saccharide. It's one of the active ingredients in absorbable sutures. So many of us have actually already had it in our bodies before if you've ever had a surgery. When we inject it, it's basically laying down little seeds under the skin and then your body will slowly produce collagen in response to it.

Monique Ramsey (01:44):
So is it liquid or is it... You've got pieces of things in it? The PLLA, what would it look like to the naked eye? Can you see what is happening in there as you inject it?

Amy (01:59):
It's a product that comes in a small vial and it is a dried product, so we have to reconstitute it in sterile water and then we can inject it into the face.

Monique Ramsey (02:10):
So who's a good candidate for this volumizer, I guess? Because it's not a filler per se. Is it more... Because it's stimulating your body to have that collagen response, do we call it something different?

Amy (02:24):
Well, we now use the term bio stimulator. So it is sort of like a filler. It's not exactly like a hyaluronic acid filler, which goes in, we inject it, and it's basically putting a gel under the tissue. This is more of a product that's going to lay down underneath the tissue and then stimulate your body to produce its own collagen.

Monique Ramsey (02:47):
So as far as who's a good candidate and maybe an age range, what would you say?

Amy (02:54):
So the product is FDA approved for anyone over the age of 18. I would say that I've injected patients as young as in their 30s all the way up to mid to late 80s. So it can be used in a wide age range, many different patients, and we can use it for different things. So when you look at Sculptra, you have to... Or when you look at fillers just in general, you have to look at what we're using them for. So we're looking at the aging process and what's happening during that aging process. So we're losing fat in the face, which usually starts in our 30s. We're losing collagen, elastin in the face, which is a continuous process, but it's accelerated around the age of 45. By 45 we lost about 25% of our collagen. And then once we hit menopause, then we're actually losing bone in the face as well.

(03:48):
So we're using Sculptra to mimic those three things, depending on what we're losing over time. So if it's in a younger patient, then I'm usually using it to mimic fat in the face. If it's someone in their 40s or 50s, then I'm using it to mimic fat as well as stimulating collagen. If it's somebody who's postmenopausal, then I might be using it to mimic bone as well, so the product is so versatile in that respect that you can use it to mimic all three of those things.

(04:21):
And it does a beautiful job of just improving the quality of the skin and giving the skin that glow back. And it happens slowly over time. It doesn't happen just overnight. It takes about eight to 12 weeks to see your end result. Most people see a result by eight weeks, some even much sooner by four to six weeks. And then by eight to 12 weeks you're seeing your end result. And usually it's so subtle over time that people just look at you and say "wow, you look really good. Did you change your hair? Did you get a facial? Something looks different about you. I can't really know what it is, but you look really good" because it's so very subtle over time.

Monique Ramsey (05:01):
Now, what would be some of the common reservations people would have about having Sculptra or choosing Sculptra versus some other way to rejuvenate the face?

Amy (05:14):
I think that probably the main concern is when patients want to have a result right away. If they're not patient enough to wait for the collagen to build over time, then maybe using a hyaluronic acid filler is a better option. When Sculptra first came out, not everyone was going through the proper training to inject it. So they were having a lot of complications injecting it in areas where it shouldn't be injected like around the mouth and underneath the eyes, and they were getting nodules under the skin. So we've developed much more knowledge about Sculptra over the years and realized that what we were initially taught has changed over time. So initially we were reconstituting it in just five CCs of sterile water, and now we've learned that the volume of solution that we use matters. So we're starting to use larger volumes with the Sculptra and getting even better results.

Monique Ramsey (06:11):
So what do your patients say to you about their results after they see it take place and magically sort of transform over a few months? What is their feedback?

Amy (06:24):
Well, it's funny because sometimes the results can be so subtle over time that they don't even realize how much they've changed. So they come in and say "I don't really see much of a difference. I haven't really noticed much of a change." And then I show them their before and after photos and there's a tremendous difference. And then they say "wow, I really do see it. And you know what? Actually, so and so was commenting on how I looked." And it's amazing because it is so subtle, and I say subtle in the sense of, because it's happening slowly over time, you just don't necessarily realize it.

(07:01):
I remember the first time that I had Sculptra, I said "this didn't work, I don't believe in this product" about eight weeks later. And then at around 12 weeks I saw a photo of myself and I said "oh my goodness, I really see it and I see a big difference and I really love it." And that was in my 30s. So I started using it at a pretty young age and have been able to really maintain over time. I won't tell you my age now.

Monique Ramsey (07:29):
I was just going to say like "well, how old are you?" Because I thought you were in your thirties.

Amy (07:34):
Yeah, so now I'm in my 40s. So now I'm at the stage where the collagen is really starting to break down pretty quickly and I'm definitely noticing changes. But by doing this product, and once you get to where you want to be initially... We might start with, say if it takes two vials, four vials, five, six vials to get to where you want to be initially, then we just maintain once a year, usually with half that amount. I'd say most people can maintain once a year with one to two vials. Occasionally it takes a little bit more, but usually it's one to two vials once a year, you're always maintaining, you're never fully breaking down. Sculptra, the studies show that it lasts up to about two years, but the studies stopped at two years. So we know clinically what we see is maybe five or even more years. And if you continue to maintain it, you're going to age so slow and you're building that foundation of the face and maintaining the foundation of the face so that you see much less changes over time that are undesirable.

Monique Ramsey (08:41):
So for the face, let's say there's a patient in their fifties and they've never had any surgery, maybe they've done things in the med spa, some fillers. If they're in their fifties, is one to two vials sort of normal or does it really depend on how much volume has been lost? I mean, is it correlated by age, I guess, how much you need? Or is it more correlated by where they're losing volume no matter what age they are?

Amy (09:09):
I would say both of those are correlations to how much we would use. Typically, if I have someone coming to me in their fifties, then I'm probably going to need to use two to four vials, maybe even sometimes more. It's sometimes up to six, depending on how much volume loss. There's so many things that go into determining how your body ages, how your face ages. Your ethnicity... You look at Asian and African ethnicities and they're starting out with much more bone than Caucasian ethnicities. So they will naturally age much slower. If you are starting out with a more petite frame, a more petite face, then you're going to age much faster. So then in that case, I probably would need to use more Sculptra than I would on an African or Asian face.

Monique Ramsey (10:00):
So if a person comes to you for the first time, you recommend four vials, they get four vials. So in a year, is it still a touch up of one to two vials or would it be four again?

Amy (10:13):
Typically then if I do four vials initially, then usually it's just two vials once a year.

Monique Ramsey (10:18):
Okay. Once a year. And what if the patient has had fillers before? Let's say they had fillers a month ago or three months ago. Do you have to dissolve what's already there to start building again?

Amy (10:34):
No, and that's the great thing about Sculptra is that it can be layered with all of those other treatments that we do. So I often have patients that will come and say "I have this special event that I'm preparing for." So we will do hyaluronic acid fillers because they have a short timeframe so that we can get that result right away. And then usually I'll have them come back to me in three to six months and then we can do Sculptra so that way they're maintaining and actually they will see an even better result with their hyaluronic acid fillers and the thread lifts. They will see it maintain much longer.

Monique Ramsey (11:14):
And is that because of that bio stimulating part of it?

Amy (11:19):
Yes, because they're building collagen. So the hyaluronic acid fillers will break down over time, usually over one year to two years time, depending on where it's placed. And then the Sculptra is going to build upon that. It's going to build the collagen. And depending on what layer of the tissue we're injecting it, whether it's over the bone, if it's in the fatty layer, if it's just underneath the tissue to stimulate collagen in the skin, tightening of the skin, mimicking the fat or mimicking the bone, then that determines what the result is going to be.

Monique Ramsey (11:51):
So I teased at the beginning that we're talking about cheeks and cheeks. So the other cheeks are butt cheeks. Tell us about Sculptra in the butt or the derriere, or the behind.

Amy (12:06):
Yeah. So Sculptra has been used in the buttock area actually for quite a few years now. It's just really gained popularity over the last, I'd say, five years where it's become more widely known that we use it in those areas. So it's actually not a new area that we're using it, but we use it in the buttock area for a variety of reasons. We use it to stimulate collagen. So if there are stretch marks and there's laxity of the skin or looseness of the skin, then we use it to thicken the tissue and tighten the skin and improve the actual skin quality. If the goal is to build volume, then we can use it to... You hear a lot about the hip dips so we can inject it into the hip dips to create more volume. Patients that are thinner that are not good candidates for the Brazilian butt lift procedure where they're using their own fat to inject into the buttock are good candidates for Sculptra because they just don't have the fat that they need to put into the buttock to get that filling.

(13:08):
Now, it's not going to replace a Brazilian butt lift, but it is going to give some nice volume there. And then we can also use it for cellulite, for improving the appearance of cellulite. So there are varieties of reasons why we get cellulite, and one of them is looseness of the skin, laxity of the skin. So by improving the skin quality, that will help with that. Also by thickening the tissue, it will give the appearance of filling in that area as well. So there's a variety of things that we can use Sculptra for. It's such a versatile product.

Monique Ramsey (13:45):
So we've got face, easy. Buttocks... But do you have some place that you thought, let's just try it and did it work or not work?

Amy (13:54):
Yeah, so I've used it in the knees.

Monique Ramsey (13:56):
Oh.

Amy (13:57):
I mean, there's just so many places. Anywhere you want to stimulate collagen, where you want to improve and thicken the tissue. It's been injected in the knees, it's been injected under the arms in this area where you get that crepey skin over time. It's been injected in the chest, in the neck. There are just so many places that we can inject it. And yes, it typically does work really well for tightening the tissue.

Monique Ramsey (14:23):
I was actually thinking about the chest like that.

Amy (14:25):
Yes.

Monique Ramsey (14:26):
Just that kind of decolletage area. That's really interesting that that was where my head was going when I was asking the question "where else could we put it?" Now, if you had it done and you were interested in your face and you're interested in some body places as well, can you do that all at the same time and what's the recovery like?

Amy (14:46):
You can do all of that at the same time. It's a lot to do at one time, but you can do it. And it depends on your tolerance. I think our techniques for injecting Sculptra have improved tremendously over the years, especially now that we have cannulas available to us. Traditionally, we've injected it with a needle which has a sharp tip versus a cannula that has a blunt tip. So if you think about liposuction, they're using cannulas. So we have little tiny cannulas that look like needles that we use to inject it and that has... I mean for me, in my injection technique, it's been a game changer in terms of comfort for patients. So you can do multiple areas in a day.

(15:29):
You can do a full face, you can do the buttock area. In fact, I think the buttock area is really an easy area. Much faster recovery than doing a Brazilian butt lift. You have many less limitations to your activity. The main thing afterwards is just preventing infection, but there's really very few limitations on you afterwards. In the face, it's going to be very similar to any other filler with your limitations. And you'll probably have possibly a little bit of swelling, potentially bruising. So usually the downtime and recovery is pretty quick.

Monique Ramsey (16:06):
If you had an event and you wanted to do Sculptra ahead of that event, would you say a week minimum or three days? Or what's kind of the safe zone?

Amy (16:19):
Usually my rule of thumb, if there's an event coming up, I like to allow at least two weeks. Ideally you would come a month before any sort of major event just so that we have enough time, but with Sculptra, the recovery is pretty quick. And if you have an event coming up, usually I'm not choosing Sculptra.

Monique Ramsey (16:39):
Right. Well, I guess if you're getting ready for the event, yeah, you would do it ahead. But if you were just worried about "I've got to go see so and so next Friday and I don't care about my result yet"-

Amy (16:50):
A week is plenty of time.

Monique Ramsey (16:52):
A week, okay. In terms of downtime, I guess.

Amy (16:54):
And for body, if you're doing buttocks, the area's covered, so you really don't have any downtime at all with that.

Monique Ramsey (17:01):
Yeah, if there's bruising or something, then it wouldn't really show. Now can you sit? I mean, obviously we all sit, I'm sitting here talking to you and I'm thinking "God, if I have this, all the stuff, do you have to avoid sitting for a little while?"

Amy (17:13):
No, you don't have to avoid sitting.

Monique Ramsey (17:16):
How does this work, Amy?

Amy (17:18):
I probably wouldn't go home and sit for 24 hours on your buttock. But yeah, you really don't have to avoid sitting, because the areas that we're injecting are usually a little bit higher than where you sit.

Monique Ramsey (17:29):
Oh.

Amy (17:30):
It's usually on the upper buttock area and then on the sides. So sitting is not really going to affect those areas.

Monique Ramsey (17:38):
Interesting. Well, this has been so fascinating. I didn't realize that it's been around for a long time. I remember back in like 2005 to 2010 we were using it. But what's interesting is that changes in the techniques and the different layers, that you can use it in different layers of the skin or the face depending on what the goal is. And I know that our Glam Fam members, in terms of pricing, because if you're doing an area like the buttock, then there's going to be more vials, and each vial costs some money. So you have financing programs, but I know that our Glam Fam members, typically we have kind of a package where the more you buy, the more you save type of thing. So do you know if that's the case?

Amy (18:29):
Yes, absolutely. When we have patients that are going to be doing multiple vials, we want to make it more beneficial for them because we know that they're going to benefit from doing more vials. So we definitely have some price breaks on that to help accommodate that financially.

Monique Ramsey (18:44):
Oh, that's nice. Yeah, I think it's one of those things where it's not going to do the same thing as surgery, but it's going to give... You don't have the downtime of surgery and there's that trade off, like you mentioned, but then also it doesn't cost as much as surgery, so that's nice too... Depending on how many you're using.

Amy (19:03):
Yes. And then you don't have to be under anesthesia. You don't have the long recovery time. So it definitely has a lot of advantages.

Monique Ramsey (19:13):
And I guess the other question I'm thinking now that we're talking about sort of a Sculptra BBL is, on the maintenance of that, would it sort of be the same, every year or so, that they're going to have a touch up if they want?

Amy (19:26):
Yeah, I think that when you're dealing with the body, I would say once you get to where you want to be initially, we can reevaluate, reassess once a year to determine if we need to do more.

Monique Ramsey (19:38):
Okay. Well, I love learning about this with you, Amy. So for everybody in our audience, you can find information about Sculptra on the website. But then I would say everybody's first step is probably to have a consultation with you. And so do you like to do those consultations virtually via Zoom or in person? What's your preferred method, Amy?

Amy (19:59):
It's always ideal to see patients in person, but we can certainly do it over Zoom as well. It's pretty easy to assess for Sculptra when we're doing a Zoom consultation.

Monique Ramsey (20:12):
Awesome. So if you're listening today, if you guys have any questions or want to see the links of the things we talked about, it'll be in the show notes. And just a reminder, if you love our podcast, share it with your friends, write us a review on either Apple Podcasts or Good Pods or wherever you're listening. And thanks again, Amy, it was nice to talk with you today.

Amy (20:35):
Yeah, so wonderful to talk with you as well. Thank you for bringing out the subject of one of my favorite products.

Monique Ramsey (20:41):
I love it. I love it. Well, we haven't talked about that yet in terms of our podcast. We've talked about a lot of things, but Sculptra, this is something we haven't really mentioned. So I appreciate you taking the time to inform our audience.

Speaker 1 (20:59):
Take a screenshot of this podcast episode with your phone and show it at your consultation or appointment, or mention the promo code PODCAST to receive $25 off any service or product of $50 or more at La Jolla Cosmetic. La Jolla Cosmetic is located just off the I-5 San Diego Freeway in the XIMED building on the Scripps Memorial Hospital campus. To learn more, go to ljcsc.com or follow the team on Instagram @ljcsc. The La Jolla Cosmetic Podcast is a production of the Axis, the axis.io.