Sculptra (PLLA Biostimulator)

A suspension of poly-L-lactic acid microparticles is injected into the deep dermis or subcutaneous tissue at pre-mapped points. The liquid carrier provides immediate-but-temporary visual volume (dissipating within 2–4 days). Over the following weeks and months, macrophages phagocytose the PLLA particles, activating resident fibroblasts. The fibroblasts produce new collagen I, collagen III, elastin, and proteoglycans in the tissue. As new collagen is deposited, the treated area gains real structural volume — gradually, over 3–6 months. The PLLA particles themselves biodegrade via normal metabolic pathways and are cleared within 9–24 months, but the collagen they stimulated remains.

Numbing cream applied for 20 minutes. Treatment takes 30–45 minutes. Multiple injection points per area. Sensation: mild stinging, tolerable. Immediately after: visible temporary swelling and volume from the liquid carrier; the treated area looks 'corrected' for 2–3 days, then returns to baseline as the carrier dissipates. Days 3–14: no visible change — this is expected. Weeks 4–12: gradual volume return as new collagen builds. Peak results at 3–6 months. Standard protocol: 3 sessions 4–6 weeks apart. Critical post-care: massage the treated area for 5 minutes, 5 times a day, for 5 days ('the 5-5-5 rule') to distribute PLLA particles evenly and prevent nodule formation.

Sculptra (Galderma / formerly Dermik) is the original PLLA biostimulator — an injectable suspension of poly-L-lactic acid microparticles that, after subdermal injection, trigger a controlled inflammatory response. Macrophages phagocytose the PLLA particles, activating fibroblasts, which then produce new collagen I, collagen III, elastin, and extracellular matrix components over the following 3–6 months. Unlike hyaluronic acid fillers (which provide immediate visual volume from the HA itself), Sculptra's initial volumising effect is largely from the liquid carrier and dissipates within days — the real volume, from new collagen, builds over 3–6 months and lasts up to 2 years. FDA-approved in 1999 (originally for HIV-associated lipoatrophy) and for cosmetic use in 2009, Sculptra has a 25+ year safety track record. Typical treatment protocol: 3 sessions spaced 4–6 weeks apart, each delivering 1–2 vials (reconstituted with 7–9ml sterile water + lidocaine). Best candidates: 40+ patients with diffuse volume loss, midface atrophy, hollow temples, and skin laxity. GLP-1 weight-loss patients ('Ozempic face') are a significant growth segment — Sculptra restores skin quality + volume progressively in a way that HA filler can't replicate. Evidence base is strong (Lowe et al. 2023 RCT showed 90.57% improvement in midface volume at 12 months, outperforming HA fillers on longevity).