LAM FACIAL PLASTICS

This is probably an unfair question to present to you, but I thought I'd write anyway.

I had nasolabial implants (Gortex) put in by a wonderful PS 12 years ago. I've loved them. No problems with them whatsoever. They greatly enhanced my appearance.

Six weeks ago, I had one Sculptra injection by a board certified plastic surgeon whose specialty is Sculptra and who teaches other doctors how to inject it. She and her staff never discussed the risks with me (short of passing along a Sculptra brochure for future reading), but I did obessively try to address this with them. She and the staff both assured me that none of their patients got lumps... So I consented to Sculptra rather than Juvederm ...My PS made one injection above my right nasolabial fold, multiple injections to my cheeks, and one injection near my chin/jaw. She never injected directly into the nasolabial folds or under my eyes. I massaged as instructed.

Shortly after, I struggled with a rash and swelling. I may have been allergic to a topical. My dermatologist calmed the rash down with a week of steroid tablets. As he treated me, he told me he will no longer do Sculptra because it often migrates to places outside of injection areas. He believes the massaging is the inadvertent cause of this migration.

Well, his assessment may have proven true for me. During the past 6 weeks, I have not seen any facial enhancement from the Sculptra injection. However, I do have a small grain-of-rice-sized nodule beneath my right eye .... I can live with it. It's invisible and does not appear to be growing.

Unfortunately, a pea-sized lump has also appeared beneath my Gortex implant in my right nasolabial fold. Despite its size, the lump is invisible when my face is relaxed. It's only visible when I attempt to stretch my skin by dramatically pulling my jaw down. (Well, so far. I hope the lump doesn't become bigger.) ... The problem is that lump is at the bottom of the Gortex implant and the lump's volume is pushing the top of the implant slightly upward. This occasionally creates a very faint pinching sensation of the top of the implant. It was my investigation of this odd sensation which caused me to discover the lump last week. Otherwise, I'm comfortable.

My PS was on vacation this week. Her young associate looked at the lump but was reluctant to kenalog for fear of doing further damage and compromising the implant. It's very tricky -- the wiry nature of the implant is obstructing the ability to know where and if a Sculptra lump is actually involved. I often believe I can feel something but cannot know for sure. I can only be certain that I first became aware of the lump after the Sculptra injection.

I'm terrified I will have to remove my beloved implants if this growth continues. Few doctors will insert them anymore. Also, my husband is already mad that I paid $1,000 for no results but two facial lumps and two trips to the derm. He will certainly be furious if we have to pay thousands to remove the Gortex implants.

So I'm wondering if I: 1) should leave things alone and just learn to live with another Sculptra lump and occasional slight pinching sensation now and then; or 2) consider the possibility of kenalog injections to help my right implant -- though I've read they can cause dents and hyperpigmentation.

I'm also wondering if a kenalog injection into an implant might raise the risk of infection, which is known to be a tricky situation for implants?

Finally, would I be better off seeing a dermatologist for a kenalog? My derm is highly esteemed and has helped me a lot with the ensuing rash.... He's also conservative. For example, he literally wrote The Book on chemical peels but refuses to give me one because he says I don't need it.

Any thoughts?

Have you ever encountered this situation in your practice?

P.S. Ironically, my PS advised against fat grafting/injections because she feels it's far too risky and unpredictable. She believes Sculptra is far more reliable.

hi,
first, i am sorry to hear of your situation. second, i am not here to give you direct medical advice since i cannot do that. i can only speak in general terms of situations similar to yours and please keep in mind my comments are fully biased by my own experiences, which are different than other doctors. for instance, IN MY HANDS, fat grafting is a wonderfully predictable and lasting result that i can use to overall create better balance to the face than almost any other filler IN THE RIGHT CANDIDATE. i have found sculptra to be highly unpredictable and has caused lumps (not many or bad but more like you are describing) in the lower face. does that mean fat is good and sculptra is bad? absolutely not. it means i do fat very well and i do not believe i can achieve great results with sculptra. maybe your PS can. so those biases affect my answers here unfortunately. similarly i believe kenalog also has risks of indentations so i rarely if ever use kenalog. i use it only in severe hypertrophic scars or in keloids. i would truly wait until your PS comes back into town and allow that person who has been treating you to treat you without my biases layered on top. i just want to be fair to me, you and your PS. hope that all works well for you.
best,
sml

I completely understand and appreciate your response, Dr. Lam.

good luck with everything.