What is Sculptra and Radiesse and what makes these biostimulators unique from each other?
If you are someone who has received aesthetic treatments before, then you are probably aware of hyaluronic acid (HA) fillers – aka household names like Juvederm, Restylane, RHA, and others. However, there is a popular treatment that has been around for awhile now that is gaining more popularity these days as people are becoming leery of HA fillers and are looking into more “natural” treatments.
As a disclaimer, I personally love biostimulators AND HA fillers for many reasons. I think they are both beautiful, impactful treatments that can make people appear more vibrant and youthful. I am not choosing one treatment over the other. The purpose of this article is to explain an alternative to fillers that may be a better fit for those who are either a) more cautious or apprehensive about fillers or b) curious about biostimulators and their role in regenerative aesthetic medicine.
To learn more about the difference between HA fillers and biostimulators, you can read my separate article here [INSERT HYPERLINK].
What are Biostimulators?
In short, biostimulators are injectable treatments that are designed to stimulate your body’s own natural collagen and elastin production. This is often why people may view biostimulators as more “natural.”
Biostimulators (through their unique mechanisms of action) stimulate fibroblasts to create more collagen and restore volume in areas where there are more hollows such as temples, cheeks, jawline, and smile lines. Collagen and elastin are what gives skin its good qualities like how plump, firm, hydrated, and elastic it is.
The two biostimulators that are FDA approved in the United States are Sculptra (manufactured by Galderma) and Radiesse (manufactured by Merz).
Sculptra and How it Works
Sculptra is a poly-L-lactic acid (PLLA) injectable designed to gradually restore facial volume and smooth out wrinkles by stimulating the body’s own collagen production. Fun fact, Sculptra was first used to treat HIV patients who had severe facial volume loss and muscle wasting! The PLLA particles come in a vial containing lyophilized powder that is then reconstituted with sterile bacteriostatic water to make a liquid suspension. That liquid is what gets injected into the tissues.
After being injected, it triggers a controlled inflammatory response in the deep dermis and subcutaneous tissue. The biodegradable PLLA microparticles act as a scaffold that stimulates fibroblasts to produce new collagen (primarily type I). Over several weeks to months, the PLLA particles are gradually absorbed by the body, leaving behind a matrix of fresh collagen that restores volume and improves skin texture.
What to expect if you get Sculptra
The key takeaway is that Sculptra’s collagen induction process takes time! Unlike traditional HA fillers that provide immediate results, Sculptra works subtly and progressively, leading to a more natural-looking rejuvenation.
First, your injector will numb the area in your skin that will act as an entry hole for the needle or cannula. They will carefully use either cannula or a long needle to fan the product in the right plane of the face. It’s important to note that after receiving Sculptra, it may become more difficult to use cannula due to the new matrix of collagen that was created in the process.
General guidelines for Sculptra state that the number of vials of Sculptra you will need will depend on your age. For example, someone who is 27 years old will need 2 vials. Someone who is 50 years old may need 5 vials for a full treatment.
Patients who opt to receive Sculptra will have initial swelling from the bacteriostatic water. Bruising and swelling are common side effects of this procedure. After 24-48 hours, swelling subsides as the body absorbs the water. You should not be surprised that you will look the same as how you did before you got the Sculptra.
Patients are instructed to follow the same aftercare instructions as receiving filler (avoiding intense exercise for 48 hours, avoid applying makeup, avoid heat, no blood thinners). Additionally, patients are instructed to massage their face using the 5-5-5 rule. Massage face in areas injected for 5 minutes, 5 times a day, for 5 days straight. If you remember, Sculptra works by means of inflammation; the purpose of this massage is to induce inflammation by irritating the tissue! This practice also helps to lower the risk of getting nodules. Note: people who have unmanaged autoimmune disorders should NOT get Sculptra because they are likely to develop nodues.
Patients will begin to see results starting at 4-6 weeks. Full results will take several more weeks to a few months. Results can last up to 2 years.
Radiesse and How it Works
Radiesse is made of calcium hydroxylapatite (CaHa) microspheres that are suspended in a smooth gel carrier. The CaHA microspheres within the gel then stimulate fibroblast activity, promoting new collagen and elastin formation around the microspheres. Over time, the gel carrier is absorbed, and your body will metabolize and excrete the CaHA particles. What is left is the new collagen that was synthesized, giving you results that last 12-18 months or longer.
Radiesse is unique from Sculptra in that it can be used as both a filler AND a biostimulator. It comes in syringes and appears as a thick, white opaque gel. This gel can be injected directly into areas that need more lift and structure, such as cheeks and jawline. Additionally, Radiesse may be diluted with different amounts of bacteriostatic saline to make a runnier gel or even a thin liquid suspension similar to Sculptra or HA fillers. This is called Hyperdilute (HD) Radiesse.
In this regard, patients who get Radiesse will see a little bit of immediate filling from the gel carrier, AND they will also continue to stimulate collagen over the next several weeks.
What to expect if you get Radiesse
Like any other injectable, you can expect some immediate post procedure swelling and tenderness. Bruising is a potential side effect as well.
With HD Radiesse, your injector will numb the entry point for the cannula to slide into the dermis or subcutaneous tissue and then fan the product. Similar to Sculptra, subsequent treatments may be harder to do with cannula because of all the new collagen that was created.
One of the benefits of Radiesse over HA fillers and Sculptra is that each syringe comes with 1.5 cc of product! So you get a little bit more bang for your buck.
Patients are instructed to follow the same aftercare instructions as receiving any injectable treatment. Unlike Sculptra, you do not have to follow the 5-5-5 massage rule with Radiesse.
Some immediate results will be seen due to the gel carrier. The gel carrier will break down around the 12 week mark and the collagen induction will continue for up to 12 more weeks. Results peak at 4 months after injections and results will last 12-18 months or longer.
Which one should I choose?
That is a great question! How do you decide between Sculptra and HD Radiesse when they both do the same thing (collagen regeneration) and last almost the same amount of time? It generally boils down to these 3 points:
Autoimmune disorders: If you have an autoimmune disorder that is not managed, then get HD Radiesse. Autoimmune conditions will predispose clients to nodule formation.
Level of volume loss: If you need some extra immediate filling due to moderate to severe hollowing/collagen loss, then HD Radiesse is the way to go because the gel carrier will give them an added boost of volume. Sculptra is great for patients who want to take preventative anti-aging measures and only want the collagen stimulation to tighten and firm the skin, not add significant volume.
Age: Not a rule, but from what I have noticed is that younger clients often get Sculptra while older clients prefer Radiesse because of #2.
Cost: while Sculptra and Radiesse are oftentime priced the same, generally patients will need more Sculptra vials, especially if they are in their 40-60s. Each Radiesse syringe has 1.5cc of product which can be a more cost-effective solution.
Ultimately, everybody is different and will react differently to different injectable drugs. Some people may respond better to Sculptra while another person may have better results from HD Radiesse. Longevity is comparable, but again, it just depends on the person!
My thoughts: If you are interested in the powerful regenerative properties of biostimulators, it doesn’t hurt to try either (as long as you are medically cleared for both drugs). It’s best to book a free consultation with your injector to discuss overall goals and create a treatment plan that is right for you.
Written by: Christy Nguyen BSN
Aesthetic Nurse Injector and Certified Laser Safety Officer