Sculptra is a poly-L-lactic acid (PLLA) biostimulatory injectable that induces neocollagenesis rather than providing immediate volume.
The FDA has approved it for facial lipoatrophy, but ongoing research has expanded its use to other areas as well, such as the preauricular region and the hands.
This article discusses the most common Sculptra injection sites, emerging applications, and high-risk areas where injections should be avoided.
Key takeaways
- Sculptra injections for the face have shown significant improvements in cheek wrinkles, skin radiance, firmness, and jawline contour.
- Sculptra in the temporal region is administered using a three-point bolus injection technique. The technique improves midface support, soft tissue repositioning, and eyebrow elevation while reducing accordion lines and upper eyelid ptosis.
- Jawline and chin augmentation with Sculptra requires supraperiosteal and subcutaneous placement, avoiding the depressor anguli oris and marginal mandibular nerve.
- Sculptra periorbital injections should be performed by experienced professionals using a diluted 11-cc solution in the supraperiosteal plane.
- Emerging Sculptra uses include hand rejuvenation, neck and décolleté enhancement, atrophic scar improvement, post-breast reconstruction chest wall correction, and treatment of Romberg syndrome.
- Sculptra should be avoided at the lips, vermillion border, nose, glabellar region, and forehead due to risks of vascular occlusion, nodule formation, fibrosis, and unnatural collagen deposition.
What Are Sculptra Injection Points?
Here is a breakdown of the various Sculptra injection sites:
Cheeks
The cheek region plays an important role in midface volume restoration and structural support.
A recent clinical trial evaluated the efficacy of Sculptra in correcting moderate-to-severe cheek wrinkles compared to a no-treatment control.
Patients received injections with an 8 mL Sculptra reconstitution combined with 1 mL lidocaine, with up to three additional treatments administered at monthly intervals. [1]
At the 12-month follow-up, 71.6% of treated patients demonstrated at least a one-grade improvement in cheek wrinkles on the Galderma Cheek Wrinkle Scale (GCWS) at rest.
Clinical assessments also highlighted improvements in skin radiance (>95%), firmness (>91%), and jawline contour (>85%).
Temples
The temporal region is another well-established site for Sculptra injections.
One study used Sculptra in the posterior temporal region using a three-point bolus technique:
- 2 mL in the superior region
- 1.5 mL in the mid-temporal zone
- 1.5 mL in the lower temporal point
Post-treatment assessments revealed a significant reduction in accordion lines with better facial contouring in the temporomandibular region. It also improved midface support, which led to a noticeable lifting effect.
Patients exhibited soft tissue repositioning, which contributed to the attenuation of infraorbital hollowing, nasolabial groove refinement, and malar projection enhancement.
Furthermore, at the 90-day follow-up, structural improvements in the upper face included a widened palpebral fissure, elevation of the eyebrow tail, and reduced upper eyelid ptosis. [2]
Jawline and Chin
Along the jawline and mandibular angle, injections are administered in the superficial subcutaneous fat layer.
Care must be taken to avoid the depressor anguli oris and marginal mandibular nerve to prevent functional asymmetry or undesirable contour irregularities.
In the pre-jowl sulcus, where soft tissue loss contributes to an irregular jawline, a supraperiosteal injection is preferred.
Injections in the chin (menton region) are placed in the supraperiosteal plane, where deep collagen stimulation supports bone remodeling and projection enhancement. Placement along the mentolabial sulcus improves chin prominence and lower face balance.
Sculptra injection technique in this area uses a 25-gauge, 1.5-inch needle, introduced through a single well-concealed puncture site at the oral commissure. The approach minimizes trauma while allowing the injector to tunnel the needle into the inframalar hollow and distribute the product effectively. [3]
Preauricular Area
The preauricular region is particularly susceptible to volume depletion due to its reliance on superficial fat compartments for subcutaneous support.
Subcutaneous injection of poly-L-lactic acid in the preauricular area induces neocollagenesis that reinforces structural support across adjacent regions, including the malar area, zygomatic arch, and mandibular angle. [4]
Sculptra in the preauricular area is injected in a subcutaneous plane to restore volume and stimulate collagen synthesis. A single session per year is recommended to sustain collagen production.
For persistent fine wrinkles or subtle surface imperfections, complementary treatments with 2-3 mL of hyaluronic acid-based skin boosters or regenerative solutions may be applied 30-90 days post-Sculptra.
Periorbital Region
An 11-cc dilution is preferred for the periorbital area to facilitate even dispersion and minimize the risk of palpable nodules or overcorrection.
To address infraorbital hollowing, two to three deep supraperiosteal depot injections are administered along each infraorbital rim. [5]
Approximately 0.1 cc per Sculptra injection site is deposited uniformly. After placement, an immediate digital massage against the bone should be done to evenly disperse the product.
Unlike other facial regions, the periorbital area should be undercorrected to prevent excessive collagen deposition and contour irregularities.
Off-Label and Emerging Sculptra Injection Sites
Sculptra has many off-label applications for tissue remodeling and dermal atrophy correction. Emerging Sculptra injection sites and reconstructive uses include:
- Dorsum of the hands
- Horizontal neck lines and skin laxity in the neck and décolleté
- Congenital, traumatic, and postsurgical soft tissue depressions [5]
- Atrophic scarring in acne and varicella scars
- Sculptra injection for breast and chest wall deformities post-breast reconstruction
- Facial asymmetry and Romberg syndrome
- Sculptra injections for hip dips and buttocks
- Postoperative soft tissue loss (e.g., melanoma excision) [6]
Where Should Sculptra Not Be Injected?
There are five areas where Sculptra injection should be avoided due to safety concerns and the risk of complications.
- Lips and vermillion border. The safety and efficacy of Sculptra in the lips have not been established. It should not be injected into the vermillion due to the risk of nodule formation, contour irregularities, and fibrosis in this mobile, highly vascularized area.
- Periorbital region. Injections directly around the eyes may cause granuloma formation, vascular occlusion, and irregular collagen deposition due to the thin skin. Supraperiosteal placement on the infraorbital rim may be cautiously considered.
- Nose. Sculptra should not be used for nonsurgical rhinoplasty or nasal contouring due to the high vascularity.
- Glabellar region. The glabellar complex has limited soft tissue coverage and crucial vascular structures that are highly susceptible to vascular compromise and tissue necrosis.
- Frontalis muscle area. Injecting Sculptra into the frontalis muscle can lead to uneven collagen deposition, palpable nodules, and an unnatural aesthetic outcome.
Is the Sculptra Injection Technique the Same for All Injection Sites?
Sculptra injection technique varies by facial region due to differences in anatomy, tissue depth, and vascular considerations. Here are a few points to note:
- Cheeks. Sculptra is injected subcutaneously or deep dermally using a fanning or cross-hatching technique. Care must be taken to avoid the zygomaticus muscles and vasculature, including the infraorbital foramen, to prevent vascular occlusion or unwanted nodules.
- Temples. The temporal region has a thin subcutaneous fat layer, so it requires deep supraperiosteal placement to avoid intramuscular injection and vascular compromise. [7]
- Jawline and mandible:
- Mandibular angle and lateral jawline — Injected into superficial subcutaneous fat for definition
- Menton and prejowl sulcus — Placed supraperiosteally for structural support. Avoid injecting into the muscle fibers of the depressor anguli oris and oral commissure [8]
- Periorbital region. The area around the eyes requires a highly cautious approach due to the delicate anatomy. Supraperiosteal placement in the infraorbital and lateral orbital rim is recommended, with very dilute Sculptra solutions and minimal product deposition.
FAQs
Find answers to most frequently asked questions about Sculptra injections.
Where Is the Best Place to Inject Sculptra?
The best injection sites for Sculptra include the deep dermis or supraperiosteal planes of cheeks, temples, jawline, preauricular area, and chin.
What Is the 5-5-5 Rule for Sculptra?
The 5-5-5 rule for Sculptra refers to massaging the treated area for five minutes, five times a day, for five days post-injection. It helps distribute the product evenly and reduce nodule formation.
Is Sculptra Safer Than Fillers?
Currently, no substantial published evidence confirms that Sculptra is safer than hyaluronic acid fillers. However, its more fluid consistency theoretically reduces the risk of vascular occlusion compared to traditional dermal fillers.
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References
- Fabi S, Hamilton T, LaTowsky B, et al. Effectiveness and Safety of Sculptra Poly-L-Lactic Acid Injectable Implant in the Correction of Cheek Wrinkles. Journal of drugs in dermatology: JDD. 2024;23(1):1297-1305. doi:https://doi.org/10.36849/JDD.7729
- Munia C, Parada M, Henrique M. Changes in Facial Morphology Using Poly-L-lactic Acid Application According to Vector Technique: A Case Series. The Journal of Clinical and Aesthetic Dermatology. 2022;15(7):38. Accessed March 13, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC9345188/
- MOY R, FINCHER E. Poly-L-lactic acid for the aesthetic correction of facial volume loss. Aesthetic Surgery Journal. 2005;25(6):646-648. doi:https://doi.org/10.1016/j.asj.2005.10.001
- Munia CG, Morais M, Sato M, Parada M, Avelar LE. Optimizing Skin Quality with Injectable Poly-L-Lactic Acid and Hyaluronic Acid. The Journal of Clinical and Aesthetic Dermatology. 2023;16(6):26. Accessed March 13, 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC10286875/
- Lam SM, Azizzadeh B, Graivier M. Injectable Poly-L-Lactic Acid (Sculptra): Technical Considerations in Soft-Tissue Contouring. Plastic and Reconstructive Surgery. 2006;118(Suppl):55S63S. doi:https://doi.org/10.1097/01.prs.0000234612.20611.5a
- Lacombe V. Sculptra: A Stimulatory Filler. Facial Plastic Surgery. 2009;25(02):095-099. doi:https://doi.org/10.1055/s-0029-1220648
- Glasgold R, Kontis T, Smith S, et al. Volume Rejuvenation of the Lower Third, Perioral, and Jawline. Facial Plastic Surgery. 2015;31(01):070-079. doi:https://doi.org/10.1055/s-0035-1544945
- Vleggaar D, Fitzgerald R, Lorenc ZP. The need for consensus recommendations on the use of injectable poly-L-lactic acid for facial and nonfacial volumization. Journal of drugs in dermatology : JDD. 2014;13(4 Suppl):s28. https://pubmed.ncbi.nlm.nih.gov/24719073/