Facial Rejuvenation For the Thin Patient
Posted Wed, Mar 31, 2010

Pan-facial atrophy. The 21st century word for the aging face. As fat and bone, muscle, and skin whither, the face shrinks and wrinkles. Most important, the face looks older. To my regret Google Tyra Banks and Sandra Bullock. What a shame these 2 lovely ladies don’t understand the gestalt they communicate with their newly minted gaunt appearance. It seems strange that in a country where our primary health problem is obesity, a new generation of women and some men seek to enhance their appearance with an asthenic appearance.
Pan-facial atrophy, the whithered aging face, is a natural product of aging and is enhanced when adults do not maintain adequate body weight to support their skin envelope. For people with normal body weight the best solution is fat transfer from a more robust area of the body such as abdomen or hips to the depleted cosmetic units of the face: the temples, the cheeks, the mouth, and in front of the ears. However, it is not uncommon to see patients who have normal to low body fat and aging withered faces, for whom gaining weight is not a psychological option.
The answer for them is Sculptra, poly-L-lactic acid. Poly-L-lactic acid is a synthetic particulate which can be produced as minute fibers that can be suspended in salt water and then injected under the skin. Once injected, this alpha-hydroxy acid acts as a biostimulant to induce collagen production in both fat and skin. There is some consideration in Europe that when layered over bone the collagen may cover the bone and in some way add to its bulk. Regardless, the new collagen restores depth to the subcutaneous layers and, when properly distributed, restores normal contours to the aging face.
Like previous fillers, hyaluronic acid (Restylane, Juvaderm) and collagen, poly-L lactic acid is naturally metabolized in tissue and presents no harmful foreign tissue. Unlike these other fillers the Sculptra fiber does not provide the bulk needed to restore normal contour but rather induces our own body to generate tissue needed to restore shape.
Sculptra is not a new product and was successfully used 10 years ago to treat the facial ravages of HIV patients who had been treated with antiviral agents. It was quickly recognized that it had great potential for treating cosmetic patients. Unfortunately, the dilutions that were recommended and used were too concentrated and they induced unsightly nodules in some patient’s skin. There are numerous, probably exaggerated, horror stories on the web of patients treated with Sculptra. Now however, following reports by Dr. Rebecca Fitzgerald of some 2000 patient interventions treated at UCLA and by Dr Neil Sadick of some 1000 patient interventions in New York City, it is recognized that this is a very safe product when diluted and injected correctly. To protect the public the company, Dermik Sanofi-Aventis, has stipulated that it will not sell its products to medispas or non-board certified cosmetic and plastic surgeons.
This is the first practical use of a group of compounds which will be developed over the next decade that will reverse the stigma of an aging face by inducing the human body to regenerate tissue that was lost through aging and/or a low caloric lifestyle. We have implemented the Sculptra program at MetropolitanMD and Drs Rachel, Franco and I anticipate it quickly becoming the gold standard in facial rejuvenation. For patients who do not want to undergo a fat transfer procedure or who do not wish to gain weight, this is a most significant break-though in preventing and reversing facial aging.

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Edward Lack
Edward Lack MD is a board certified dermatologist and a board certified dermatologic cosmetic surgeon. He is President and Medical Director of MetropolitanMD, a multispecialty cosmetic surgery center in Chicago,which is unique in having a double board certified cosmetic dermatologic surgeon, a double board certified facial plastic surgeon, and a double board certified cosmetic plastic surgeon. Dr. Lack is also the Past President of The American Academy of Cosmetic Surgery.

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