Sculptra – Will The New Mixing Method Cause More Nodules?


Hello Dr. Irwin, I had Radiesse injected into my lower cheeks in June. in November, I developed nodules in both cheeks. On one side, it is more of a golf ball sized mass and on the other, several large, hard bumps. I went back to the nurse and she injected a small amount of diluted steroid and it showed no improvement. I am beside myself. I saw a plastic surgeon who said he has not seen this late-onset immune response before but has scheduled me to come in for an aggressive treatment of steroid injections and has prescribed antibiotics. Does this sound like it will help or what else can you recommend be done? I am 61 years old.

Please see the Radiesse question I answered in the last blog post. 🙂

As many of you know, Sculptra recently changed their guidelines for reconstituting/mixing the vials. For 20+ years, the guidelines have been to mix the product at least 6-8 hours before, and 1-3 days being even better.  It gets mixed with sterile water and often lidocaine (numbing) prior to injecting it because it ships in a vial in powder form.

Why the change after 20 years? Allergan bought this product and added it to its portfolio a few years ago. They commissioned some small studies to see if it would be safe to mix right as the patient arrives. There are clear advantages to this for Allergan. It should generate more sales by allowing newer providers and smaller clinics to inject Scultpra. They don’t have to premix it and risk their patient not showing up, with then a loss of that expensive product.

A Few Thoughts to Consider:

  • There will now be more inexperienced clinic and providers offering this service. Try to find someone who’s been injecting this for at least 3-4 years.
  • When the product is mixed just prior to injecting it, there are more product crystals that remain in the vial. This potentially reduces the results because the actual injected product is more dilute.
  • When the product is mixed just prior to injecting it, there are potentially more clumps of powder that are not fully rehydrated. This could cause more problems with Sculptra, such as bumps and nodules. These are very difficult to treat and last 3 months to 2 years.
  • Inexperienced providers may shake the vial or in other ways premix it incorrectly; also causing more bumps or nodules.

My recommendations:

  • Look for clinics that still premix the product, even if that means you need to pay for the service at the time of booking.
  • Look for dermatologist and nurse injectors who have been working with Sculptra for at least 3–4 years.
  • Ask what the clinic protocol is for treating Scultpra bumps or nodules if they occur. If they can’t answer that question, maybe find another provider.
  • More experienced clinics generally have more patients who use this product and are using 3–10 vials a week.


Hope this helps,

Dr. Brandith Irwin, MD
Founder of SkinTour & MadisonMD Skincare
Follow my skin tips and travels on Instagram!