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AAI 100: The Art of Needles and Cannulas: Aesthetic Medicine’s Essential Tools

December 03, 2024

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In the milestone 100th episode of the “Anti-Aging Insights” podcast, Dr. Teri Fisher and special guest Dr. Gidon Frame dive deep into the world of Sculptra, an innovative bioregenerative filler. Recorded during a recent Instagram Live session, this episode serves as “Sculptra 100,” covering the basics and beyond of this poly-L-lactic acid treatment. Listeners will discover how Sculptra works to naturally stimulate collagen production, resulting in healthier, more youthful skin over time. The duo explores the differences between Sculptra and traditional hyaluronic acid fillers, highlighting Sculptra’s gradual, subtle results that avoid the “filler face” effect. With engaging discussions on treatment techniques, areas of use, and even audience questions, this episode offers valuable insights for anyone considering or curious about Sculptra. Perfect for both newcomers and those familiar with dermal treatments, this episode promises to enhance your understanding of an advanced approach to aesthetic medicine. Tune in to learn why Sculptra might be your next step in achieving a rejuvenated appearance.

Today’s Guest

Dr. Gidon Frame

Dr. Gidon Frame is a kind, ethical and compassionate doctor and one of the most experienced and respected cosmetic injectors in British Columbia. He has a wonderful “chair-side manner” and a good sense of humour, which immediately puts his patients at ease.

Dr. Gidon Frame’s mission is to manage and reverse total body and brain aging, while optimizing facial rejuvenation. He also has a passion for preventative medicine.

Dr. Frame loves to coach and teach people how to make their face, body and mind “shine”. He is a University of British Columbia Clinical Assistant Professor and often gives educational talks to the general public. After 13 years of performing regular, cosmetic injectables and laser treatments, Dr. Frame has become recognized as an expert and teacher of balanced aesthetic rejuvenation.

Episode Summary

In this landmark 100th episode of the Anti-Aging Insights podcast, Dr. Teri Fisher and Dr. Gidon Frame dive into the world of Sculptra, a revolutionary bioregenerative filler that stimulates collagen growth for a natural, youthful appearance. Recorded during a live Instagram session, this episode brings listeners a comprehensive primer on Sculptra, discussing its unique properties and applications.

Sculptra, made from poly-L-lactic acid (PLLA), is not your typical filler. Unlike hyaluronic acid fillers that provide immediate volume, Sculptra works gradually to rejuvenate and thicken skin by stimulating collagen production. This subtle approach can yield dramatic improvements over time, making it a perfect option for those seeking long-lasting results without overt changes.

Dr. Frame explains the distinctions between Sculptra and traditional fillers, noting the common pitfalls of overusing fillers that can lead to “filler face.” They delve into Sculptra’s ability to provide a natural enhancement, smoothing wrinkles and revitalizing skin texture. Approved by Health Canada, Sculptra is versatile, suitable for various facial areas, neck, arms, and even the buttocks.

The conversation highlights the procedure’s safety, emphasizing the use of a cannula—a blunt-ended instrument that mitigates the risk of damaging blood vessels during injection. Listeners also learn about the post-treatment protocol, famously known as the “5-5-5 rule,” involving routine massage to ensure even distribution and optimal results.

Dr. Fisher and Dr. Frame address audience questions, comparing Sculptra’s efficacy and coverage to other fillers, while sharing insights on the treatment’s longevity—typically two to three years. They underscore the increasing popularity of biostimulatory products like Sculptra for their gradual yet effective transformations.

Concluding with an overview of Sculptra’s compatibility with other cosmetic procedures, Dr. Fisher invites those interested to contact their Vancouver clinic for consultations and personalized treatment plans. Whether you’re new to aesthetic treatments or a seasoned patient, this episode offers valuable insights into achieving age-defying results with Sculptra.

Key Insights

  • The episode celebrates the 100th episode of the Anti Aging Insights podcast and features a discussion about Sculptra, a bioregenerative filler.
  • Sculptra, made of poly-L-lactic acid (PLLA), stimulates collagen growth and improves skin texture over time, offering a gradual and natural enhancement.
  • Unlike hyaluronic acid fillers which provide immediate results, Sculptra works gradually and typically offers results over a period of three to four months.
  • Sculptra can be used for various areas including smile lines, marionette lines, neck, decolletage, arms, and buttocks, and is suitable for a wide age range, promoting long-term skin improvement.
  • The process involves using a cannula for safer and more even distribution, with post-procedure care including the “5-5-5 Rule” of massaging the treated area to prevent any nodules.

Episode Transcript

Dr. Teri Fisher: Hey there and welcome to episode number 100 of the Anti Aging Insights podcast. Can you believe it? We are here at episode 100 and before I say anything else I do need to take a moment and thank you For listening, for subscribing, for sharing the episodes and for all the great feedback that I have received since I started this now a couple of years ago.

So thank you so much for your participation. Thank you so much for being a listener. And, it just really means the world to me. Today we’ve got a special episode. It is an episode that we recorded when we were doing an Instagram live recently. And we talked all about Sculptra. You can consider this essentially Sculptra 100, all the basics of Sculptra, things that you may want to know about when it comes to this special bioregenerative filler. And so rather than reinvent the wheel, I thought we would just share this Instagram live with you.

Now I do apologize for the audio. The microphones aren’t as great when we are doing the Instagram lives, but nevertheless it was great content and I wanted to share it with you, as I said. So without any further ado, let’s get right to it. This is Dr. Gidon Frame and myself talking about Sculptra.

Dr. Gidon Frame: Hello there, Dr. Teri Fisher, Dr. Gidon Frame here at the Anti Aging Medical Laser Clinic in Kitsilano, beautiful British Columbia, sometimes sunny, not usually in the winter, but we love the air. So, today here at Anti Aging, Dr. Fisher and I have been doing some training and education and upgrading on Sculptra, one of our favorite bio stimulators.

Dr. Teri Fisher: Sculptra is PLLA, poly-L-lactic acid. It is a type of regenerative, injectable implant that we can inject into various places in the body. And the beauty about this little magic powder is that it actually encourages the body to grow collagen and stimulate the growth of good, healthy skin and tissue.

And it can make a huge difference in our appearance.

Dr. Gidon Frame: So it’s not a filler.

Dr. Teri Fisher: It’s not. Well, it’s a type of filler, but most people when they think of filler, they’re thinking of hyaluronic acid. Hyaluronic acid, and this is a great point. One of the differences between hyaluronic acid and something like this; hyaluronic acid, you see immediate results. You inject it, it is a filler in the true sense of the word, you fill up the area that you’re working on, and you see it immediately.

Dr. Gidon Frame: That’s the trap. That’s the trap. Because filler, hyaluronic acid filler, looks so good most of the time, we are tempted to over treat, over do, over go, and if you do it year after year after year in the same place, what happens? You get filler face. Now, good hyaluronic acid filler done by our team here at Anti Aging Medical Laser Clinic, we don’t do that. We try not to do that. But, if you’ve accumulated filler, how long does hyaluronic acid last in your body?

Dr. Teri Fisher: People say it lasts a year, two, but we know from studies and from our own playing around with the ultrasound probe.

Dr. Gidon Frame: You did an ultrasound not long ago on one of our patients, and how long had she had the filler in there?

Dr. Teri Fisher: Years. Years. Three to five years. So, it does stick around, and as you put more and more in you get, you get what he’s talking about.

Dr. Gidon Frame: Exactly. So, there is a movement. Some people want the immediate effect of the filler, and some people want the bio stimulatory effect of the Sculptra. They want to slowly, over three months, rejuvenate, grow collagen, thicken skin, smooth skin, get tissue underneath the skin to slowly and gently fill out.

So, let’s have a look at what some Sculptra can do. So this is the Sculptra. The areas of the face that are on label for Sculptra are smile lines, marionette lines, other wrinkles. That’s what Health Canada has approved. However, we’ve been doing Sculptra in this clinic for over 12, 13, I think it’s coming up for 15 years. And we’ve learned and we’ve got experience with using Sculptra for face, for neck, for decollete, for arms, for that as well. And both Dr. Fisher and I have done numerous butt smoothing and filling out with Sculptra.

Let’s go back to the face. So, if we look, and it’s a bit gruesome, pardon us, you know, spoiler alert, if you don’t like cannulas, okay, but for safety’s sake, what do we use over here?

Dr. Teri Fisher: So here we have a cannula. Cannula is very different than needle. If you’re not familiar with a cannula, the cannula is a device that has a blunt end, and that allows us to, once we have made a little hole for it, to actually slide it through the tissues. It’s a much safer way, because we’re not going to be hitting and going into blood vessels. The blood vessels just kind of bounce out of the way of the cannula. And we can slide and we can fan the Sculptra in a larger area than you can with just a needle.

Dr. Gidon Frame: So, interestingly enough, if we look closely here, that Sculptra is actually an opaque liquid. But yet, aha! Blow it up. Yeah, look at that. That’s a milky liquid. But hey, this Sculptra is a powder. So it’s stable, it comes as a freeze dried powder. It’s got a long expiry time. It’s stable on the shelf. We used to have to rehydrate it, put water in and rehydrate it months before, keep it on hand, agitate it.

Now we’ve realized that we can rehydrate it, reconstitute it, day of the treatment. You come in, you say, I want to smooth the skin on my face, I want to tighten the skin, I want to fill gently in my temples, in my cheeks, in my marionette areas. No problem. We add sterile bacteriostatic water, a bit of lidocaine, so it becomes relatively painless. Mix it up. We’ve got all special techniques. We have a mixer, a mixologist, we have an assistant. We have all kinds. We’re agitating it all the time. There’s a special ritual to the Sculptra. The Sculptra that we’ve learnt is the best way to do it. And then, boom, with the cannula, it’s spread around. You don’t have to be particular about, I want this much here and this much there. You’re doing a general field treatment.

So this is great for people, like me, who don’t particularly want a particular type of filler. I’m not fussed about my cheekbone here, my cheekbone there. I want general improvement. And I don’t need it to happen today. I’m happy to have it over three months when nobody can see. Nobody would know that I’ve got, well, of course I will not admit to. I cannot confirm nor deny that I have tried Sculptra myself a few times over the last 15 years. I cannot, but I do like Sculptra, just to say. And it does produce a beautiful smoothing and a slight filling of temples, of cheek area, and pulling and tightening back.

Dr. Teri Fisher: I think that’s a great point because some people will come in and they want to have some type of treatment done, but they don’t want it to be obvious. They don’t want to have someone that they know look at them and say, Oh, you just had something done. This is a way to do it because it happens gradually over time as the body grows the tissue. And so it’s a very subtle treatment, but once that growth has occurred, you can have quite dramatic results.

Dr. Gidon Frame: So let’s have a look. In about three to four months, this gentleman gone from like having, you know, a fair decent amount of lines, some pores and what not. Boom. He’s got a smoother, clearer face.

Dr. Teri Fisher: Even the scar on his face too.

Dr. Gidon Frame: Before, you know, the fine lines. After, smoother, better texture and better tone, catches the light better. The fine lines are improved. The pores are improved. The crepiness of the skin is improved. And when you stiffen and you create collagen, you get a bit of a gentle tightening. So nobody should be able to see. I dare you to tell me whether I have a Sculptra in my face or not. And where I have Sculptra. Assuming that I may or may not.

Dr. Teri Fisher: Once you have this treatment done, then there’s a little bit of homework for this particular type of treatment. You do have to massage it. We want to make sure that everything is distributed very evenly. So we’ve got the 5 5 5 rule. 5 minutes of massage, 5 times a day, for 5 days when you get the treatment. And that’s to help to ensure that it’s distributed really evenly in the areas that we treat.

Dr. Gidon Frame: That’s the only real complications that I’ve seen over the years is a little bit of a nodule. An overgrowth of the collagen in one particular area. And I’ve seen it twice out of many, many patients. And it settled over time. We managed to disguise it, to dissolve it, to get it to go down, and it wasn’t a train smash.

Sculptra is supposed to last two years. That’s kind of the average time. It’s rated for two years. My experience, I’ve seen it last a bit longer in some people, three years. For sure, this is a great niche bio stimulator for people who come in and say, you know what, I keep getting filler, and it just wears off quickly. It doesn’t show. I’m applying money to my face, I’m keeping to do 2, 3, 4 vials of hyaluronic acid filler, and it’s just going nowhere, but yet it’s building up inside.

Audience Question: I have one question here. In comparison to someone who would need one or two syringes in their temples, how many vials would they need? Does it tend to cover more surface area compared to filler?

Dr. Gidon Frame: It’s almost a one to one basis. If you need two vials of filler into your temples, one, two, you’re probably going to need at least two vials of Sculptra. And the pricing is about the same. You can start with one, half and half, you can go two, you can go full one, full one. And you might, you’re waiting for it to grow at three months. If you’re a good collagen grower, you’re happy at three months. If you’re not as good, and you want to do more, you can do another one, one. The recommended amount of Sculptra for full facial treatment is one vial per decade of age. So, assuming I were to have Sculptra, or may have, or may not have uh, being 63, I would need six vials.

And you can choose. You can come see Dr. Fisher. And you can do one or two vials today. And you can, in one to three months time, you can do another one to two vials. And one to three months after that, another one to two vials. You can get up to six vials. Or, if you don’t mind the one day of swelling, because it’s water. It’s mainly water taking the Sculptra powder in, the PLLA powder. You can do it all in one go. That’s off label. But many, many of our patients have tolerated doing six vials at once. It’s easy to tolerate, you’ve got one day of swelling, you get it over and done with, you’re over the swelling and now you wait for it to grow.

Dr. Teri Fisher: And I think we are seeing more of this, more in terms of people requesting this. There’s a trend where people want to have more of the biostimulatory products, and it’s a great one for that.

Dr. Gidon Frame: Yeah, I totally agree.

Okay, any more questions? No giveaways today. Sorry, we can’t give away Sculptra. This is a physician procedure and we wouldn’t want to be enticing you. You don’t need any enticement. I’m sure that almost anybody of any age, and that’s the beauty of Sculptra as well, you can do Sculptra up until you don’t make collagen anymore. And for some people that may be in their 70s, 80s, or 90s, but certainly from a young age up to 80, you can probably benefit from Sculptra. Even younger people, this is becoming a trend. We have people walking in, or phoning in, or direct messaging in, and saying, my friend told me I need Sculptra. And we say, what for? They say, I don’t know. I need it for looking better. How old are you? 32. Okay. well, this is a 32 year old, doesn’t need filler, hardly needs botulinum toxin, maybe a bit of lasering, needs some skin care, they don’t need filler. But they do want to improve tightness and collagen, kind of de-aging or anti-aging of the skin. And that’s where we see this as a biostimulatory, anti aging, injectable intervention.

Audience Question: Some patient and client asking about is our brand is the top or the best brand in North America.

Dr. Gidon Frame: This is the number one. In fact, this is, sorry, the only purely L lactic acid available in Canada. And it happens to be the brand name. So if you come from another country and say, I had Sculptra, maybe you didn’t. Maybe you had a generic equivalent of Sculptra, a wannabe. But in Canada, at a licensed, professional, registered physician clinic, you will only get Sculptra, certainly at our clinic. I can’t speak for all my colleagues out there. At our clinic, you ask for Sculptra, you’re getting brand name Sculptra. Because as you can see, we have it, and it is from Galderma, which is a company that makes also Restylane. And Restylane is one of the, I remember in 2003, when we launched our cosmetic service, the only filler we had was Restylane from Galderma.

So they’re one of the oldest, most founded companies in injectable cosmetic business. And they are the ones that have now brought out, well not now, 15 years ago, have brought out Sculptra. And it is internationally probably the primary brand of poly L lactic acid. So yes, this is the Coca Cola, the Botox, the Hoover, and the Electrolux, and the Kleenex of Poly-L-lactic acid biostimulators.

Dr. Teri Fisher: Fun fact. The other way you can get this is through threads. The type of threads that we do, it has PLLA in it as well, which has biostimulators.

Dr. Gidon Frame: Yeah, good point there. I like that. Yeah, so that’s a nice combination. And some of us may or may not have poly-L-lactic acid threads, and this is the thread, if you can look, see. This is the thread that we use at our clinic, and it’s also made of poly-L-lactic acid. So the collagen stimulation of this thread, these threads are designed to tighten. They go well together. The, both PLLAs, they smoothen, they tighten, they create collagen. So you can inject it in, or you can thread it in, and it’s going to last for two years.

So that’s a good point. Why our InstaLift thread lift, Silhouette InstaLift thread lift lasts two years. And not three to six months of a non health Canada approved opposition thread available in other countries besides Canada.

Dr. Teri Fisher: There you go. So you can actually pick. You want it injected within the solution or as a thread? We have options here. Yeah. There you go.

Dr. Gidon Frame: And some people mix poly-L-lactic acid Sculptra in areas they want smooth. And they use a little bit of filler, hyaluronic acid filler to create defined lips. You know, there’s areas that Sculptra is not gonna, is not recommended. Lips, tear troughs, there’s some areas. There’s also some areas that if you want done, you should go to an expert. You should go to an experienced expert that’s been doing this for a while and know how to handle it because there are off label and other ways to use Sculptra on the face to make it act more like a filler. But those ways need a higher level of expertise.

Dr. Teri Fisher: Alright, there we are.

Dr. Gidon Frame: Okay, so we’ve now spoken today about Sculptra, poly-L-lactic acid, injected with the cannula, used for smoothing, sculpting, that’s why it’s called Sculptra. Filling gently, tightening gently, and improving the overall texture of the skin, of face, body, butt, and almost anywhere in the body that you can want to use it.

And this Sculptra is available from Dr. Fisher, from myself, Dr. Frame, from Dr. Govindasamy here at the Anti Aging Medical Laser Clinic. We have a whole team available that will counsel you, will consult with you, will answer your questions, and will assist the three doctors here at Anti Aging Medical Laser Clinic in Kitsilano, Vancouver to help you decide if Sculptra is your way to go, and what’s the best way to do Sculptra here at our clinic, and augmented and complemented with other injectables and other lasers.

Alright. Great. Thanks everybody. Bye. See you next week.

Dr. Teri Fisher: See you next time.

Well I hope you enjoyed that primer on Sculptra. We answered lots of questions as you can see, talked a little bit about how it’s done, what it’s good for, who it’s good for, where we use it, the whole bit. So if you are thinking about Sculptra, if you know somebody that’s thinking about Sculptra, Feel free to share this video, of course, or this podcast with those people.

Thanks again for tuning in this week. As always, feel free to check out our resources on the web at AntiAgingVancouver. com, and we’ll talk to you soon. Take care.

Anti-Aging Insights Podcast Cover

Anti-Aging Insights Podcast

with Dr. Teri Fisher

Weekly interviews, insights, and inspiration to navigate the world of anti-aging and aesthetic medicine.