In the columns so far I have gone through the order that body sculpting follows, one step at a time: clear what hides the line, decide the target silhouette and build the shape, and design on one picture where to add and where to take down.
By this point the line itself is largely set. There is one more thing I check at the end, though. Is the surface covering that line keeping up with it? Shape and surface lie one on top of the other in the same place, but handling each is a different job.
The last step in sculpting is not refining the shape further. It is tightening the surface that covers the shape so that it fits.
When the shape is there but the surface does not follow
Patients who have been through some body treatment say this: the shoulder angle is set and the collarbone shows, but in photographs something is still a little short. Up close the line is right, yet the skin over it looks slightly slack, or feels less firm than they had hoped.
I see this especially often in people who have been through the clearing stage. When the layer that hid the line is reduced, the skin that covered that layer is left behind, and skin does not shrink straight away to match the volume that has gone. In places where the skin is thin, such as the inner arm or the front of the shoulder, the sharper the shape becomes, the more the slackness of the surface can stand out.
Adding more filler is usually not the answer here. Filler pushes shape up from below; it does not tighten the skin that lies over it. When the shape is already sufficient and more volume goes in, things go the way I have described in the previous columns: the area gets heavier rather than sharper. The layer with the problem is a different one. This time it is not underneath but on the surface.
Immediate volume versus restoring over time
The method I most often describe for the surface is an injection of PLLA, poly-L-lactic acid, a treatment known under the name Body Sculptra. Because it goes in by injection and the name sounds similar, many people take it for a kind of filler. It does a different job.
| Aspect | Filler (hyaluronic acid) | PLLA (Body Sculptra) |
|---|---|---|
| How it works | The gel itself becomes the volume that makes the shape | The material acts as a stimulus that helps the body make its own collagen |
| When change shows | From immediately after treatment | Gradually, over weeks to months |
| What remains | The volume of the gel that was placed | The material is slowly absorbed; the collagen the body made remains |
| Its role | Adds shape that is missing | Restores the thickness and firmness of the skin covering the shape |
| Where it suits | Areas short of volume | Surfaces where the skin has thinned or slackened |
The first row is the point. With filler, the gel that is placed is the volume. That is why the shape shows straight after treatment and the result follows the amount. With PLLA, the material placed does not become volume. It works as a stimulus within the tissue, and as the body responds by making collagen, the skin changes in the direction of becoming thicker and firmer from the inside. So it is normal that little change shows immediately after treatment; the change appears with time, and how much of it appears differs from person to person.
In other words one is a job of filling now, and the other a job of helping the skin restore itself. Use PLLA where shape is needed and the angle you want will not appear; use filler where the surface is the problem and only the volume grows. That is why the two treatments cannot stand in for each other.
Why it is gradual, over three to six months, and natural because the collagen is your own
When I first describe PLLA most people ask two things: how long it takes, and whether it looks natural.
On time first: the change usually begins a few weeks after treatment and builds up little by little over roughly three to six months. That is the pace at which collagen is made, and it is not a pace that can easily be hurried. It is more often done as several sessions spaced apart than as a single one, and how many sessions are needed, and how far the skin changes, differ from person to person with skin thickness, age, the area and the degree of slackness, so in consultation I give these only as ranges.
The naturalness comes from the same place as the pace. Volume does not appear one day; your own collagen builds up over months, so there is little boundary between where the treatment ends and where the original skin begins. What remains is not something that was placed but something that was made.
There are conditions to this approach, though. It takes time, and how much is made differs between people. If the aim is to have it today and be ready for an event next week, this is not the right answer, and to someone with that aim I would describe a different order and a different method. It is a method that suits when the aim is to restore the surface over time.
Some treatments have to be waited for, and they suit those who can wait. It is the skin, not my hands, that sets the pace.
The three stages of body sculpting: clearing, shape, surface
By this point what the series has covered settles into a single order.
| Stage | What is done | The layer it addresses | In this series |
|---|---|---|---|
| Stage 1 · Clearing | Clear what hides the line first | The layer covering the shape | Part 9 |
| Stage 2 · Shape | Decide the target silhouette, add to it, and take down what rises too high | The shape itself | Parts 7, 8 and 10 |
| Stage 3 · Surface | Tighten the skin that covers the shape to finish | The outermost skin | Part 11 |
Stages do not mean that everyone goes through all three. Someone with almost nothing to clear skips stage 1, and someone whose surface is already firm has no need of stage 3. This table is not a to-do list but the order in which to judge: which layer to look at first when deciding what is needed. That is why, when I look at a line in a first consultation, I look at the three layers separately.
There is one reason for separating them. Different layers need different methods, and disappointing results come when one method is asked to solve all three: pushing up what is covered with filler, hiding a slack surface under volume, or burying what stands too high by filling around it. Most of the mismatches I have described in the previous columns arise exactly here.
Having every tool is not the same as using every tool
There is one last thing I want to say to those who have followed the series. From the injections and devices of the clearing stage, to the filler that builds shape, the botulinum toxin that tidies direction and the PLLA that restores the surface, there are many ways of working on a body line. But having many methods and using all of them are entirely different things. If anything they are opposites: it is because the options are there that what is not needed can be left out and only what is needed chosen.
So in consultation my work is closer to taking away than to piling on. Which layer is the problem in this person's line, which single method fits it, what can be left until later and what need not be done at all. Once only what is needed remains, for some people three stages come down to one.
At the start of the series I said that the first question in body filler is not "how many cc". Five columns later we come back to the same place. The question to ask in body sculpting is not "how many cc, for how much" but "in what order, and what shape". Within the order of clearing what hides the line, building the shape, tidying the direction and tightening the surface, which stage you need now is the answer a consultation should give.
If you are weighing up your shoulder, collarbone or arm line, instead of "how many cc will I need" you might ask this: which layer of my line should be looked at now? If the answer contains an order, the line is being seen as sculpture. That brings the body filler series to a close. Thank you for reading.
