Milwaukee Radiesse doctors

I’m sure the lumps you are feeling are the Radiesse product, and some residual swelling. I’m not exactly certain, based upon your description, where the Radiesse is located and whether it is visible on the inside of the lip. But there may be several reasons why the Radiesse is more palpable in this anatomic region.

Radiesse is generally placed in the deep dermal, sub-dermal, or the subcutaneous plane. The actual thickness of the lip is only several millimeters, so the subcutaneous layer is rather thin. It is therefore easier to feel the product in the lip (compared to the cheek for example); especially if a large amount of product is used, or if the product is not massaged and contoured after it is injected.

If the needle is accidentally placed a bit deeper than desired, injection into the muscle may occur, allowing the Radiesse to be more palpable from inside the mouth. Again, this is more likely to occur if a large amount of product is used, or if the product is not massaged and contoured after it is injected.

If the Radiesse is injected rapidly, or with significant pressure on the plunger of the syringe, the product may seek the path of least resistance and may work its way into the submucosal plane. The Radiesse would then be visible as a white- or yellowish-colored mass on the inside of the lip just beneath the mucosa.

Following injection, Radiesse is associated with more swelling than the hyaluronic acid gel fillers (Juvederm, Restylane, and Perlane), and that swelling lasts longer. Because of that additional swelling, and the characteristics of the calcium hydroxylapatite, Radiesse feels firmer, stiffer, and/or harder, and is less malleable when compared to the gel fillers. Given several weeks, this improves and the tissues soften to normal consistency.

Remember that fillers are meant to provide volume so any filler product may be palpable at times or in certain areas; that is fine, as along as it is not externally visible as a lump or mass.

Given more time, the area is likely to soften as swelling subsides. The Radiesse will eventually breakdown over time but this is a slow process that may take up to a year or more. Dispersion of Radiesse nodules has been described following injection of saline or sterile water, and I have referenced that in two previous answers.

You did the correct thing in seeking a follow-up appointment with your physician. I’m sure he or she will be able to guide you through this period so you don’t have to worry.

Best wishes and Happy New Year. Ken Dembny

The lump you have in your lip is an accumulation of the Radiesse material, calcium hydroxylapatite (CaHA), and perhaps some fibrous tissue as well. Radiesse usually lasts about 9 -12 months, but can last much longer. Based upon your story and the picture you provided I suspect this will be present for some time yet, and I understand your frustration. I’m surprised that you don’t accidentally bite down on regularly.

Merz and Bioform have not recommended Radiesse for use in the lips for several years. When Radiesse was first introduced to the cosmetic market (called Radiance at that time) there were some discussions about carefully using it for lip enhancement. I actually have used Radiesse several times for lip enhancement, and have done so very effectively without problems. You have to do it very carefully, use only a small amount of product, and use a different technique than what you use for hyaluronic acid (HA) fillers. I am not here to advocate Radiesse for lip enhancement and it would not be considered standard of care. And there really is no reason to use it when Restylane and Juvederm are available, easier to inject into the lip, and have a good safety profile.

I’m not sure what your physician injected into the nodule, but this was not unreasonable. To be more specific, there is no enzyme or other product that currently exists to degrade CaHA (like hyaluronidase is available to degrade HA). But there is a study which discusses injection of fluid, in the early post-injection period, to treat nodule formation.

A study published in Dermatologic Surgery (Voights et. al., Dispersion of CaHA Accumulations, 36:S1:May 2010, pg798-803) discusses a possible treatment for inadvertent accumulations/nodules of CaHA. This describes injecting fluid into the accumulation and then performing massage. This helped promote flattening of the nodule and dispersion into the tissues. Following injection of CaHA, nodule dissipation by mechanical massage becomes less apparent over time, suggesting that early intervention with fluid to correct any observed palpable accumulation of CaHA material would be the preferred course of action. Regardless of the fluid used (lidocaine, sterile water, or saline), the addition of fluid to the accumulated CaHA was found to be superior to massage alone. Although no enzyme currently exists to degrade CaHA, this simple technique of fluid plus massage provides a mechanism to more effectively treat technical errors and perhaps avoid the need for more aggressive techniques.

You certainly could continue to wait and let this improve with time. There is some possibility that it will not completely resolve. If you want to get rid of it sooner, then you could have it treated by a relatively simple surgical procedure. The incision can be placed in the inner part of the lip, the risk of lip deformity should be low, and the resulting scar should be minimal. Seek a board certified plastic surgeon to discuss this treatment option.

If you seek lip enhancement in the future, please use Restylane or Juvederm. After these products have been used regularly for several treatments, they do have good longevity, but are not permanent.

Best wishes. Kenneth Dembny