I know this is a tricky question but as I already have aquamid in my cheeks injected 2 yrs ago and do not want more aquamid now, which filler is safest to inject on top of aquamid with the least likelihood of granuloma or delayed reaction/infection? I'm choosing between Juvederm & Radiesse. Thanks
Which Filler is "Safest" to Combine with Aquamid?
Doctor Answers 2
Combining Facial Fillers
Patients who prefer PERMANENT fillers are betting that everything would go well. Plastic surgeons who prefer using temporary fillers are hedging their bets for a good temporary result just in case the outcome is NOT ideal. Permanent fillers have several serious complications but the top two are scarring and infection. The problem with infection associated with a permanent filler is that it is extremely hard to cure because of a bio-film of germs that is not totally accessible to the body's immune system.
Since you already have a permanent filler, I would NOT compound it with another permanent filler such as Radiesse. I would choose a hyaluronic acid filler instead such as Juvederm. If the result is good - it can be repeated. If it is not - it will be temporary.
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Combining Aquamid with Juvederm or Radiesse
The two fillers you proposed to combine with your previous Aquamid treatment, Juvederm and Radiesse, fall in the categories of hyaluronic acid and calcium hydroxyapatite, respectively. Both products are very predictable in their action, with one having a longer efficacy than the other, and they are both very reputable products.
The real question, then, is whether you want to risk the possibility of introducing an infection by contamination of the permanent filler, Aquamid. As my associate was eluding to, if these permanent injectable fillers develop an infection, such as Staphlococcus, they may form a biofilm around them which is a complex matrix of extracellular polymeric substances which become very resistant to treatment with antibiotics. Subsequently, when considering the addition of a secondary filler to a permanent filler, it is critical to utliize and maintain a sterile field during the injection course. I think that an experienced injector would be comfortable using either product in your case, thus it will be an issue of clinician preference and comfort level.
Best of luck ~
Glenn Vallecillos, M.D., F.A.C.S.
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