Should I try a different filler to correct poor Radiesse results?

Dear Julie,

Trying to understand what went wrong is difficult by email. The things that can cause your problem include;

1. Too much filler in one area (overcorrection).
2. A scar in the skin that does not allow skin to expand when a filler is injected, thereby creating the appearance of a depression.
3. Injection of radiesse too close to the skin. Not all fillers are the same, if Radiesse is injected as close to the skin as the other fillers (Restylane and Juvederm) it will create more lumps and bumps.
4. Radiesse injected around the mouth has an increase risk for cyst formation. The cyst can create the apppearnce of deprssions around it.

Treatments:

For #1 - try to correct the areas around the original filler, but if this creates too much or a mountain of filler, consider massage or steroid injections.

For #2 - consider subcision and filling of the scar. Subcision is a technique to break up the scar and then fill the depression. This technique is also good for acne scars.

For #3 - The only thing to do is massage.

For #4 - Massage or steroid injection should help.

Good luck,

Robert M. Freund, MD, FACS

Any filler can occasionally result in bumps or slight skin irregularities. It is most often a result of where the filler is placed ( too high in the skin) or how much is used (overcorrection).  Generally speaking, these slight imperfections can be alleviated with massage, extraction or using a needle and cortisone injections to break up hard bumps. These all must be done by experienced hands so as not to worsen the problem.

Sometimes, indentations can be caused by small scars in the skin that are not obvious at the time of injection.  These cn be from old wounds that have healed, past surgeries or acne scars.  This situation causes the filler substance to pool around the scar creating an indentation in the center.  This situation can be corrected using subcision, a technique that breaks up underlying scrs through a single needle stick. Once the scar is removed, a little extra filler smoothes out the dent.

Radiesse is an injectable form of calcium hydroxylapatite and tends to be thicker than hyaluronic acid-based fillers.  Radiesse generally lasts aound 9 months, but traces of the product can remain for longer than one year.

Rarely, granulomas can form after Radiesse injections. These are areas of inflammation that can present as a red, tender lump. Small amounts of steroids injected locally can help in the resolution of granulomas. Massage may also be of benefit.

A depression caused by scar tissue after inflammation such as a granuloma may be treated with subcision with a needle or a wire scalpel. Further injections with another class of filler may also disguise a visibile irregularity.

In most cases, these complications are self-resolving and many patients are happier after receiving reassurance.

As Radiesse is injected more frequently by inexperienced physicians, I am seeing more and more complications. Radiesse is not very "user friendly" and unlike Restylane, Perlane, and Juvederm, it cannot be dissolved.

The most common problem is over-injection, causing lumps. Sometimes, this can be reversed with aggressive massage, especially if done in the first 2 weeks.

Other times, the Radiesse was injected in the wrong place (like lateral to the nasolabial fold). For those, I softened the drop off by injecting Restylane in a feathering pattern around the area to blend.

Finally, the big problem is incorrect injection into the lips, causing hard pea-sized papules. Sometimes they must be cut out using a stab opening to pop it out.

In the end, Radiesse complications go away 100%. It can just take up to one year, so see an experienced injector next time.

You might consider what left you with a less than aesthetic appearance or a complication prior to considering the addition of another dermal filler. Many of the problems encountered can be corrected through either massaging, extraction, or some addition of the same filler, etc.

• Many areas of ovecorrection, undercorrection, or surface irregularities can be improved (not always resolved) through either massaging, extraction (if recently injected) or the additional of small amounts of filler. Sometimes an undercorrection can be experienced if the physician injected your particular deep subdermal or, more likely, in the subcutaneous plane. Remember that all patients will swell immediately after injection, and may exhibit residual swelling for days after the initial injection. Thus, hold off on any sharp criticism and decision planning until you're confident that the majority of the swelling has resolved.

• Even in the most skilled hands, sometimes patients exhibit a better result with one dermal filler than another, etc. It is my suggestion that you stay with that same product that's previously worked.

• Keep things simple. Choosing a larger particle-based filler for deeper lines (Sculptra, Artefill, Radiesse) can be complemented with a small particle for more superficial lines (Juvederm, Restylane, Perlane), etc. In addition, we know Botox and fillers are complimentary as well. But I believe using multiple products during the same injection period can complicate what should be a straightforward process.

However, it is my suggestion that trying to find out why a less than optimal aesthetic appearance resulted is more important than simply adding in one more product into the mix.