Are Radiesse Lumps at Two Weeks Normal?

Radiesse is an FDA-Approved filler that we use very frequently in our office to sculpt the contours of the face. Since we are a national center of excellence for filler reversal, we also encounter patients from other doctors' offices who wish to have Radiesse fillers removed for one reason or another. In our office, we employ a directed technique to visualize the filler material, if possible on ultrasound, and then use non-surgical methods to dissolve the filler or granuloma tissue using intralesional injections. There are many methods using a combination of enzymes, intralesional modulators of scar tissue, and Kenalog to help reduce volume and remaining filler. These techniques require meticulous attention to detail and can be performed at intervals of two to three weeks to achieve longterm effect.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Two weeks after the injections most of the swelling has likely resolved.  It is likely that you are feeling the product. If you include pictures it may be helpful, but in person examination may be best.  For first time injections, I normally recommend an HA product such as Juvederm or Restylane since these products can be melted with a special injection.  Radiesse is a great product, but is usually used in the cheeks and nasolabial creases.  However, use of Radisse around the chin is normal, but the injections are usually right on top of the bone and not within the soft tissue.  At this point, massage of the area may be your best bet.

 

Good Luck.

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