Yours is an interesting situation. I don't like to use Radiesse under the eyes because it does get firm over time and is primarily reserved for use in the deep tissues typically along the cheek bone and placed right on top of the bone. But even in this situation I don't like to use it while granting that it can still do a good job. And here's the reason for my preference not to use it. Firstly, once its in and your practitioner has done as much as he/she can do to mold it right after installation, then there isn't much you can do to get rid of it. Fortunately, in your case, based on your pictures, attempting to get rid of it doesn't seem necessary. The area that you are concerned about can be easily tweeked to blend it in with the surrounding under the eye area laterally using a standard thin hyaluronic acid filler. My preference is to use something called Belotero Balance. Its thin and easily moldable for those thin areas under the eyes and is perfect when done properly. The actual nodularity that you are concerned about looks bad primarily because it has not been properly blended in with the more lateral aspect of your under eye. It looks like the practitioner was just trying to fill in the so called "tear trough" and over did it a bit. But again, that can be blended in nicely with the rest of the under eye area by someone experienced with one of the thin HA products such as the Belotero. And with the HA product (hyaluronic acid), if too much is used then it can be dissolved with an enzyme very easily. Can't do that with Radiesse. As well, my preference is always to do a little less than I think would ultimately be necessary and anticipate finishing up in a second visit perhaps in 2-3 weeks. That is so that I never do too much. So find yourself an experienced injector in working under the eyes. Again, no need to think about removing the Radiesse as long as you find someone who can properly blend in what you have with a HA product such as Belotero. Good luck. J DeStephens, MD Gainesville, Florida
Ultherapy can be variably uncomfortable depending on your sensitivity but is no where close to laser treatment. I think injections of Demerol or Toradal prior to the procedure are a bit of overkill but don't really object to it. I really don't want my patients to be uncomfortable so I err on the side of giving them some oral codeine or demerol about a half hour prior to the procedure. I make sure that they are clear before releasing them to go home or perhaps even have someone else drive them home. Most people however, don't need anything at all. But I'd rather them feel a little woozy for awhile than to have them experience unnecessary discomfort.
Fortunately, the lump that you are highlighting is not so obvious to the naked eye even though I'm sure you can easily feel it and know that its not right. These lumps happen from either not smoothing the radiesse after injecting it in the deep subcutaneous area or even beneath the muscle or because the practitioner injected it into the dermis which is very superficial and only a few millimeters in depth. You can't massage the dermal injection of radiesse like you can if it were properly placed in the fatty area. Fortunately, these small lumps will gradually resolve over the following 6-12 months. Make sure that the practitioner who injected you knows about this. They should be more careful about these injections. Unlike the Juvederm products which are all Hyaluronic Acid, radiesse cannot be reversed. And again, fortunately, from a visual standpoint, this little 'lump' is hardly noticeable and again should slowly go away over several months. You'll be fine. Hopefully, the rest of it went well. Dr. DeStephens
Radiesse works differently from the Hyaluronic Acid fillers such as the various Juvederm products. It can work very well, but its not reversible. Like the Juvederm products, Radiesse can also be significantly molded shortly after its placed in order to smooth it out but this needs to be done during the time of placement before you leave the office by the individual placing it. Once it is placed and settled over the course of several weeks it forms calcium like cystals in the area of the subsurface of the skin where it is placed. This helps to stimulate collagen formation which can also be beneficial to maintaining the integrity of your skin. However, the HA products can be reversed if you don't like the results but Radiesse cannot be. It will gradually fade away over the course of 1.5-2 years but not so sure when it is apparently been placed in a "glob" as it seems in your case. However, a minor incision by your plastic surgeon underneath the jawline where it wouldn't be seen would likely allow for the 'moveable nodule' to be easily removed and you can start all over once it has properly healed. Your result usually happens from someone who has no experience with dermal fillers. Anyone who has done any filler work at all routinely massages the filler to 'smooth' it out. It looks like this was not done. I have used Radiesse myself and it has always worked well. However, it isn't my preferred filler. I stick to the newer Juvederm products. They are easy to use and can last up to 2 years. If someone over does something it can always be reversed easily with something called Hyaluronidase which is injected into the area. Consider your situation to be a nuisance and an aggravation but it can be fixed simply enough as I have suggested. A good many plastic surgeons don't do the filler work themselves but have a trained aesthetician do it. If such was the case for you, the aesthetician was not properly trained. Good luck but again, its easily fixed by simply removing the nodule with a small incision and a little local anesthetic. No big deal in the end. BTW, no xrays should be necessary for this. The history makes it obvious as to what this is and the hard lumps that are easily movable also consistent. Just have them removed. Dr. DeStephens
The picture that you posted on the far left shows a little fullness under the left eye with some mild associated 'Crow's feet'. Frequently, the fullness that I see there can be much improved by correcting the crow's feet with Botox. A couple drops of Botox into the lower line of that lower lid puffiness of the type that I see can frequently relax that muscle which can smooth out the lower lid bulge. In other words, in your case, unlike so many others, your problem with that lower lid bulge appears in that picture to be due to excessive tension in that lower lid. But just a little. Too much and that lid might sag and we don't want that. Regarding the loose skin in your neck, the one picture that shows it reveals a fairly mild looseness that should be taken care of quite well with Ultherapy if properly done. My preference is to use more than the standard amount of energy in order to get an even better result than advertised. Ultherapy is designed for what would be considered as mild to moderate looseness in the face. Your picture would suggest that you should be an excellent candidate. And Ultherapy can do a great job on upper and lower lid looseness if it isn't severe. Your pictures suggest that you don't need that. But remember that though you may see an initial benefit, half to 2/3 of the tightening effect will occur by 3 months after the procedure is done and the other 1/3 or so in the following 3 months. And doing Ultherapy early as the media people frequently do helps to keep the skin tight for those even in their early 30's. Such would be considered preventive in nature rather than waiting until the sagginess kicks in. I hope that helps.
