Causes of discoloration and swelling, 85 days post Radiesse? (Photo)

Question

I had 1 syringe of Radiesse (mixed w/lido) to tops of my cheeks. I'd had restalyn in the tear trough 6mos prior. It has been a nightmare. Severe swelling, inflammation, pain (day3-now). I'm on a 30day prednisone taper which has controlled the severe edema (for now). The discoloration is unrelenting. Using hydrquinone & tretinion, too. Is this discoloration in the skin or under the skin? How can I understand if it is due to active irritation, or the remaining effects of a prior reaction?

Jason Emer, MD · Answer

First off, hyaluronidase needs to be injected to get rid of any HA filler.  Second, a biopsy needs to be performed to see if this is just lymphedema (which is common after fillers into this area) or if there is hemosiderin staining of the skin along with the swelling.  Also a biofim and other irritant reaction needs to be ruled out.  If this is just hemosiderin, q switched/pico and/or pulsed dye lasers will help.  Topical creams will have no effect.  I suggest you go to an expert for treatment.  Best,

Raffy Karamanoukian, MD, FACS · Answer

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

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Mehryar (Ray) Taban, MD, FACS · Answer

Consider a dermatologist. There might some laser or even topical products for the discoloration.  But if there is active inflammation going on, then that needs something else and see an oculoplastic specialist.

Samuel Baharestani, MD, FACS · Answer

When injected with the wrong technique, many patients can develop a localized reaction to the fillers.  Along with colleagues at Johns Hopkins, I recently published a series of cases where an oculoplastic surgery consult was necessary to treat this condition.  I would recommend for you to see one in the Beverly Hills area.  Good luck!

Michael Contreras, MD · Answer

Thank you for providing a picture of your condition.  It is unclear from your description if the Radiesse was injected infraorbitally into the tear trough area where your Restylane had been injected 6 months ago.  If so, I would assume that you are having a reaction to the product in the form of an immune/allergic type hypersensitivity reaction creating edema and erythema deep to the skin surface.  Radiesse is ideally used in areas covered by thicker dermal and subcutaneous tissue such as the malar cheek eminence and zygomatic arch.   Unfortunately, it cannot be dissolved like the hyaluronic acid products.  However, hyaluronidase injection should still be consdiered since is known to have edema-reducing benefits.

Causes of discoloration and swelling, 85 days post Radiesse? (Photo)

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