Radiesse very big lumps chin area. (photo)

Question

Hallo. I got radiesse in my chin 13 months ago. I have very big lumps. I can feel them all the time. It bothers me so much and look so ugly. I want to get rid no matter what. Even surgery as long as i look like myself again. Please help we. Any suggestions?!

Melvin Elson, MD · Answer

It is possible that this is Radiesse although by this time frame the only thing that should be left in the area is your own collagen. I would check with the injector and make sure you were not injected with silicone or Artefill. be sure you see a board certified dermatologist or plastic surgeon

Inessa Fishman, MD · Answer

I'm sorry to hear about your negative experience.  Radiesse doesn't typically last more than 6-9 months in most people; are you sure it was Radiesse that was injected 13 months ago?  Are the lumps tender, red, or intermittently inflamed?  Are they improving with time?  I think you would do well to consult with a Dermatologist, Plastic Surgeon, Facial Plastic Surgeon, or Oculoplastic Surgeon who does aesthetic injections and deals with their associated complications frequently.  It would also be helpful, although not critical, to have the records from your previous injection.  Though nothing truly dissolves Radiesse, injections of steroids and/ or hyaluronidase may help.  A low-grade infection, if present, should be treated with antibiotics.  I would view surgery to remove this as a last resort.  Best of luck!

Amiya Prasad, MD - Account Suspended · Answer

Thank you for your question. You submitted 2 photos and state you received Radiesse injections in the chin about 13 months prior. You’re describing lumps in your chin from that time forward, although you are not specific about the duration and any changes along the way. You ask about what your options are, including surgery.
I can give you my perspective on how I evaluate people like yourself who come to my practice. A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I’ve been in practice in Manhattan and Long Island for over 20 years. I use Radiesse as well as hyaluronic acid fillers like Juvederm and Restylane, as well as natural fillers derived from platelet-rich plasma (PRP). I have a lot of experience in this area, plus I have dealt with a lot of complications of fillers. People have come here from all over the world for me to manage a few unique issues, including problems related to fillers that create inflammation, scarring as well as fillers which have become lumpy and irregular. I’ll guide you a little on my evaluation for someone like yourself. 
I would first ask if this irregularity or elevation was present from the time you had the injectable treatment. Very often when people get injectables, initially the material feels lumpy and irregular, but often with just facial movement and sometimes massage, it softens and then blends. That said, what I would first and foremost be concerned about is if you’re dealing with a situation where the material was well integrated, or slightly lumpy in the beginning, or if these areas became more lumpy over time or became more swollen. 
My first thought is to eliminate the possibility of a low-grade infection which is referred to as biofilm. Biofilm is something that’s becoming more common as the popularity of fillers grow. Biofilm is a low grade infection typically from the skin, where the bacteria lives on the material and hibernates in a way that creates a capsule that becomes hardened. Biofilm does take a lot of work to address, and is often described in other areas such as breast augmentation or facial implants. This isn’t necessarily biofilm, but it is something to consider. Other things to be aware of is if the material becomes just a nodule or doesn’t go away, it could be a capsule formed around it and not a biofilm, so excision can be considered, but in this area, an excision can be potentially disfiguring.
You will need more evaluation requiring a one-on-one consultation to determine what the issue is. In our practice, we have helped a lot of people in many different ways not specifically just Radiesse, but also with hyaluronic acid fillers. In some situations, these fillers did need to be removed, and in others they were managed as biofilms through a combination of materials to dissolve, antibiotics, and continuous monitoring. This is not something you jump into and do something. You really need to get a medical opinion if this particular issue has gone from stable to okay, or a situation where it is nodular and inflamed. This is not readily apparent from just the question and the photo, but it is important you learn about this possibility.
I recommend you see the physician or the provider who did the original injections to learn what specifically the material was. You may want to ask if there were any other people who had similar reactions. This is not necessarily just the things I mentioned as there could be something the particular batch of injectables. There are more than a few possibilities, and the simplest could be just irregular distribution of this material. 
Radiesse is a combination of a gel vehicle with a material called calcium hydroxyapatite. Calcium hydroxyapatite is a fine powder similar to what makes up bone. In general, its benefit is it’s a longer lasting filler, but the challenge is it might stay in your body longer than you may want it to. That said, there are some possibilities of how to manage this, but it does require a proper examination to make the right determination. Find a doctor with experience with these types of filler problems or issues, but ideally you want to go back to the original doctor to at least figure out if there is something they can do to help overcome this issue. I am assuming you went prior to the 13 months, but again that wasn’t elaborated in your question. I hope that was helpful, I wish you the best of luck, and thank you for your question.
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Francis R. Palmer, III, MD (retired) · Answer

Hi, I have performed many facial shaping procedures using dermal fillers, facial implants (cheek, chin), liposuction and/or facelifts for over 30 years. Following the beauty principles outlined in my book on face and body beauty, women look the most feminine, youthful and attractive with heart shaped faces. Heart shaped faces have cheeks that are full and round in the front.  Cheek augmentation with a dermal filler or using cheek implants for a permanent enhancement will create full, round cheeks that will feminize the entire face.

Unlike the HA fillers, Radiesse can't be dissolved or otherwise adjusted.  This is one of the reasons that I prefer using Restylane Lift to shape the cheeks, chin and jaw line when using a dermal filler.  Best to just wait until it dissolves on its own (6-9 months but up to a year).  Unclear as to why the chin was augmented, with Radiesse, upwards in a curve towards the lower lip. I have performed many Chin Augmentations using chin implants for over 30 years.  From the photos, your chin is weak.  A weak chin creates an imbalance making the nose appear larger, the mid face top heavy and the lower face look short that de-emphasizes the lips and allows early formation of a double chin.  Chin augmentation using a chin implant will add projection to the chin creating harmony and balance to the lower face.

I have found that placement of a silastic chin implant, through a small curved incision under the chin (also allows excess skin removal) to be very safe, quick, highly effective and far less invasive than a sliding genioplasty.  I perform chin implant surgery in 30 minutes or less, often using a local anesthetic alone.  In my opinion, you are a good candidate for chin implant surgery.

Hope this helps.

Radiesse very big lumps chin area. (photo)

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