Can the Radiesse injected under my eyes a year ago be taken out with lower eyelid surgery (either scalpel or laser)? (Photo)

Question

I had radiesse injected by doctor Kane a plastic surgon under eyes for hollowness on 6/2014 and Created huge kidney shape under my eyes( left is worse) after a year i still have noticeable swollen. Dr. Kane said he can try removing it by eyelid surgury Took second opinion from a plastic surgon Dr.Gallup. He is suggesting to wait longer because it's not easy to remove radiesse and I still have a lot A dermatologist suggesting adding volumizing fillers around it to make it less noticeable

Raffy Karamanoukian, MD, FACS · Answer

Radiesse is a stimulatory filler that is an excellent option for patients who desire a longer-lasting filler alternative to hyaluronic acid dermal fillers. In our office, we use Radiesse to complement structural areas of the face and contour bony prominences. Our office also is a center of excellence for filler complication treatments and we see patients who have been treated by other doctors and have undesirable results from Radiesse or other long-lasting fillers. We have treatment options available for Radiesse filler nodules, granulomas, and soft tissue thickening. The first step would be to diagnose the nodularity and determine whether there is an option for surgical vs. non-surgical removal. Surgical excision is a possibility in some patients; whereas others with more diffuse fillers may benefit from intralesional therapy using scar modulators and enzymes and kenalog. Radiesse complications may be long-lasting and prompt action is key. Patients who have no access to an expert in the field should begin gentle massage of the areas of nodularity with Plato’s Scar Serum twice daily. RF and invasive lasers can actually do more damage by stimulating further collagen growth. 
 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Bhupendra C.K. Patel, MD, FRCS · Answer

You state that the injections created a "huge kidney shape under my eyes", but what I see is the white of the Raidesse on both sides, the left being worse than the right. If that is indeed the case, the Radiesse is very superficial and will be "intertwined" within the orbicularis oculi muscle. To put it mildly, this will be a bugger to remove surgically. Certainly some particles can be dissected out but there is a risk of creating irregularities to your lower eyelid skin, and in the worst case scenario, achieving very little but be left with an incisional approach. If you have an experience dermatologist who feels he can camouflage the Radiesse with one of the other fillers, I would be inclined to doing a "spot area" first. There is certainly a risk of too much filler and fluid in this area, which can persist. Lasers really do not have any place for this. Steroid injections can give you local atrophy: I see you may have some colour in your skin. In such cases, the atrophic skin can look worse than what you have. Over time, dissipation will occur, but as has been correctly pointed out, we are talking about more than a year, probably two. Even so, particles within the orbicularis can persist for a long time. The only time I have surgically removed this, I have been left with prolonged oedema and some irregularity. I am afraid, it is a case of picking your poison. Let us know what your physicians decide to do and how things turn out. You can help others too. Sincerely,Prof. Bhupendra C. K. Patel MD, FRCS

Patrick Flaharty, MD FAACS · Answer

Radiesse is a thicker, clumpy filler that can be visible under the eyes due to the thin skin in this area.  All three opinions hold merit.  Removing the radiesse surgically can be technically difficult and unless it is done through the inside of the eyelid can cause a visible scar.  Also it may be difficult to achieve the desired contour as the material is difficult to remove.  If you can make the filler less visible by using other fillers around this area that would be fantastic as the Radiesse should gradually resolve over time.  You can also try injections of hylenex to break up (not dissolve) the filler in combination with gentle massaging to the area.  The radiesse should gradually resolve over time but may take another year.  Lastly some people have used an 18 gauge needle to mechanically break up the material to reduce the visibility.  I would recommend you try all non-surgical options prior to attempting surgical removal.

John R. Burroughs, MD · Answer

Yes, Radiesse can sort of be removed.  I have had to treat two patients referred to me.  One had some good resolution of a nodule attributed to the Radiese by a steroid injection alone.  The other I had to surgically remove.  Over time, this displeasing appearance should resolve on its own but it can last more than 2 years in the lower eyelid.  Technically the Radiesse is gone after a few weeks and is replaced by collagen.  This is why surgery can be problematic.  You simply just can't go in and pull it out easily.   If too much surgical debunking is done this could lead to a depression once its heals.  Some additional reversible type filler (e.g., Belotero or Juverderm) could be placed to mask the appearance, but too much filler in the lower eyelids can cause fluid retention and worsen the overall puffy appearance.  Perhaps massage to the area and conservative steroid injection could be considered.  Best regards to you.

Can the Radiesse injected under my eyes a year ago be taken out with lower eyelid surgery (either scalpel or laser)? (Photo)

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