Radiesse in Cheeks 5+ Years? Cut Out?

Question

I had asked this question with my twice layered radiesse in my cheeks. I was under the impression that Radiesse has a gel carrier which the body dissolves in a few months after injecting, and leaves behind CaHA deposits which then create fibroblasts which build up collagen in the area and then the calcium deposits disintegrate over time and what is left is your body's own collagen. If you say the only way to remove Radiesse is to cut it out, then why after 5 years would it still be there? Thanks

Kenneth Hughes, MD · Answer

After 5 years, the radiesse material should have dissolved although scar tissue in that area may have increased. The area can be debulked surgically or the surrounding areas brought up, whatever is appropriate.

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

Sam Naficy, MD, FACS · Answer

I believe it's the biopolymer gel or "permanent" filler that someone suggested would have to be "cut out. No one would suggest you have Radiesse cut out. You description of Radiesse is correct. It is calcium in a gel carrier that breaks down in 4 months or so, leaving the calcium behind to stimulate new collagen growth. The issue is the Biopolymer gel you mentioned. It sounds like this was a permanent filler that does not break down? There would be no way to remove that without a surgical procedure.

Stacy Chimento, MD · Answer

Hi! We use Radiesse frequently to increase the volume in the cheeks and see great results. Indeed the calcium that remains does stimulate the body to naturally increase new collagen growth. There is no particular substance that can injected into the area to dissolve the calcium HA deposits. This is unlike the hylaronic acid filler such as Juvederm or Restylane in which Hylaronidase can be injected to dissolve the product. In some instances if there is a complication (such as the product is injected too superficially and can be seen), then we can make a small incision in the skin and try to express the material but we do not "cut out the Radiesse" per se. The product can last a while, which is a great thing! Remember, we change! Over time you lose volume in the mid facial area and then you should consider other products such as Sculptra. You may need to start volumizing different areas.

Alan M. Engler, MD, FACS (retired) · Answer

My understanding of Radiesse is that it's unlikely it would still be there after five years.  You could, on the other hand, (at least in theory) have scar tissue, possibly from the injections, though this also seems unlikely to any significant degree.  Either way, "removing" the area could probably only be done via surgery, but that may leave irregularities that are worse than what you have now.  I agree with others that the best approach may be to consider fillers, whether HA or Radiesse, to address any new changes in the contour of your face.  I understand that you may be hesitant to go in that direction, but it may still make the most sense.

	I hope that this helps and good luck,

	Dr. E

F. Victor Rueckl, MD (in memoriam) · Answer

Original answer to your question: An ultrasound would probably not help because it won't determine exactly what it is, just that something, theoretically, is there. I have seen Radiesse last for a few years, and more often we do see this in areas like the upper cheeks where there isn't as much movement, so fillers do last longer there. Additionally, you said you did one syringe, then went back again for a second 6 months later. This is called layering fillers. What it does is actually make most fillers last longer because the patient doesn't return to baseline, but adds volume to the existing filler that still remains. In some cases the particles are able to bond together better, and the initial filler then lasts longer. My assumption would be this - in the past 5 years you've now lost volume in other parts of your face, like your central cheeks. Because you still have some Radiesse in the upper cheeks, it make them look more pronounced than before, because you now have more volume loss around it. Unfortunately unless there is a significant problem, we don't recommend removing Radiesse, as the only ways to do it are by injecting cortisone (not a great option with minimal results at best) or cutting it out (something you don't want to do). So time is going to be your best bet, unless you want to put additional fillers around the Radiesse to re-voluminze the other areas, making everything appear smoother and more even.

	New answer: Please understand that I said the only way to remove Radiesse is to cut it out and I was suggesting that is NOT what needs to be done in this case. That should only be done in cases where something has gone exceptionally wrong (not you!). While your assessment of what Radiesse does is correct, what I believe is that you have volume loss (remember it's been 5 years!) in the rest of your face, and now those areas look hollowed out, while your upper cheeks still have some volume to them. I don't really think you have Radiesse left; if you do, it'd be a tiny amount only, but what you have is volume loss in the rest of your face. You don't need to cut out the Radiesse area AT ALL, but you may need to seek re-volumization or treatment for the other areas that have since lost collagen and volume.

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