Periorbital and Malar Edema 6 Weeks Post Injection of Radiesse in My Cheeks. Is this swelling due to presence of foreign body?

It sounds to me like you have a pretty good understanding of the swelling process

after Radiesse.  How long it will last depends on how much was injected and each person's metabolism. Radiesse has 2 components;  Calcium and a gel carrier.  The gel carrier breaks down in 4 months and is gone.  The calcium part can last another 6 months to a year. But at 4 months half the volume is gone so you should see some relief.

  Malar edema after Radiesse should resolve with the dissolution of the product.  Unfortunately, the product cannot be degraded like the HA products.

Radiesse can be used in the tear trough and over the lateral orbital rim, but this needs to be carefully and sparingly placed deep over the bone by an experienced injector. Even then, there are more risks associated with irregularity or lumpiness when compared to the hyaluronic acid gel fillers which are more forgiving.

Swelling after Radiesse injections lasts longer than it does for hyaluronic acid gel fillers. But by six weeks post-treatment this swelling is generally resolved. I think for a few individuals the reaction you describe can lead to more prolonged swelling with Radiesse; but the swelling usually tends to be mild. I have seen several patients who have experienced a more prolonged (several months) mild redness over the site of Radiesse injection. In these situations the Radiesse was placed more superficially in the subdermal plane; I have not seen that mild redness when the Radiesse is injected deep.

For the injection you describe, the placement of the Radiesse is very important. If the Radiesse was placed more superficially (and not deep over the bone), then the swelling you are experiencing may be the direct result of the (Radiesse and its associated) swelling trapped in a more superficial anatomic (sub-orbicularis) compartment. In this case the swelling will likely persist for a long period of time, and is unlikely to resolve until the Radiesse is metabolized; this could take a year or more.

A technique which involves an injection of sterile water (or saline) and massage has been described to break up Radiesse nodules. I don’t know if this will work for your situation. If the Radiesse is located deeper, then dispersing it somewhat may provide improvement. If the Radiesse is more superficial, this technique may not work.

This treatment is referenced in  --
Voigts R, et. al., Dispersion of Calcium Hydroxylapatite Accumulations in the Skin: Animal Studies and Clinical Practices, Dermatologic Surgery, 36:S1, May 2010, 798-803.

Best wishes. Kenneth Dembny

Swelling is normal from any filler. While, yes, a substantive foreign body is present this doesn't usually have this type of effect, meaning the encapsulation and reaction, which you are discussing. Quite frankly it's most likely over injection and over correction of the area. But your question is about metabolization and lasting, so... like any filler, Radiesse is naturally absorbed by the body. Because it is a filler made from material which is similar to bone (a calcium product) Radiesse does take longer to be absorbed than hyaluronic acid fillers, and absorption does also depend on where the product is used. Under the eyes and in the malar cheeks, unfortunately, it will last longer, than say in the NLF lines. Thus, you're probably looking at a year or more.