Can Radiesse Complications Be Reversed?

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

Although Radiesse has a good safety profile, I'm not sure what you mean by mouth lines. If these are the smile creases that run from the corner of the nose to around the corners of the lips, then you have a greater track record of safety than if the RAdiesse is used to try to fill in deep upper (cutaneous - lip colored, not the vermillion or red lip) lines than run vertically from the edge of the red lip to the bottom of the nose (called smokers lines by some). In the latter area there is a greater chance for the Radiesse to cause lumps in the red lips.

NO filler is without some chance of risk. Thick fillers such as RAdiesse can cause a problem but very very rarely with circulation when injected in the smile crease near the corner of the nose and skin changes have occurred with possible scar formation although many of these rare events have healed well. There is no reversal of this or a lump that is noted later with Radiesse compared to the dissolving that can be done with Restylane or Juvederm by using hyaluronidase.  Overall, as you have confidence with your doctor who is very experienced, after you discuss your concerns with them, the two of you can decide to proceed ahead if you still feel comfortable knowing the risks. The numbers of procedures done with Radiesse are evidence of its great safety profile.

The biggest issues with Radiesse are poor filler placement or the creation of palpable nodules.  Both of these issues are not correctable.  It is important for patients to understand that any injector, particularily an injector of Radiesse, should be highly skilled technically, have knowledge of facial anatomy, and understand facial aging and beauty.

In my opinion, I would stay away from Radiesse for lipstick or smoker's lines because of the thickness of the product and the lack of fat in this area.  I never use it there.   I think it would be too lumpy and not easily corrected if you did encounter a problem.  I generally prefer hyaluronic acids like Restylane or Juvederm in this sensitive area which can be dissolved with Hyaluronidase if there are any contour issues.   Other options to treat these lines include Botox which of course is temporary.  Combining Botox with Restylane is a more effective method to treat these lines than either alone.  More lasting correction of lipstick or smoker's lines can be achieved with dermabrasion, chemical peels or CO2 laser.   These treatments do have some downtime but over the most natural, long lasting results. 

Radiesse is a FDA approved filler based on refined calcium granules that serve as nice scaffold for collagen production and temporary volume replenishment. Unfortunately, it cannot be reversed if there is nodularity performed by an inexperienced injector; however it will fade over 9 months. In the hands of experienced physician injector for nasolabial folds, I believe Radiesse may offer the best value for the investment.

Radiesse is a calcium based filler.  It’s not reversible like Juvederm or Restylane.  For lines around the mouth, you have to be very careful using Radiesse.  For marionette lines that are deep, Radiesse works well.  But, for fine lines around the mouth, it can get lumpy.  If the doctor has a lot of experience with Radiesse, however, you can get very nice results.  It depends on how you dilute the Radiesse.  As far as reversibility and bumps, you certainly are safer around the to use juvederm or restylane around the mouth.  These products are reversible and less likely to to cause lumps.  If, you do get a bump or problem with Radiesse, it does eventually go away, but it can take a long time.  You can inject it with a steroid to break it up, but it doesn’t always work very well.  If you’re going to use Radiesse around the mouth, make sure your doctor has a lot of experience, otherwise, choose a reversible filler like Juvederm or Restylane.  You should also realize that all these applications for these products are “off-label”.

I'm not sure what you mean by "mouth lines" but assume you mean those around the lip. If so, I would prefer to use a softer filler such as Restylane or Juvederm. If you mean the lines in the corners of your mouth I think that Radiesse might be a good choice but if you are worried go with Juvederm or Restylane  which last less long and can be dissolved. 

Radiesse complications such as lumpiness, or over-filling should resolve once the filler dissolves, but are not reversible in the short-term.  I generally do not suggest Radiesse be used in the vertical lip lines.  Radiesse especially should not be used in the vermilion (red portion) of the lip.  If you are concerned about the possibility of Radiesse-related complications, you may be better off going with one of the hyaluronic acid fillers (Restylane, Juvederm) which can easily be dissolved with hyaluronidase.

Radiesse works well in skilled hands to help correct the vertical lines coming from the red part of the lip (the vermillion) into the lip skin, sometimes called "smoker's lines". Radiesse is less forgiving than other fillers and must be precisely injected by an experienced facial surgeon into the right depth of the skin, in the deep dermis. In my experience, injecting Radiesse in the upper lip 2 mm above the vermillion horizontally adds a youthful fullness and helps to obliterate wrinkles in that area that can make lipstick bleed. A powerful CO2 laser such as Total FX is also very useful to ablate the wrinkles and recreate fullness of the upper lip, but has about 5 days of downtime and is more expensive, although the results will last longer.

Some side effects are expected and are transitory, like swelling, redness or bruising after the injections.  Those usually resolve on their own or with some icing over 2-3 days.

There are also reports of swelling that can happen 2-3 weeks after Radiesse injections.  We do not know the mechanism, but these usually require some prednisone to resolve.

The chances of long-term side effects, such as granuloma or nodules, although a possibility, are very low.  If granuloma or nodules do occur, those are difficult to reverse.  Also, if Radiesse is not placed correctly, the result will only go away when Radiesse dissolves, which may take up to a year.

However, two recent studies that evaluated side effects of Radiesse injections in the nasolabial folds, one at New York University and one at Cornell Weill Medical College, with a total of 215 patients had long term follow up after Radiesse injections and none had long term side effects.

There are no guarantees, of course, as the outcome of any cosmetic procedure depends on the patient factors, doctor factors and product factors, but from the studies where Radiesse was injected by board-certified dermatologists with proper training and experience in Radiesse injections, the safety and efficacy profile of Radiesse is excellent.