Radiesse Developed a Small Bag Under my Eye? (photo)

You have a festoon, which is a collection of fluid/swelling in the junction of upper cheek and lower eyelid area. This is a the area of the face that acts as a sponge and has tendency to collect fluid/swelling from any trauma to the upper face/eyelid area. This anatomical area may be okay for a while and a trauma, such as filler injection, can set it off.  It is also possible that something (?Radiesse) is still irritating the area, causing continued swelling.  Improvement is possible over next few months and avoiding salty diet but it may not go away.  Consult an oculoplastic surgeon for possible treatment options.

Radiesse is an FDA-Approved filler that we use very frequently in our office to sculpt the contours of the face. Since we are a national center of excellence for filler reversal, we also encounter patients from other doctors' offices who wish to have Radiesse fillers removed for one reason or another. In our office, we employ a directed technique to visualize the filler material, if possible on ultrasound, and then use non-surgical methods to dissolve the filler or granuloma tissue using intralesional injections. There are many methods using a combination of enzymes, intralesional modulators of scar tissue, and Kenalog to help reduce volume and remaining filler. These techniques require meticulous attention to detail and can be performed at intervals of two to three weeks to achieve longterm effect.

Best,
Dr. Karamanoukian
Realself100 Surgeon

    This look is most likely remnant filler.  Unfortunately, this cannot be dissolved like the HA fillers. Once it does dissolve, you could consider Restylane - a better choice for the tear trough.  Kenneth Hughes, Los Angeles

Hi Chit.  We think Dr. Persky was being very generous regarding the caution in using Radiesse around the eyes.  Most practitioners will not use Radiesse around the eyes.  

Because of the thickness of the product and the thin skin in the under eye area, the product is not a great match.  It is much more appropriate for cheeks where it can be placed deeper.

With that said, we have not heard of any way to remove it other than waiting.  The body will normally metabolize Radiesse over a period of about 1 year.  If the product has been placed very superficially then Ulthera and/or laser treatments may help, although we do not have proof of that.  It is only based on the concept that radiofrequency, ultrasound or light (laser) generate heat and my speed up the process of degrading the product.

Sorry we cannot be more help.

Hi Chit,

Unfortunately Radiesse cannot be dissolved with injections.  It must be used very cautiously around the eyes.  We have treated patients over the past two years with Ulthera (micro-focused ultrasound) and some patients have told us that it seems that their "filler went away after the treatment."  This was in patients in whom we were not trying to dissolve filler.  I believe that a few had felt that their Radiesse had been dissolved.  In your case it may be worthwhile to give Ulthera an attempt to help with the swelling.  Good luck and be well.

Dr. P

From what I can tell, this looks like a bit of product that was injected where it shouldn't have been. The anatomy under the eye is complex and unforgiving, meaning injection of Radiesse (or any filler for that matter) under the eye is best left to the very most experienced physicians. To me, that does not in any way look like "water" and cortisone will have no impact whatsoever (even if it was). Stop using the cortisone, as steroids on the face can lead to skin thinning. I recommend seeing another physician next time you have Radiesse injected, and consider another substance like Restylane instead. In the meantime, massage the area to help the body break it down.

I agree with Drs. Kaplan and Persky in that Radiesse should not be used around the eye area, unless it's done by an incredibly experienced physician and placed very, very deeply and layered with a softer filler like Restylane or Juvederm on top of it. Unfortunately the eye area is extremely thin skin and Radiesse is a thicker, harder filler, more similar to bone calcium. Thus injecting it into this area can leave pockets of filler or whiteness that simply cannot be fixed because there is no product that removes Radiesse. Injectable cortisone is sometimes used, though I'd say with very small effectiveness, and I wouldn't do this in the eye area. You could try a deeper laser treatment like Ultherapy or ST Refirme or Titan in this area, but putting too much heat there can also cause atrophy to the area and you could potentially end up with a deep pocket of fat/collagen loss. Thus, my most simple opinion is that you're going to have to wait this one out. Radiesse in the eye area can take a year or so to resolve, and I hate to say that, but it really shouldn't be used in the soft, thin areas of the face.