Small Nodule Formed After Radiesse Injection, Should I Be Concerned? (photo)

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

Nodules are a common side effect with Radiesse around the mouth and eyes.  These typically can take up to one year to resolve.  However, firm, aggressive massage may speed up the process in the flattening and dissolving of the nodule.  If that doesn’t work, I usually have my patients do a ReFirme laser treatment with elos technology that can offer great results with little or no discomfort.  Since yours is not causing you any major issues or symptoms, I wouldn’t recommend having it surgically removed.

The nodules could be a side effect of the Radiesse injections, unfortunately these nodules may not dissipate even if the product is no longer there. The nodules are not causing the jowling. Probably due to the product dissolving and the normal aging process.

The first question to answer is the etiology of the lesion--as other posters have noted, whether it is associated with the Radiesse injection techniques, the filler itself or the site of the injection.  You can definitely return to your doctor for evaluation.  It is difficult to appreciate the nodule on the photograph or to determine whether it is a hematoma, which would resolve fairly quickly, or the Radiesse itself.

Whether to be concerned about nodules after Radiesse injection depends on what the cause of the nodule is and when it appeared.  If the nodule appeared immediately afterwards, it could be some Radiesse deposited in a small area or a resolving hematoma from the injection.  Acne can also be exacerbated by injections in the area. 

If the nodule is Radiesse itself, it will take up to a year to dissolve.  A hematoma should resolve in 1-2 weeks.

If the nodule appeared later, it could be an allergic reaction to Radiesse or potentially even a late-onset inflammation or infection. 

I recommend an evaluation by your injecting physician or a board-certified dermatologist or plastic surgeon with training and experience in Radiesse injections.  Sometimes just a small intralesional injection of Kenalog and a short course of antibiotics can help resolve persistent nodules.

It is very difficult to see your nodule in this photo.  It may be something that you can appreciate by touch rather than by sight.  Radiesse nodules are an uncommon side effect of the filler and will definitely resolve with time.  The exact time frame varies from patient to patient.  Radiesse can last for up to 12 months in some patients.  If it bothers you, please return to your injector.  Sometimes a mild cortisone injection can help it resolve faster.

I use quite a bit or Radiesse and Perlane to shape the cheeks, chin and jaw line.  These fillers do create volume and the lump is most likely a collection of the Radiesse.  Unless, the Radiesse is causing a white lump that is visble through the skin representing a superficial placement...there should be no problem.  If you're concerned, you should ask the MD that injected the Radiesse.  

It is dificult to know what to do without knowing what is causing the nodule.

If it is a lump of Radiesse, (most likely) it should have been there from the day of injerction. In this case, repeated injections of Sterille Water may slowly reduce it and even dissolve it

If it is a granuloma( unlikely) a Cortisone shot may make it disappear.

Is it a "Biofilm"? The Biofilm concept is controversial and  gradually being questioned.

Therefore:

1-I would try first a shot of Kenalog into the lump.

2-If no improvement ensues, I would try repeated injections of sterile watrer followed by vibration to help dissolve the Radiesse bump.