Swollen Nose After Using Radiesse for Revision Rhinoplasty

Question

I had Radiesse injected into the bridge and tip of my nose as a means of augmenting it after a Rhinoplasty and Revision Rhinoplasty left me with what I perceived as a shortened nose.
The plastic surgeon suggested a "grecian nose" and injected the Radiesse from the top of my bridge down to the tip. That was over 2.5 year ago. Despite the claim that the filler is supposed to dissolve and return the skin to its pre-injected stage, my nose has hardened and remains swollen, and there is a distinct wavy outline along both sides of the bridge of my nose that protrudes.
I have sought out dermatologists, and other plastic surgeons re: what can be done..my nose remains swollen, enlarged, and although the filler is gone, it feels like it has been replaced with scar tissue. I am beside myself. I am fearful of making a horrible look even worse and am reticient to try lasers or steroid treatments. Help! Anyone who can offer me some direction on what to do?

Michael A. Persky, MD · Answer

Hi UBthejudge,
Your nick name reminds be of the old Flip Wilson skit and song "Here Come Da Judge".  In your case I would like to be the judge, but without a photo or examination of your nose, this "judge&rdquo; has to dismiss the case.
I am truly sorry that you are suffering long term effects of the "Non-Surgical Rhinoplasty", which has nothing to do with "rhinoplasty" and everything to do with "non-surgical".  We are finding that some fillers are lasting longer than expected in selected patients, whether it is due to new collagen formation, scar tissue, or the product itself.
You should consult with a rhinoplastic surgeon.  Your nose should be carefully examined, diagnosed, and then a treatment plan will be created to achieve your cosmetic nasal goals.  You may require revision surgery, or may only need "Tincture of Time" (don't look for tincture of time in the pharmacies as one of my patients once did).
I offer complimentary consultations for rhinoplasty if you wish to approach the "bench" regarding your case.  Getting as many opinions about your nose is always best.  Choose your rhinoplasty surgeon most carefully.  
This "court&rdquo; will now take a recess until tomorrow.  Good luck and be well.
Dr. P

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

Toby Mayer, MD · Answer

See a revision Rhinoplasty specialist. Lasers and steroid treatments won't help. An experienced revision Rhinoplasty expert will be able to give you good direction to resolve your problem.

Steven Wallach, MD · Answer

Too much a good thing may not be a great idea. That is what it sounds like. I have used it on a few people that had multiple rhinoplasties and had mild contour deformities. In these cases, I think it is alright. I used maybe 0.3 cc's total. Unfortunately for you, it is unclear what is going on. It sounds like you should get another opinion to see if there is anything that can be done for you without making things worse.

Peyman Solieman, MD · Answer

Dear Ubethejudge,
I am very sorry to hear that you have had the problems with your non surgical rhinoplasty.  Unfortunately, this is one of the complications that can arise with non surgical rhinoplasty done with Radiesse, and it is one of the reasons we concluded in our recent review of non surgical rhinoplasty patients that it is best to use a fully dissolvable filler, such as Restylane or Juvederm, when first considering a nonsurgical nose job.
That being said, at this point it is more likely that you have a mixture of scar tissue and Radiesse that has remained, causing you issues; though it may be possible that you have had some further calcification of the Radiesse into a more solid bony matrix.
When we have encountered patients with this problem, we have often been able to remove the Radiesse during surgery and revise the nose, though it is a somewhat complicated problem.
In fact, recently, we, in association with our colleagues, reviewed the largest series of injectible rhinoplasties done by anyone to date, and we are presenting our findings in a rhinoplasty meeting in Houston next month.
If you are interested in reading more on the topic, feel free to review our blogs pertaining to the subject by searching for non surgical nose job or liquid rhinoplasty in our blog. And if we can be of any more help please feel free to email or call us.

Swollen Nose After Using Radiesse for Revision Rhinoplasty

Answers (5)