Radiesse is uneven. Can I massage to even out or compress? Any recommendations to dissolve some or all of the filler

Question

Greetings Doctor/s I had radiesse x5 days ago. I do not like it at all. If I massage the cheek that is larger (right) will it help compress it? I am in a desperate search and reaching out to PS attempting to secure a doctor that has treated patients successfully in getting rid of and/or dissolving some of the filler. I appreciate your time and expertise greatly.

Julia Ann Sullivan Miller, MD · Answer

Since it has only been 5 days, I recommend waiting another week for all of the swelling to resolve before you take any action.  Unfortunately, there is no "dissolving" agent for Radiesse.  The company recommends saline injections with aggressive massage to the area to help break up the product.  Please see a doctor who has experience in the matter to investigate your options.

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

Best, 
Dr. Karamanoukian
Realself100 Surgeon

Nelson Lee Novick, MD · Answer

I am sorry that you are having this problem. Unlike hyaluronic acid products, Radiesse has no specific enzyme to dissolve it. However, I personally have had success in breaking up Radiesse via the use of saline injections; anti-inflammatory agents, such as triamcinolone in varying concentrations and amounts; and through physically disrupting the particles with subcision. I have also successfully used hyaluronidase (the enzyme for dissolving hyaluronic acid) adjunctively for dealing with Radiesse. Having said this, it should be emphasized that you are only five days past treatment and there is likely quite a bit of swelling simply from the treatment. Before racing to do anything, I would consider waiting at least two weeks, if not four, to ensure that all clinical and subclinical edema (excess tissue fluid) has been reabsorbed before considering any treatments. Good luck.

Jason Emer, MD · Answer

I suggest seeing an expert.  If its been more than 2-3 weeks then you should consider radiofrequency treatments, hyperbaric oxygen, or 5fu/steroid injections.  Saline injections can sometimes help.  Best, Dr. Emer.

Lisa Vuich, MD · Answer

Thanks for your question. It is certainly possible that you have been "over filled". However, be aware that Radiesse does induce more inflammatory reaction than the hyaluronic acid fillers (Restylane and Juvederm products), SO it is quite likely that you still have some tissue swelling there. I would wait a couple of weeks to see where things settle. Radiesse can be broken down somewhat by injecting sterile water into the region. You should of course see an expert about this.
Best,
Lisa Vuich, MD

Glenn Messina, MD · Answer

Radiesse unlike the hyaluronic acid fillers is not reversible however there are some things that may help just as you said massaging it down. The filler becomes less sensitive to pressing down upon it after several hours so after 5 days getting any true depression is lessened. The good news is that in time this will resolve and your cheeks return  to normal however that may take a year depending on how much was placed in the area.

Radiesse is uneven. Can I massage to even out or compress? Any recommendations to dissolve some or all of the filler

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