Are ripples on the cheeks normal after getting Radiesse? (photos)

A photo in the smiling position taken before the Radiesse treatment would have been extremely helpful in this case. I have been injecting Radiesse for many years for all kinds of folds and volume defects all over the face and hands, even before it was given its current name and was called Radiance. In those many years, I cannot say I recall a link between the injection of the Radiesse and the development of significant motion-related "ripples" as seems to be the case from the photos provided. Unfortunately, unlike hyaluronic acid injectables, there is no way to remove the Radiesse once injected. While frustrating, the good news is that if Radiesse is the culprit causing this problem, with a tincture of time and patience, the untoward results will gradually disappear. Of course, if the crinkles relate to tissue swelling (edema) due to the injections themselves, this will resolve in the next couple of weeks or so.If it is due to the Radiesse and a more immediate solution is required as may prove to be the case here, I have had gratifying results treating similar problems of "ripples" and crinkles at rest and with expression (i.e. static and dynamic crinkling) of the lower face to the sides of the mouth using a combination approach of diluted Botox and diluted Restylane.  The diluted concentration of the filler serves to volumize and stretch the ripples and the diluted Botox, which is typically injected immediately after the filler, serves to damp slightly the muscles of facial expression that contribute to the crinkling/rippling in that region. Both materials are injected via cannula in a cross-hatched pattern throughout the affected region. Consultation with a board certified aesthetic core physician with extensive expertise and experience in these techniques is of course strongly advised.

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

This is very hard to comment on without any type of pre-photo to compare this to. Also, are the ripples only present when you smile like you are in the photos? Or are the ripples there at rest too? The only way to "fix" this would be to add filler into the small ripple lines that have been created by the injection of the other fillers around it. But we need to see what your face looks like at rest too, because I'm not sure if that's going to work if there are no lines when your face is at rest. It could make it look more swollen. "This answer has been solicited without seeing this patient and
cannot be held as true medical advice, but only opinion. Seek in-person
treatment with a trained medical professional for appropriate care."