Why Not Seeing Results with Radiesse?

Over thirty years ago, when I first started injecting the original collagen fillers, we chased each wrinkle and filled them. The results were seldom satisfactory and didn't last that long. In the past decade, with increasing knowledge and experience and the development of volumizing fillers, like Radiesse, we began to treat areas of lost volume. Our results were better and lasted a bit longer, but we still were not addressing gravitational effects and laxity. 

Fortunately, in in the last couple of years our understanding of how our skin ages has undergone a revolution. Whereas once the visible signs of facial and neck aging were attributed exclusively to skin laxity or looseness, today, we know that the sagging, drooping, wrinkling, textural alterations, etc that characterize the passage of time are a result of a number of anatomical and physiological events. These include loss in the quality and quantity of collagen and elastic fibers, largely due to years of accumulated sun exposure and other environmental damage; an increase in facial expression muscle activity (hyperkinesis);  loss of facial volume (due to decreases in fat, bone, cartilage and muscle); weakening of the retaining ligaments that suspend and hold the skin and underlying tissues in place; and the fragmentation and downward displacement--due to the effects of gravity--of the fat compartments that are responsible for giving fullness, smoothness, and youthful contour to the face and neck. The result of this gravitational pull on compromised, devolumized facial tissue is that the face loses its youthful triangular shape and takes on a more boxy look as the jowls and neck sag.

To illustrate what happens to our skin as we age, just Imagine a fully expanded dining room table covered with a beautiful, smooth table cloth that hangs just so halfway down each of the sides of the table. Now consider what would happen if you were to remove both leaves from the middle of the table. Not surprisingly, the table cloth that draped so beautifully now droops down to the floor. To restore the table cloth to its proper position, you wouldn't conclude that it had gotten too loose and proceed to cutting it down all the way around the table to shorten it. You would simply reinsert the leaves of the table and voila. However, for decades, physicians perceived jowls and turkey necks and sagging cheeks to be simple laxity (skin hanging) and merely cut away the "excess" tissue" as part of surgical facelifts, necklifts and eyelifts--often creating artificial, cadaverous, skeleton-like, overly pulled tight faces--giving rise to the obvious and much dreaded,  "They've been done" look..

Now, for sagging skin and apparent laxity, we have the Nonsurgical 3D Vectoring Lift.

A vector describes a magnitude and direction of force. Aging skin is characterized by a negative downward and inward vector of sagging. To counter this, surgeons traditionally pulled skin upward and outward--i.e. using a positive vector. The key difference between the outcomes of traditional surgical correction and nonsurgical 3D vectoring, both of which lift upwards and outwards, is the Nonsurgical 3D Vectoring Lift's additional corrective dimension of ‘forward projection’. This 3D effect is the result of volumizing with the use of injectable agents designed for this purpose, such as Radiesse, Voluma, Restylane SQ, and Stylage XXL. 

In general, the proper order of treatment should be to deal with the falling vectors first, then, if neccessary (and often after the 3D vectoring has been done, it is not necessary) any remaining furrows and depressions can be treated and finally fiine wrinkles with superficial fillers, like Belotero Balance. Otten if this order is followed and respected the overall amount of material injected is  less and the results far more gratifying.

The Nonsurgical 3D Vectoring Lift is predicated upon the fact that the face and portions of the neck differ in their degree of mobility. The region directly in front and behind the ears is a fixed, denser, relatively immobile area, in contrast to the mid-cheek region (hence the greater tendency of this region to sag with the passage of time). These anatomical differences are exploited in the Nonsurgical 3D Vectoring Lift by making the fixed areas serve as anchoring points for the mobile tissues.

In determining the positive vectors for the mid to lower face, the tissues that require lifting are identified by pulling the skin directly in front of the ears in a direction perpendicular to the area that requires correction. If the pulling results in lifting of the desired tissue, then the vector has been correctly identified and is then marked in accordance with 3D vectoring protocol. A similar approach is used in the region of the bone in back of the ear when dealing with neck laxity. One the proper vectors are marked, the volumizing agents are injected in a series of radiating bands that serve as support struts to the skin and that impart the necessary 3D outward projection--the lift--that distinguishes and defines this nonsurgical approach. The high viscosity and elasticity of the volumizing fillers serves to hold and re-support the overlying tissue and restore more youthful contours.

Although volumizing fillers are reabsorbed over time, they do promote new, native collagen synthesis, which may continue to provide structure, firmness and improved skin quality while continuing to lift tissues. A typical Nonsurgical 3D Vectoring Lift of the face takes about fifteen minutes and requires about three or four syringes to perform. Bruising and swelling tend to be minimal, and most people can return to work or social activities immediately following treatment.

Unfortunately, Since you did not post any "before" and "after" photos there is no way to comment on your concerns. 

   If you have injected a lot of product and you have not noticed a difference, I would start taking pictures if you have not already.  You may want to consider fat grafting to get a larger volumetric change.

Thank you for your question. Given the volume of filler injected, I would expect to see a result. It is difficult to comment further without before and after photos. Discuss your concerns with your injector or seek consultation from another. Best wishes.

Hi Deesi.  Part of the problem here sees to be that no photos were taken.  If before photos were taken, you would absolutely have to see some ind of result from 5-6 syringes of product.  It's unprofessional not to have photos taken so we would suggest finding a new injector.

With this much product, I can't imagine not seeing results. But if you're truly not seeing any change in the facial appearance, I recommend seeking out another physician who is more experienced in injecting these products. There is no reason that with that much product you shouldn't see results. 

Your story illustrates the importance of good before and after photos. Often times, both the doctor and the patient forget the baseline, and photos can be invaluable in making a comparison. Five syringes of Radiesse seems like a lot of product, but Radiesse comes in two different sizes and I wonder if you received the smaller syringe. If you received the larger syringe,  and you really believe there has been little to no benefit, then your injector may be placing the product too deep. Deep injection lasts longer, but requires a larger amount of product to see results. If there are no photos, and if you do not see a benefit from your treatment, you and your practitioner may not make a good fit for each other.

Its difficult to assess why you are not seeing results after a significant amount of filler injection  without before and after photos.  From what you described it sounds like you have been only having a small amount injected at one time, without ever achieving the desired correction.  There could be multiple reasons why you are not seeing results.  The placement of the product can significantly effect the outcomes.  Product can easily be wasted by injecting into areas that aren't going to produce an augmentation or the desired result.  Another cause could be that you have significant volume loss or deficiency in the midface and cheek area that actually requires a large amount of fillers to correct.  Without a picture it is difficult to tell you whether this is the cause.  If that is the case, you may want to consider other methods of volume replacement such as fat grafting that will be more cost effective.  Another issue could be that this filler has been injected over a long period time (7 months) and in a large area distribution.  Subtle changes could be harder to notice if it occurs a little at a time. Comparing photos before the start of your fillers to now will maybe also be helpful. 

There should be visible results from this much product. Perlane is one of the thicker filler materials as well.   My concern is that you are being injected by a nurse and not a board certified plastic surgeon or dermatologist.   Don't rely on what people are telling you.  Compare a pre-procedure photo with a current one and then evaluate.  If the nurse performs the injections under the supervision of a physician, then you should discuss this with him or her.  Experience, understanding of the facial anatomy and use of product purchased from the manufacturer and not offshore are all important considerations.

I am sorry to hear about your troubles. When it comes to fillers, not only do you need to have the right product used, you should be seeing someone who has the experience and training. Fillers sound simple but require a high level of understanding of facial anatomy, something only a board certified dermatologist, plastic surgeon or other facial surgical specialist would have. Only a few types of physicians get this training in their residency and fellowships. It is often tempting to go to someone who charges less, but I have seen time and time again, that cheaper alternatives often cost the patient more money in the long run because they need more and more product to reach the same type of result that a properly trained physician injector can achieve.