Storing Radiesse Mixed With Lidocaine OK?

Question

Hello, Can any of you fine doctors tell me why once calcium hydroxylapateite (Radiesse) filler is mixed with lidocaine, ALL of it must be used up? I know that some of the hyaluronic fillers come premixed with lido (powder form) and are fine to store but I've heard this is not the case with Radiesse. Is there some chemical change that occurs if the two are stored together in a syringe for a period of time? Or is it just the added contamination concern with in-office mixing?

Michael I. Echavez, MD · Answer

In addition to the potential issue already mentioned with sterility, the other practical reason that Radiesse cannot be stored is that after a few days, the product becomes hard and is then impossible to inject. This is true whether it is mixed with lidocaine or not.

Kenneth Hughes, MD · Answer

In general, radiesse should be injected once opened and not stored due to risk of contamination or infection.  Kenneth Hughes, MD Los Angeles, CA

Vivek Bansal, MD · Answer

Once you open up a filler syringe it is no longer sterile, so I wouldn't keep it to store if product is remaining per standard protocol fo the company (Merz).

Donna Bilu Martin, MD · Answer

It's better to use the full syringe of Radiesse and not store any unused portion. Infection and contamination are theoretical risks with mixed stored products. Radiesse comes in teo sizes: 0.8 mL and 1.5 mL, so if a lesser amount is needed, the smaller size can be used.

Kenneth Beer, MD · Answer

It is probably safe to store Radiesse with Lidocaine for a short amount of time but the problem is that no one knows how long this is because it is not an approved way to use Radiesse so there is no data. There are publications about other products and they show that the others were safe to store but there is nothing about safety or stability for Radiesse.
	While the practice is probably fine, there is just no way to know and I typically inject full syringes and do not store anything.

Samir Shureih, MD · Answer

The syringe of fillers is one time use, can not be stored for future use because of possibility of contamination and infection. That is how you can mistakingly use one patients syringe on another and possible spread of hepatitis.

	Once the syringe os opened it has to be used or discarded. The portion remaining not used has to be discarded. These are principles of preventing infections.

Alan M. Engler, MD, FACS (retired) · Answer

In general, once a sterile package is opened, the material contained within it should be used expeditiously, and not stored for a prolonged period.  The HA fillers now come with lidocaine already mixed in but, once opened, it's probably not advisable to leave them unused.  This has to do with at least the theoretical risk of contamination and subsequent injection of a product that is no longer sterile.  That being said, I don't know of clear data showing such a risk, but it seems to make sense.

	I hope that this helps and good luck,

	Dr. E

F. Victor Rueckl, MD (in memoriam) · Answer

The fillers you mention that come premixed with lidocaine have been approved by the FDA this way. Radiesse isn't approved with a combination of lidocaine mixed in, nor does it come this way from the manufacturer - that's why there is no definitive answer for you. All fillers are single-use syringes so technically none of them should ever be stored, plus once you open a syringe and expose it to air, changes in the potency of the filler can occur if not used within 1-2 weeks maximum. This is an additional reason that it's not recommended to partially use syringes. Smaller size syringes of every filler are available so rather than storing syringes, it's best to find the right size needed and use the entire syringe at once, regardless of whether or not it has lidocaine in it.

Mitchell Schwartz, MD - Account Suspended · Answer

Radiesse is commonly mixed with lidocaine in the office just prior to injection (I do this myself for all of my injections). I am not aware of any studies showing how long Radiesse is still safe to use after it is mixed but this would depend on each physician and how sterile their technique was as well as whether or not lidocaine with preservative was used. Since I only mix in the lidocaine just prior to Radiesse injection and since partially used syringes should not be stored, it should not matter how long it can be stored after it is mixed.

Storing Radiesse Mixed With Lidocaine OK?

Answers (9)

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