Can Very Strong Finger Pressure Dissolve Radiesse or Make It Migrate?

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

As the other panel members indicated, it would be highly unlikely that the two events would have any bearing on each other.  It's unusual to undergo Botox injections to the cheeks or that these treatments would require very firm pressure - unless one is experiencing an impending bruise.

It is not uncommon to use a deep pressure by your physician to mold Radiesse to achieve an optimal cosmetic result. The pressure will not cause the radiesse to dissolve but will shape it. We do not use deep pressure on botox treated areas.

When Radiesse is injected, it is very common for the physician to gently mold it into the desired position and to smooth out small bumps under the surface.  It can be inadvertently moved out of its ideal position for a while afterward.  How long until it is well "set"?  No one can say with certainty, but I always instruct my patients to be careful for at least three weeks after Radiesse.  This includes avoiding facials, Clarisonic cleanser, and even dental work for 3-4 weeks after I've injected them.  It is an investment worth protecting!

As for your doctor applying "lots of pressure" when injecting Botox, I feel there is no need to do this routinely, and worth your questioning him about it.  Certainly remind him if you've recently had Radiesse; if it was more than a month ago, then no worries.

I agree that pressure on the skin after Botox is unlikely to affect the Radiesse if the Radiesse was done a while back.  If the Radiesse was done very recently, then it might not be "set" yet and it could be affected by strong pressure.  The only time that I apply pressure after Botox is if there is an injection that bleeds a bit.  In that case, pressure helps to stop the bleeding and reduce the risk of getting a bruise.  Otherwise, pressure or massage after Botox is unnecessary. 

You did not mention the time frame between the two procedures, but it is highly unlikely that the pressure applied after Botox injections would affect your Radiesse especially if they were done at different times.  

Strong finger pressure within a couple days after Radiesse injections can be used to subtly contour and mold the material. However the pressure you describe with Botox injections will not cause the Radiesse to dissolve or move.

  I use quite allot of Perlane and Radiesse to shape cheeks, chins and jaw lines and use pressure immediately after these fillers are injected to shape, mold and feather the filler.  I don't believe pressure days, or weeks later, will move the filler and certainly won't make it dissolve.  

Radiesse can be shaped or molded in place for only a short time after it is injected and only for several days at most. It also takes a good deal of firm pressure to make it blend into the injection site. It is not likely that pressure used during a Botox injection would have any negative effects. By the way, when I inject Botox I barely touch the skin so there is almost no pressure on the cheeks.

For a short period of time after injection, Radiesse can be moved with firm pressure or massage.  After a few days, however, Radiesse becomes less likely to move.  Unless the Botox was done and the pressure applied in the week after Radiesse treatment, I don't think you should have any problem.