Over a Year Later and Bumps from Radiesse Still in Upper Lip, What's The Cause and How Can It Be Fixed? (photo)

The lump you have in your lip is an accumulation of the Radiesse material, calcium hydroxylapatite (CaHA), and perhaps some fibrous tissue as well. Radiesse usually lasts about 9 -12 months, but can last much longer. Based upon your story and the picture you provided I suspect this will be present for some time yet, and I understand your frustration. I’m surprised that you don’t accidentally bite down on regularly.

Merz and Bioform have not recommended Radiesse for use in the lips for several years. When Radiesse was first introduced to the cosmetic market (called Radiance at that time) there were some discussions about carefully using it for lip enhancement. I actually have used Radiesse several times for lip enhancement, and have done so very effectively without problems. You have to do it very carefully, use only a small amount of product, and use a different technique than what you use for hyaluronic acid (HA) fillers. I am not here to advocate Radiesse for lip enhancement and it would not be considered standard of care. And there really is no reason to use it when Restylane and Juvederm are available, easier to inject into the lip, and have a good safety profile.

I’m not sure what your physician injected into the nodule, but this was not unreasonable. To be more specific, there is no enzyme or other product that currently exists to degrade CaHA (like hyaluronidase is available to degrade HA). But there is a study which discusses injection of fluid, in the early post-injection period, to treat nodule formation.

A study published in Dermatologic Surgery (Voights et. al., Dispersion of CaHA Accumulations, 36:S1:May 2010, pg798-803) discusses a possible treatment for inadvertent accumulations/nodules of CaHA. This describes injecting fluid into the accumulation and then performing massage. This helped promote flattening of the nodule and dispersion into the tissues. Following injection of CaHA, nodule dissipation by mechanical massage becomes less apparent over time, suggesting that early intervention with fluid to correct any observed palpable accumulation of CaHA material would be the preferred course of action. Regardless of the fluid used (lidocaine, sterile water, or saline), the addition of fluid to the accumulated CaHA was found to be superior to massage alone. Although no enzyme currently exists to degrade CaHA, this simple technique of fluid plus massage provides a mechanism to more effectively treat technical errors and perhaps avoid the need for more aggressive techniques.

You certainly could continue to wait and let this improve with time. There is some possibility that it will not completely resolve. If you want to get rid of it sooner, then you could have it treated by a relatively simple surgical procedure. The incision can be placed in the inner part of the lip, the risk of lip deformity should be low, and the resulting scar should be minimal. Seek a board certified plastic surgeon to discuss this treatment option.

If you seek lip enhancement in the future, please use Restylane or Juvederm. After these products have been used regularly for several treatments, they do have good longevity, but are not permanent.

Best wishes. Kenneth Dembny

Radiesse is an FDA-Approved filler that we use very frequently in our office to sculpt the contours of the face. Since we are a national center of excellence for filler reversal, we also encounter patients from other doctors' offices who wish to have Radiesse fillers removed for one reason or another. In our office, we employ a directed technique to visualize the filler material, if possible on ultrasound, and then use non-surgical methods to dissolve the filler or granuloma tissue using intralesional injections. There are many methods using a combination of enzymes, intralesional modulators of scar tissue, and Kenalog to help reduce volume and remaining filler. These techniques require meticulous attention to detail and can be performed at intervals of two to three weeks to achieve longterm effect.

Best,
Dr. Karamanoukian
Realself100 Surgeon

Hello,
 
I am sorry to read about your unfortunate experience with lip augmentation.  In my practice, Radiesse is only used in the nasolabial folds, the marionette lines, and other deep, thick tissues.  I believe this filler to be too thick for application in the lips or around the eyes. 

Unlike Juvederm or Restylane, there is no “dissolver” for Radiesse.  The expected duration of Radiesse is 12 to 18 months.  You have the option to continue to wait for the material to be resorbed.  However, given that it is has already been a year, I think it reasonable to remove it.  A small incision on the under side of your lip can be used to evacuate the remaining Radiesse.  If there is scar tissue in the area, which appears possible in the photo, this can also be removed at the same time. 

Hope this helps.