What if Radiesse is injected in a fat pad? And the fat pad is enlarged due to it?

This is a continuation on my other question, and I have done some research and I think I found wich part under my skin is larger after radiesse. It's the jowl fat pad on one side of my face. So as for Radiesse causes collagen stimulation. I think it enlarged this fat pad. It's harder then on the other side and i can feel it under my skin in a sort of big lump. Is this possible? And when it's a fat pad, does this also fade away? Or isn't it going to get smaller?

Doctor Answers 1

Fillers can shift or weigh down if placed in soft tissue - deeper placement can help with jawline definition

Thank you for your question. You describe undergoing Radiesse injection and say it collected inside the jowl fat pad. You are concerned it has caused enlargement of the fat pad, and you are asking what are your options based on the possibility that Radiesse causes collagen stimulation. I think it’s very important you understand some basic concepts and ideas before you draw that conclusion.

A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I perform a lot of face lifting surgery, and often administer injectable fillers. I have a lot of experience with most of the popular injectable fillers, so  I can give you some guidance for what I suspect may be the issue in the absence of photos.

Let’s start with what you originally went for, which I assume was to improve the appearance of the jowls by blending it with the jaw using a long-lasting filler like Radiesse. When fillers like this are placed under the skin, there is an issue with the tissue integrity, and how the filler eventually moves to blend with the rest of the skin. I would ask is how much volume was placed? When we are talking about injectable fillers, it always seems that the terminology is large such as an X number of syringes. I had 1-3 syringes, but the volume is relatively small, typically milliliters - with Radiesse, it can be 0.8 or 1.6 milliliter volume.

Radiesse, for clarity, is a suspension of a material called calcium hydroxyapatite. The intention is this material would last longer than hyaluronic acid fillers. My concern about a material like this is unfortunately, if you don’t like the way it looks, you can’t dissolve or remove it.

In our practice, for similar scenarios, when somebody has a little jowling and isn’t quite ready or not a candidate for a facelift, we do something called structural volumizing. Structural volumizing is placing a longer lasting and thicker hyaluronic acid filler such as Juvederm Ultra Plus as well as Juvederm Voluma at the deeper level below the muscle. While fillers are generally placed at the skin level or right below the skin level, what I do is place it below the muscle level against the bone. Understanding a little about anatomy, a jowl looks prominent not only because the skin and fat has descended, but because there’s an area right in front of the jowl called the mandibular notch. This notch is an indentation of the bone that becomes accentuated with aging, so often, I’ll add volume there. It may have been your doctor’s intention to place the material in front of this area, or at the area of the mandibular notch, as opposed to the jowl. It’s possible the material may have migrated to that area.

That said, it might not be the collagen stimulation that is responsible, but the physical weight of the material that may be causing the jowl to look enlarged or descended, or it could also be the laxity of the skin. These are technical issues that require physical examination. It is certainly something to at least approach your doctor about and ask what transpired. Typically, a doctor who’s placing an injectable will have a plan A and a plan B in case a patient is not happy with the injectable treatment, so I suggest moving forward.

If you have significant enough skin and jowl laxity, then you may want to consider a procedure like a limited lift or structural volumizing to restore at a deeper level the volume, and using a filler that can be dissolved. That’s the big advantage of a hyaluronic acid filler - for any reason someone has an undesirable result, I can use an enzyme to dissolve the material, which you can’t do with Radiesse. There are ways to manage Radiesse, but it doesn’t involve dissolving because calcium hydroxyapatite lasts a fairly long time. There are options such as imaging to see the material.

Sometimes, when people are not happy with the look of a certain area, often it’s not a subtraction that makes a difference, but addition. We can place other material in a different way to blend these areas. Non-surgical tightening  is also an option with a thermal device. We have 1064 YAG laser that without ablating the skin, heat the dermis and the deep tissue similar to the way radiofrequency or ultrasound energy devices do, but in a gentler way so the tissue contracts more easily.

You shouldn’t be in despair about your outcome, but have your doctor who placed it evaluate you. If you’re not comfortable with that, move on and speak with other doctors and get some opinions and evaluation. Understand the foundations of the anatomy so it makes more sense, and not just focus on the materials and the perception of what went in a way you didn’t like. I hope that was helpful, I wish you the best of luck and thank you for your question.

Fillers can shift or weigh down if placed in soft tissue - deeper placement can help with jawline definition

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Thank you for your question. You describe undergoing Radiesse injection and say it collected inside the jowl fat pad. You are concerned it has caused enlargement of the fat pad, and you are asking what are your options based on the possibility that Radiesse causes collagen stimulation. I think it’s very important you understand some basic concepts and ideas before you draw that conclusion.

A little background: I’m a Board-certified cosmetic surgeon and Fellowship-trained oculofacial plastic and reconstructive surgeon. I have been in practice in Manhattan and Long Island for over 20 years. I perform a lot of face lifting surgery, and often administer injectable fillers. I have a lot of experience with most of the popular injectable fillers, so  I can give you some guidance for what I suspect may be the issue in the absence of photos.

Let’s start with what you originally went for, which I assume was to improve the appearance of the jowls by blending it with the jaw using a long-lasting filler like Radiesse. When fillers like this are placed under the skin, there is an issue with the tissue integrity, and how the filler eventually moves to blend with the rest of the skin. I would ask is how much volume was placed? When we are talking about injectable fillers, it always seems that the terminology is large such as an X number of syringes. I had 1-3 syringes, but the volume is relatively small, typically milliliters - with Radiesse, it can be 0.8 or 1.6 milliliter volume.

Radiesse, for clarity, is a suspension of a material called calcium hydroxyapatite. The intention is this material would last longer than hyaluronic acid fillers. My concern about a material like this is unfortunately, if you don’t like the way it looks, you can’t dissolve or remove it.

In our practice, for similar scenarios, when somebody has a little jowling and isn’t quite ready or not a candidate for a facelift, we do something called structural volumizing. Structural volumizing is placing a longer lasting and thicker hyaluronic acid filler such as Juvederm Ultra Plus as well as Juvederm Voluma at the deeper level below the muscle. While fillers are generally placed at the skin level or right below the skin level, what I do is place it below the muscle level against the bone. Understanding a little about anatomy, a jowl looks prominent not only because the skin and fat has descended, but because there’s an area right in front of the jowl called the mandibular notch. This notch is an indentation of the bone that becomes accentuated with aging, so often, I’ll add volume there. It may have been your doctor’s intention to place the material in front of this area, or at the area of the mandibular notch, as opposed to the jowl. It’s possible the material may have migrated to that area.

That said, it might not be the collagen stimulation that is responsible, but the physical weight of the material that may be causing the jowl to look enlarged or descended, or it could also be the laxity of the skin. These are technical issues that require physical examination. It is certainly something to at least approach your doctor about and ask what transpired. Typically, a doctor who’s placing an injectable will have a plan A and a plan B in case a patient is not happy with the injectable treatment, so I suggest moving forward.

If you have significant enough skin and jowl laxity, then you may want to consider a procedure like a limited lift or structural volumizing to restore at a deeper level the volume, and using a filler that can be dissolved. That’s the big advantage of a hyaluronic acid filler - for any reason someone has an undesirable result, I can use an enzyme to dissolve the material, which you can’t do with Radiesse. There are ways to manage Radiesse, but it doesn’t involve dissolving because calcium hydroxyapatite lasts a fairly long time. There are options such as imaging to see the material.

Sometimes, when people are not happy with the look of a certain area, often it’s not a subtraction that makes a difference, but addition. We can place other material in a different way to blend these areas. Non-surgical tightening  is also an option with a thermal device. We have 1064 YAG laser that without ablating the skin, heat the dermis and the deep tissue similar to the way radiofrequency or ultrasound energy devices do, but in a gentler way so the tissue contracts more easily.

You shouldn’t be in despair about your outcome, but have your doctor who placed it evaluate you. If you’re not comfortable with that, move on and speak with other doctors and get some opinions and evaluation. Understand the foundations of the anatomy so it makes more sense, and not just focus on the materials and the perception of what went in a way you didn’t like. I hope that was helpful, I wish you the best of luck and thank you for your question.

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.