There can be unfortunate results with any filler, but some of the same qualities that can make Radiesse more desirable for certain applications are the same ones that also can be problematic.
First, just to clarify things for those of you who may want a little background, the most commonly used fillers are hyaluronic acid-based. Hyaluronic acid (HA, sometimes referred to as hyaluronate) is a sugar that is found naturally in the body. There are various incarnations of this, most commonly Restylane, Perlane, Juvederm and the fairly new Belotero. Radiesse is made of calcium hydroxylapatite (CaHA), another compound found in the body in bone. Contrary to some Internet silliness that was floating around in the past, Radiesse will not “turn into bone”. It eventually breaks down into calcium and phosphate, substances that you take into your body every day.
Radiesse is an excellent filler in several ways. It’s relatively thick, so for any given amount of volume that’s administered, we just seem to get more fullness than with the hyaluronic acid fillers. Secondly, it’s a “biostimulator” in that it stimulates collagen quite actively. The hyaluronic acid fillers do that a bit, but not as much as Radiesse, which does that by design. Also, in most people it seems to last longer than the hyaluronic acid fillers.
As with any substance taken into the body, there are rare instances of a sensitivity to the product, but in all the injections I’ve done over the years (usually several each day), I’ve seen only one patient in which I suspected an allergy to Radiesse. Also, with anything injectable, strict attention must be paid to cleanliness to avoid the possibility of an infection and your doctor must be eminently well-versed in the minutiae of facial anatomy – and delicate in technique – to avoid injecting the product into a blood vessel or placing it so that it presses enough on one to cut off the blood supply.
But as for Radiesse in particular, it should never be injected into the lips as the movement of the muscle tends to form nodules. It also is, in my opinion, too thick to be injected into superficial wrinkles and is best used for contouring. The main problem I tend to see is overinjection or poor placement. The longevity that makes Radiesse such a great choice as a volumizer can make it especially frustrating when someone comes in with too much of it and/or poor technique as it can seem like an eternity waiting for it to break down and go away. With the hyaluronic acid fillers, a benign enzyme (hyaluronidase) can be injected with a satisfyinly rapid dissolution of the product.
My first encounter with a lovely patient of mine, her equally lovely friend and her father was where they had all been terribly overinjected by a well-trained individual who had gotten these patients to the point where I drove home in tears that evening, wondering how this could have been allowed to happen. The friend had been given Radiesse to the mid-cheeks to the point where it looked totally out of proportion and Perlane had been given to a depressed scar near the nose, creating an elevation where there had been a depression. I injected a little hyaluronidase to the elevation and it deflated rapidly, allowing me to fix the scar in a timely manner. But it was a waiting game with the Radiesse over a period of months with her and with the two other patients. So the bottom line here is that the advantage of Radiesse is that it tends to go further and last longer than most of the hyaluronic acid products, but it is less forgiving and requires, I believe, perhaps a more accurate “eye” along with considerable skill and experience for an optimal result.
Lastly, and I haven’t seen a whole lot written about this, but if you’re on Actonel (risedronate) for bone density, it may eat up your Radiesse. Medications such as Evista (raloxifene) have a different mechanism of action and won’t affect the Radiesse. Fosamax (alendronate) has the same mechanism of action as Actonel, but it just doesn’t seem to affect the Radiesse in my experience. I had a number of disappointed patients early on, who came back after about a month and said, “I thought you told me this would last longer…” and I gave away an awful lot of hyaluronic acid filler feeling like a horrible person, until the common denominator became clear.
Oculofacial Plastic Surgeon, Sarasota, Florida
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