I had a complication with one of my patient with Radiesse injection. I injected her cheek and the zygomation area for volume restoration with one syringe of 1.5ml radiesse mixed with 2ml of 2%lidocaine. Then she developed this redness and mild swelling under her eye which did not resolved for two months. I Injected the product quite deep but I really don't know what is going on. She only has redness unilaterally in her right side but not on her left. Can someone give me some input?

Did she have much bruising after the imjections?

1) Why are you mixing Radiesse wth 2 ml of Lido?!
A 1.3 cc radiesse should be diluted with no more than 0.2 ml lido ; additionally avoid using epinephrine in the mixture, that way if there is blanching of the tissue you know it is due to ischemia and not the vasoconstrictive properties of epi, and you will be able to act accordingly

2) Redness and swelling should be treated as an infection until proven otherwise and treated accordingly. That being said, injection in the malar area can cause a type of obstructive lymphedema which could manifest as swelling +/- redness of the lower eyelid, where their is less resistance to pressure. Unfortunately, if this is the case, only time will resolve it; Radiesse is unaffected by hyaluronidase.

Dear Mark: I only use pure lido with no epi. The radiesse sales said I can mix it with up to 2ml of lido to dilute the product, hence less lumpiness would occur. Do you suggest injecting Kenalog into the area?

Dear LH, she didn't have much bruising after the injection.She didn't tell me about the complication until two months after her injection.

The patient is very upset, any suggestion of how to handle this scenario appropriately?

Thanks

The edema may last sometimes for months and, most likely, has nothing to do with Radiesse per se. It will eventually resolve; it is little more difficult to convince your patient .
I would consider a short course of oral steroids.

There is nothing wrong to mix ny filler with plain Lidocaine. 2ml is a lot but there is no data on advantage of adding 0.2ml vs
0.4ml or any other volume. Adding Lidocaine has two major advantages: minimizes discomfort and allowing for much smaller needle to use. I personally use cannulas for almost all injections but diluted Radiesse will go through 30G needle as long as the flow is continuous. It will go easily even through your standard 30G Botox syringe without dilution but transfer to that syringe precludes its use. Simple physics related to the length and diameter.

We are thinking on adding Radiesse to our services, but we're a little skeptical if we should take it on or not. Our worries are that you can not get rid of Radiesse with Hyalase with unforeseen side effects, as you can do with Restylane.

Over the years we have used more Radiesse than Hyaluronic Acid products because of the volume in the syringe and potential longevity. If you avoid the lips and the tear trough you should be fine. We keep hyaluronidase on hand for the HA products but almost never have to use it (mostly to correct other peoples mistakes or to fix the tear trough area which can be tricky). Radiesse isn't permanent and will eventually go away even if the outcome is not desirable. I would say if you are having to "correct" your HA filler often, then stay away from Radiesse. We started when neither product was considered "reversible" and just had to depend on good technique.

I love Radiesse. I would encourage you to be confident with your techniques and know your product well. If you are confident the "undoing" of the product is not as intimidating and the results are superior.

I also have experienced complications with Radiesse so I'm a little skeptic on using this. I had difficulty removing small lumps, especially on the lips. Any suggestions?

tia67 - don't use Radiesse on the lips! I used to do the vermillion border with Radiesse and really have never had a problem but the reported "lump" rate in the lips with Radiesse is about 10% (especially when used in the lip itself). For this reason, stick with HA's for the lips

I’ve used over 250 syringes of Radiesse since May and never had any problems. Love it for the syringe size and the “non-injected” look it gives. Do not use Radiesse for lips, inject deep and slow, mix with 0,2-0,4 lido and you will have no problem. It’s an excellent product for lifting, volume loss correction and collagen stimulation. My clients love it and so do I!

I love Radiesse! It is definitely not for the lips. I use it for the lower part of the face. Just make sure you inject it subdermally so that it won't be visible.

I agree, it is strongly contraindicated for the lips. Radiesse is great for augmenting cheeks, jaw lines and the chin. Be conservative augmenting the cheeks and injecting the chin. Stay on top of the inferior orbital rim.

As a cosmetic provider, there is truly no escape from any complications. there is no antidote to Radiesse but time.

I dropped Radiesse off our services. It is opaque white in color and it will show through if placed too close to the skin or in the skin. I have also injected Radiesse with extra caution in the lips with good outcomes despite the company's warning that it could lead to lumpiness.It is only best for nasolabial folds.

Thanks for your feedback on Radiesse. I won't use this for lips.However I use Juvederm Ultra X-C for lips with good results, however it only lasts for about 6 months. Does anyone use the UltraPlus X-C? I wondered if that might be too rigid for lips. Belotero looks promising as well.

has anybody tried injecting Radiesse on the tear trough?

Radiesse is a thick product, I think it is best used in the cheeks. Never on the tear troughs or on the lips. Should you decide to administer it on the lips, you need to go slow. Lips are an art so be conservative. It's easier to add than subtract.

I have been told by my rep not to use Radiesse in the tear troughs or lips..over a period of month the muscular action in these areas can cause the product to clump..so I use it in the lower face with a cannula and for deep volumization but do not deposit it in muscle..hope this helps!

I use Radiesse for deep dermal volumization only. Belotero is my favorite dermal filler to treat tear trough as it is an ultra thin product and superficial injections doesn't produce the undesirable Tyndall effect.

Radiesse is not my first choice of product for the tear troughs. I prefer HA's like Belotero. Should you choose to still inject Radiesse on the tear trough, stay under the malar septum.

Radiesse is amazing! It is definitely not for fine lines nor the lips. I use this product for re-contouring and for volumizing.

Radiesse is a calcium hydroxyapatite (the major mineral component of our bone and teeth and a common substance safely used in modern dental fillings). Using this product in our clinic showed me that this is the most safe, most effective, most durable, and the most long lasting injectable available for robust soft tissue augmentation.

There are much better products for the lips and Radiesse is best used for cheeks, hands, and nasolabial folds.

Radiesse is definitely not a filler intended for the lips, totally contraindicated! However, it is excellent for volumizing cheeks, defining jaw lines and filling deep nasolabial folds. Beware of danger zones like nasal fossae and temples because there is no antidote to melt this in case of vascular accident. Need to know the anatomy!

Radiesse is a great product. You can use it anywhere. You can use a HA filler except for the lips and for really superficial fine lines. As for getting rid of it, yes, there is no way to dissolve it. You have to be a proficient injector to use it as it is not as forgiving as a HA. I find it generally lasts at least as long as Voluma or SubQ in equivalent quantities.

I have to say that one of my favorite fillers is Radiesse. However, I wouldn't use Radiesse in the lips as it is contraindicated. Stick with the HA's for the lips. Juvederm or Belotero. Radiesse is a phenomenal product used in the cheeks, laugh lines, non surgical nose correction, etc..

I tried offering Radiesse about a year ago. In my experience it is a product which causes many problems.It causes pain when injected. It can cause severe bruising, lumps and in one case depression.I would never use it again.I believe we now have better safer products available to us.

I started mixing Radiesse with lidocaine a few years back because of the post-injection pain the patient experiences with straight Radiesse and haven't really looked back. The more dilute the mixture, the less of a problem with its viscosity - I can and do inject Radiesse with 27G cannulas and haven't had any issues with clogging. You can use Radiesse everywhere except the lips. Tear troughs are not a problem provided you use the product judiciously and inject deep to orbicularis. At least you won't get a Tyndall effect!

The main issue with Radiesse is that you usually need more of it than you expect as the immediate filling effect rapidly diminishes once the carrier gel is reabsorbed. This is more pronounced when diluting it with lidocaine. I have heard rumors that some more adventurous injectors mix Radiesse with an HA filler to overcome the 6-8wk dip in correction. Not sure how widespread this practice is but definitely "off-label".

I use Juvederm 4 for lips with good effect but always warn clients it only lasts 6 months in the lips as they are moving constantly. I have been put off using Radiesse totally due to stories from trainers and a doctor on a course I attended - regarding the patients they have seen with inflammatory responses and granulomas happening - in one case - 11 yrs after injection. The lumps in the nasolabial folds were sent for analysis and found to be the Radiesse. Does anyone else have similar experiences of delayed reactions to this product?

Have you been using Juve Ultra Plus in the lips? Sometimes patients will do better with Perlane-L or Restylane-L in the lips and how many syringes are you using? Up to 2 is acceptable (if needed). As for your problems with Radiesse it sounds like you may be placing the product superficially. Might as well find someone in your area that uses it successfully and see if you can get some time with them.

I have had great results with Radiesse in tear trough using literally the immeasurable flick of product off the tip of the needle on to the orbital rim only. I worked in the UK as a trainer. Training was never allowed on the tear trough as injectors vary considerably in skill whoever they may be. Hence I only perform this in my private practice.

You should not risk Radiesse in tear trough. Use an HA , I like Belotero best.

I have had great results with Radiesse in tear trough using literally the immeasurable flick of product off the tip of the needle on to the orbital rim only.

I love Radiesse as a filler, one of my favorites. However, the risk to benefit ratio is not in Radiesse favor for tear trough. Proceed with caution .

My experioance is that when you use Radiesse with sharp needles it will cause a "pearl effect" (lumps) while injecting. Even with longer needles. If Radiesse is injected deep enough like in the cheeks this is no problem and you can inject many near spots to get a brilliant effect.. But for lips and tear trough it will look and feel horrible

When it comes to these areas I use Sterican cannulas 27G x 38mm instead sharp needles like for the cheeks e.g. One advantage is that you are in the exact correct tissue when inserting them after pricking a small hole with a 0,50mm sharp needle.

But the best is that these "blunt" cannulas have a great kind of "spreading" the product not pearl like but very wide and plane.