Anyone here with experience with Restylane SubQ? The company advises pysicians to inject this partical in the deep periosteal area for volume augmentation. The blunt (side exit) 16 gauge needle leaves big holes on the skin while making it difficult to penetrate deep into the periosteal region. Has anyone attempted injecting SuQ with a smaller needle (21,24, or 27 gauge) into the subcutaneous region?

Client came back for follow up yesterday. She was very pleased with her result. The filler stayed in place and nicely fi The large holes have closed and is healing quite nicely. I will use smaller gauge needle next time to minimize the chance of creating a large wound or scar.

I'm doing volume augmentation with Teosyal UltraDeep (available in Canada and Europe). The needle is 27 gauge, my clients have little or no bruising, no wound to heal and look great immediately.

I'll be interested to hear how you get along with a smaller gauge needle.

Kenneth:
Radiesse is probably better since it lasts longer (12-18months). It requires much less amount than restylane and can be used with 27 g needle. I believe its approval is pending in your country. Some of the areas can also be approached intraorally.

i use 21 gauge needles. I place the sub q over the periosteum. I find that when I use the 21 gauage needle most patients get some degree of bruising and i have not had any infection post treatment. For volumetric enhancement it gives great results but I have to warn the patients that bruising post op is the norm.

Any problems with lumps after Radiesse injection? How would you treat the lump-if it appear within a few days and when it appeared a few months later?

oral steroids or steroid injections is the treatment of choice in the uk recommended by the company for lumps following radiese if they do not respond to massage but approach this with care.
I'm not a personal fan of product as i've seen a mumber of patients in my clinic who following radiese injection elsewhere had a high rate of lumpiness (usually caused by too superficial injection or overfill) and more frequently broken capillaries and need some form of laser/IPL.
so if the lumps appear within a few days, massage and review, then consider steroids.

i mainly use teosyal ultra deep like Dr Rose for cheek augmentation. It lasts around 12 months and patients are pleased with the very natural feel of there cheeks. The new injector system has now put it on par with restylane products for ease of use and find i'm using more of the teosyal range than any other product. Thoroughly recommend it.

Dr. SHL:
Where do you inject the Radiesse?? which needle size??

UKDoc:
You are right about the causes of Radiesse-related lumpiness. I usually get less such problems with deeper injection (when possible over the periosteum ) and slow anterograde (thus requiring less amount) I think one can also "extract" it out with an 18 gage needle if necessary. I use Radiesse for cheek augmentation. It last longer and safe there since I laid it on top of the periosteum. We don't have Teosyal here in the US.

Hi I want to find a UK doctor who uses any of the above for cheek augmentation. Can I have your contact details please, I live in London. Thanks Tina

The answer to the original question is that you should use a 21 gauge sharp needle. The average particle diameter in SubQ is 1mm (hence 1000 per ml) and the internal diameter of a 21 BD thin walled needle is 0.55mm, so you would think that the SubQ particles would break up as you push them down such a needle, but they don't, and I have tested this myself by examining particle sizes through a 21G needle v direct from syringe (a drop of Betadine to act as a stain, then look through your dermascope) There is more particle break-up if you use 23 gauge needles or narrower.

You'll never suck out Radiesse with an 18 gauge needle. It's too thick. If you have visible white lumps from Radiesse I guess you'd have to incise over them and pick out the Radiesse with fine non-toothed forceps. If the lump is palpable but without appearing as white through the skin you would inject some diluted Celestone Chronodose or Kenacort. Can't say I'd be a fan of subjecting a patient's entire body to pharmacological doses of glucocorticoid just for a bump on the face when I have a needle and syringe and a good enough eye/finger team to apply the glucocorticoid locally at the site of the lump.

Such dramas can't occur with SubQ, since we all have a vial of hyaluronidase, right? there to fix any HA problems

The answer to the original question is that you should use a 21 gauge sharp needle. The average particle diameter in SubQ is 1mm (hence 1000 per ml) and the internal diameter of a 21 BD thin walled needle is 0.55mm, so you would think that the SubQ particles would break up as you push them down such a needle, but they don't, and I have tested this myself by examining particle sizes through a 21G needle v direct from syringe (a drop of Betadine to act as a stain, then look through your dermascope) There is more particle break-up if you use 23 gauge needles or narrower.

You'll never suck out Radiesse with an 18 gauge needle. It's too thick. If you have visible white lumps from Radiesse I guess you'd have to incise over them and pick out the Radiesse with fine non-toothed forceps. If the lump is palpable but without appearing as white through the skin you would inject some diluted Celestone Chronodose or Kenacort. Can't say I'd be a fan of subjecting a patient's entire body to pharmacological doses of glucocorticoid just for a bump on the face when I have a needle and syringe and a good enough eye/finger team to apply the glucocorticoid locally at the site of the lump.

Such dramas can't occur with SubQ, since we all have a vial of hyaluronidase, right? there to fix any HA problems

The answer to the original question is that you should use a 21 gauge sharp needle. The average particle diameter in SubQ is 1mm (hence 1000 per ml) and the internal diameter of a 21 BD thin walled needle is 0.55mm, so you would think that the SubQ particles would break up as you push them down such a needle, but they don't, and I have tested this myself by examining particle sizes through a 21G needle v direct from syringe (a drop of Betadine to act as a stain, then look through your dermascope) There is more particle break-up if you use 23 gauge needles or narrower.

You'll never suck out Radiesse with an 18 gauge needle. It's too thick. If you have visible white lumps from Radiesse I guess you'd have to incise over them and pick out the Radiesse with fine non-toothed forceps. If the lump is palpable but without appearing as white through the skin you would inject some diluted Celestone Chronodose or Kenacort. Can't say I'd be a fan of subjecting a patient's entire body to pharmacological doses of glucocorticoid just for a bump on the face when I have a needle and syringe and a good enough eye/finger team to apply the glucocorticoid locally at the site of the lump.

Such dramas can't occur with SubQ, since we all have a vial of hyaluronidase, right? there to fix any HA problems

The answer to the original question is that you should use a 21 gauge sharp needle. The average particle diameter in SubQ is 1mm (hence 1000 per ml) and the internal diameter of a 21 BD thin walled needle is 0.55mm, so you would think that the SubQ particles would break up as you push them down such a needle, but they don't, and I have tested this myself by examining particle sizes through a 21G needle v direct from syringe (a drop of Betadine to act as a stain, then look through your dermascope) There is more particle break-up if you use 23 gauge needles or narrower.

You'll never suck out Radiesse with an 18 gauge needle. It's too thick. If you have visible white lumps from Radiesse I guess you'd have to incise over them and pick out the Radiesse with fine non-toothed forceps. If the lump is palpable but without appearing as white through the skin you would inject some diluted Celestone Chronodose or Kenacort. Can't say I'd be a fan of subjecting a patient's entire body to pharmacological doses of glucocorticoid just for a bump on the face when I have a needle and syringe and a good enough eye/finger team to apply the glucocorticoid locally at the site of the lump.

Such dramas can't occur with SubQ, since we all have a vial of hyaluronidase, right? there to fix any HA problems

The answer to the original question is that you should use a 21 gauge sharp needle. The average particle diameter in SubQ is 1mm (hence 1000 per ml) and the internal diameter of a 21 BD thin walled needle is 0.55mm, so you would think that the SubQ particles would break up as you push them down such a needle, but they don't, and I have tested this myself by examining particle sizes through a 21G needle v direct from syringe (a drop of Betadine to act as a stain, then look through your dermascope) There is more particle break-up if you use 23 gauge needles or narrower.

You'll never suck out Radiesse with an 18 gauge needle. It's too thick. If you have visible white lumps from Radiesse I guess you'd have to incise over them and pick out the Radiesse with fine non-toothed forceps. If the lump is palpable but without appearing as white through the skin you would inject some diluted Celestone Chronodose or Kenacort. Can't say I'd be a fan of subjecting a patient's entire body to pharmacological doses of glucocorticoid just for a bump on the face when I have a needle and syringe and a good enough eye/finger team to apply the glucocorticoid locally at the site of the lump.

Such dramas can't occur with SubQ, since we all have a vial of hyaluronidase, right? there to fix any HA problems

The answer to the original question is that you should use a 21 gauge sharp needle. The average particle diameter in SubQ is 1mm (hence 1000 per ml) and the internal diameter of a 21 BD thin walled needle is 0.55mm, so you would think that the SubQ particles would break up as you push them down such a needle, but they don't, and I have tested this myself by examining particle sizes through a 21G needle v direct from syringe (a drop of Betadine to act as a stain, then look through your dermascope) There is more particle break-up if you use 23 gauge needles or narrower.

You'll never suck out Radiesse with an 18 gauge needle. It's too thick. If you have visible white lumps from Radiesse I guess you'd have to incise over them and pick out the Radiesse with fine non-toothed forceps. If the lump is palpable but without appearing as white through the skin you would inject some diluted Celestone Chronodose or Kenacort. Can't say I'd be a fan of subjecting a patient's entire body to pharmacological doses of glucocorticoid just for a bump on the face when I have a needle and syringe and a good enough eye/finger team to apply the glucocorticoid locally at the site of the lump.

Such dramas can't occur with SubQ, since we all have a vial of hyaluronidase, right? there to fix any HA problems

The answer to the original question is that you should use a 21 gauge sharp needle. The average particle diameter in SubQ is 1mm (hence 1000 per ml) and the internal diameter of a 21 BD thin walled needle is 0.55mm, so you would think that the SubQ particles would break up as you push them down such a needle, but they don't, and I have tested this myself by examining particle sizes through a 21G needle v direct from syringe (a drop of Betadine to act as a stain, then look through your dermascope) There is more particle break-up if you use 23 gauge needles or narrower.

You'll never suck out Radiesse with an 18 gauge needle. It's too thick. If you have visible white lumps from Radiesse I guess you'd have to incise over them and pick out the Radiesse with fine non-toothed forceps. If the lump is palpable but without appearing as white through the skin you would inject some diluted Celestone Chronodose or Kenacort. Can't say I'd be a fan of subjecting a patient's entire body to pharmacological doses of glucocorticoid just for a bump on the face when I have a needle and syringe and a good enough eye/finger team to apply the glucocorticoid locally at the site of the lump.

Such dramas can't occur with SubQ, since we all have a vial of hyaluronidase, right? there to fix any HA problems

The answer to the original question is that you should use a 21 gauge sharp needle. The average particle diameter in SubQ is 1mm (hence 1000 per ml) and the internal diameter of a 21 BD thin walled needle is 0.55mm, so you would think that the SubQ particles would break up as you push them down such a needle, but they don't, and I have tested this myself by examining particle sizes through a 21G needle v direct from syringe (a drop of Betadine to act as a stain, then look through your dermascope) There is more particle break-up if you use 23 gauge needles or narrower.

You'll never suck out Radiesse with an 18 gauge needle. It's too thick. If you have visible white lumps from Radiesse I guess you'd have to incise over them and pick out the Radiesse with fine non-toothed forceps. If the lump is palpable but without appearing as white through the skin you would inject some diluted Celestone Chronodose or Kenacort. Can't say I'd be a fan of subjecting a patient's entire body to pharmacological doses of glucocorticoid just for a bump on the face when I have a needle and syringe and a good enough eye/finger team to apply the glucocorticoid locally at the site of the lump.

Such dramas can't occur with SubQ, since we all have a vial of hyaluronidase, right? there to fix any HA problems