Thank you for your question.
You’ve described in your question that you underwent Radiesse injection and it appears
that the Radiesse injection has been collected inside the jowl fat pad as you described.
And you are concerned that 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.
Well, I think it’s very important that you understand some basic concepts and ideas before
you draw that conclusion definitively.
A little bit of 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.
I do a lot of injectable fillers.
I have a lot of experience with most of the popular injectable fillers and I can certainly
give you some guidance as to what I suspect may have been an issue in the absence of photos.
So to begin with, let’s just start with what you originally went for and I am assuming
that your goal was to improve the appearance of a jowl by blending the jowl with the jaw
using a long lasting filler like Radiesse.
I suspect that’s what you wanted to do.
Certainly, that is possible.
When typical fillers like this are placed under the skin, there is an issue with the
tissue integrity of the skin and how that filler eventually moves in a way that blends
with the rest of the skin.
So the question 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 X number of syringes.
I had one syringe, 3 syringes but the volumes are relatively small.
You’re dealing with typically milliliters.
With Radiesse, it can be 0.8 or 1.6 milliliter volume.
Now, Radiesse, which you already probably know, just for clarity, is a suspension of
a material called calcium hydroxyapatite.
The intention is that this material would last longer than hyaluronic acid fillers.
My concern about a material like this is that unfortunately, if you don’t like the way
it looks, you can’t really dissolve it.
You can’t remove it.
In our practice, for similar scenarios, when somebody has a little bit of jowling and isn’t
quite ready for a facelift or isn’t a good candidate yet for a facelift, we do something
called structural volumizing.
What I am doing with 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.
So understand that while fillers are generally placed at the skin level or right below the
skin level, what I do is I actually place it at below the muscle level against the bone.
Because when you think about it and just understanding a little bit about anatomy, a jowl looks prominent
not only because the skin and fat has descended but also because there’s an area right in
front of the jowl called the mandibular notch.
And this notch is an indentation of the bone that becomes accentuated with aging.
So a lot of times, I’ll actually add volume there and it might have been the intention
of your doctor 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 that it might have migrated to that area.
Now, that being said, it might not be so much of the collagen stimulation that is responsible.
It could be the physical weight of the material that may be causing the jowl to look enlarged
or descended.
It could actually be the laxity of the skin as well.
These are technical issues that require physical examination.
That being said, it is certainly something to at least approach your doctor about and
ask about what’s 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 that injectable treatment.
But I would 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 that I didn’t mention.
I can take an enzyme for any reason someone has an undesirable result and I can dissolve
the material.
In Radiesse, you can’t really do that.
Now, there are ways to manage Radiesse but it doesn’t involve dissolving and because
it’s calcium hydroxyapatite, the material actually lasts a fairly long time.
So there are options such as imaging to see the material.
There are definitely ways to approach this but I think learning about the volume and
having your doctor work with you.
Sometimes when people are not happy with the way a certain area looks, often it’s not
a subtraction that makes a difference.
Sometimes it’s addition, placing other material in a different way to blend these areas.
There are also options such as tightening procedures whether it’s non-surgical tightening
with a thermal device.
In our practice, we have 1064 YAG 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 way
that’s a little bit more gentle so that the tissue contracts a little bit more easily.
So I don’t think you have to be completely in despair about your outcome but just have
your doctor who placed it evaluate you and if you’re not comfortable with that, move
on and speak with other doctors and get some opinions and evaluation.
But understand the foundations of the anatomy so it makes more sense and not just stay focused
on just the materials and the perception of what went in a way that you didn’t like.
So I hope that was helpful, I wish you the best of luck and thank you for your question.