Thank you for your question.
Your question which was submitted without a photo is about this safety about using Radiesse
to, I assume, to further enhance the appearance of your cheeks after you already received
Voluma which was recommended by your doctor.
Well certainly, I can give you guidance as to my opinion about these fillers as well
as the safety concern and the approach.
I’m a board certified cosmetic surgeon and fellowship trained oculofacial plastic and
reconstructive surgeon practicing in Manhattan and Long Island for over 20 years and I can
certainly share with you a lot of experience from using fillers over this time frame.
I recall using the first filler which was a collagen which was called Zyderm and Zyplast
and certainly in the modern world, we have a lot of options for filling different areas
of volume loss.
So understanding what the concept is of the use of fillers in the midface is very important
and understanding structure.
Chances are you are losing volume and as part of normal facial aging or you want to enhance
volume in an area where you want augment and just accentuate.
Well, I think that it is fair to conclude, again without photos where I would see what
you look like before, what you look like after and then give you some opinion but also in
the absence of physical examination, here are my thoughts about the interchangeability
or the sequence.
First of all, I don’t think your doctor will consider doing Radiesse on top of Voluma.
If your doctor felt it is not safe so I don’t think that you need to second guess your doctor
about safety.
I think that you will get a lot of opinions about safety but in the end, the most important
thing is to avoid risk of infections, inflammation but the more frequently issue is getting the
correction or the desired result or having problems with irregularities and unevenness.
So when you look at the anatomy of your face and you see how traditional fillers are placed,
Voluma was a milestone in the development of fillers because this was highly risked
hyaluronic acid filler that was approved for the use in the mid-face.
It also has other properties that are advantageous.
So to treat the midface, there was, Allogen got the FDA approval for Voluma and that’s
significant.
But as I observed for many years in practice, first with mid-face lifting and then soft
tissue augmentation is that the cheek pad or the malar fat pad where this material is
being placed provides us anatomically some limitations.
So what you may see is an under correction maybe because the material is diffusing in
because you need a lot of volume as well as the possibility that the skin itself is sagging.
When you put a certain amount of volume in the soft tissue of the cheek, you really are
relying on the tone of the skin as well as the ability of the underlying structure to
maintain the position of the volume that’s being placed.
So when people walk in Manhattan with these giant cheeks, it’s often because the doctor
is compensating for sagging by over inflating.
So the question of adding Radiesse may still be valid or the reason for may still be valid
because your doctor might just want to add a little bit more material but something that
is a little bit more viscous.
There is no question that the density of Radiesse is a little higher than Voluma but it is different
type of filler.
It is a suspension of fine particles of calcium hydroxyapatite and it is thicker.
In our practice, what we do for this area is something called structural volumizing
and what we are doing is instead of placing the material in the cheek level in the soft
tissue, we are actually putting it on the bone structure.
And when placed on the bone structure, we actually have more of a solid foundation to
which we build up the structure of the cheek.
We can put multiple syringes of fillers such as Voluma or Juvederm Ultra Plus in this area
and get that high accentuated cheek and the material will not slide downward and it will
not dissipate and it will actually settle in and will look very nice.
Now, I think that it can be a strategy for you but understanding that essentially, the
strategy your doctor is offering you has a value but discuss with your doctor what kind
of outcome can be realistically expected from this type of strategy because you have to
use a fair amount of material to keep adding to this.
And also get an explanation to why the doctor wanted to use Radiesse on top of Voluma and
why not use more Voluma.
Could it be because you are metabolizing it?
Could it be because it’s just not reaching the level of correction?
Clarity and communication is very important but also understanding the concept is also
critical.
When someone doesn’t want to use fillers and wants something more permanent, cheek
implants are fantastic solutions for filling out this area.
But in the modern world, when people have less time, I also find that using fillers
has a very significant role in my kind of practice because I’m able to really sculpt
the fillers in a way I can’t do with cheek implants with the same level of accuracy.
But again, this is a question that’s on a different category of surgery versus fillers.
So I hope that was helpful, I wish you the best of luck and thank you for your question!