Thank you for your question.
You are asking if it’s common practice to mix Radiesse® with saline to use it as a
filler for small lines and wrinkles and you describe in your question a situation where
your doctor is suggesting to use a diluted form of Radiesse® in a way to act like a
sculptor does to help you with areas in the cheeks where there was once dimple.
Well, I can understand your hesitation once you’ve done some research and you have not
crossed this as a “common practice” but I can share with you a little bit as someone
who is very experienced with fillers and someone who has tried different innovations with fillers
and other materials to help people improve their experience.
A little bit of background, 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.
I’ve been using injectable fillers since the days of Zyderm, Zyplast, the original
collagen and I routinely use the whole spectrum of fillers in my practice from Restylane,
Juvederm, Voluma, basically hyaluronic acid filler as well as Radiesse® and Sculptra.
So certainly I would say I understand your doctor’s thinking with the idea of using
Radiesse® in a way that you use Sculptra.
Sculptra is a suspension of material called poly-L-lactic acid and its behavior or the
way the body response to it is based on certain amount of collagen response by placing this
material diffusely in an area like the cheek.
Now Radiesse® is a suspension of calcium hydroxylapatite which is a very fine particle
and when it is placed, it is actually fairly robust in its ability to be a filler by the
idea of making it into a suspension certainly has potential value.
I think what you have to understand is that physicians are often especially those who
are creative and innovative will often look at the palette of options and be creative
with those options to try to give patients the best results possible otherwise everyone
would be essentially a factory worker and just doing things at a certain repetitive
way.
And although there is certain protocol and standards that shouldn’t always be adhered
to in approaching problems and innovations, intrinsically it requires some change in the
way something is done to get a better result.
For example, when it comes to fillers, we use hyaluronic acid fillers at a level that
is between the bones and the muscle and that is very deep.
Hyaluronic acid fillers are generally used for dermal filling so that means that essentially,
putting material that is normally placed at the skin level in an area that is much deeper
now that can certainly raise questions but we have established the safety, the predictability
and the quality of the result and the unique benefit.
When I place hyaluronic acid at the bone structural level, it creates this angularity and this
fullness that is absolutely remarkable and incomparable to standard methods of using
fillers.
So if your doctor is being innovative and creative just because everybody isn’t doing
the same thing doesn’t make a suspect.
Talk to your doctor about whether or not she feels that it is likely that something like
this will work out favorably.
Has she done this to other patients and how their outcomes have becomes.
I think when it comes to being creative and innovative, full disclosure and being honest
and straight with the patient is absolutely critical.
Patients understand that you are doing something that is absolutely a little bit outside of
the box or way outside of the box.
At least you are both walking in you and the doctor is walking with the eyes wide open
and you understand that the result may not be as predictable as something else that you
are choosing this procedure over.
So, I think that it is important that you have a relationship of trust with your doctor
and if you feel you can’t trust the doctor or if you don’t have confidence then just
don’t do the procedure but don’t assume that everybody else is doing the same thing
who might disparage this type of practice to be right.
If your doctor is conscious about quality, safety and being honest about result and what
to do about different scenarios, then you should consider this option and see if this
works out favorably for you.
So I hope that was helpful, I wish you the best of luck and thank you for your question!