Question: Does Radiesse provide permanent or temporary relief of facial wrinkles?
Answer: Radiesse provides a temporary solution to facial wrinkles and folds and can last one to two years though in multiple patients I have seen them return within six months needing more volumetric enhancement. Due to this fact, we typically use the hyaluronic acid fillers Restylane and Juvederm over Radiesse, but occasionally someone will desire a significant amount of cheek enhancement and I will oftentimes discuss cheek implants, fat grafting, and Radiesse to those particular patients.
Question: I have had a dent on my nose for the past five months. My rhinoplasty was a year and a half ago. The surgeon recommended Restylane, but that is not permanent. What other options do I have?
Answer: I think Restylane in that circumstance may be a very good option if it is a very small dent and the risk of performing any sort of revision surgery is outweighed by the mild nature of the deformity. If you are extremely interested in the longer lasting result then injection of Radiesse may last up to two years or even longer in certain individuals. And as a last resort, you could consider injection of silicone into that area, though it is certainly not FDA approved as an injectable filler. Other considerations would be to perform a rather minor surgical procedure in the office where a small amount of cartilage is harvested from the back side of the ear and then, through a relatively small and precise incision, a pocket is made in the area of the depression and this cartilage is placed within it. I have performed this on a handful of my own rhinoplasty patients with excellent results, and it does not demand a trip to the operating room.
Question: Do any fillers provide permanent results? Which provide the longest lasting results, and what can they be used for?
Answer: There have been and are currently materials available that could be used as a permanent filler. One of which is medical-grade silicone, which is not FDA approved to be used as a facial cosmetic filler, but many physicians still use it for this. Another is a product that is composed of methyl methacrylate, which currently, I believe, is not available but historically has been a filler that was approved for facial use and is considered permanent. I personally am not interested in permanent fillers for folds and wrinkles since I do not know what this patient will look like in 20 or even 40 years when this filler will still be in their face. In patients that want volumetric improvement of their face and want a permanent result, I typically would discuss implants with those patients. Other long lasting fillers are Sculptra and Radiesse; Sculptra lasting typically at least two years and many times much longer, Radiesse typically lasting one to two years; however, I have seen many patients where it did not last a year. I, therefore, typically recommend the hyaluronic acid fillers as these fillers routinely last nine to twelve months in most areas of the face. They are extremely safe and reliable, and if the need occurs, they can be reversed with injection of an enzyme. Essentially, the hyaluronic acid fillers are nearly a perfect filler material, and that is why I prefer these over the aforementioned other options.
Question: I had been having chin augmentation with Radiesse. I absolutely love the shape but I am looking for something more permanent. Is it possible for surgeons to copy the shape of the Radiesse injection with an implant?
Answer: I do not know that it is possible to precisely copy the shape of a Radiesse injection with an implant but certainly we can evaluate your chin shape and decide what type of implant would give you the best results. There are other modifications to chin implant surgery that can be performed to the underlying muscle so that we can improve the appearance of a cleft or even theoretically create a cleft if one would be desired in the midportion of the chin.
Question: Over the years that fold that runs from the edge of my nose down to my mouth on both sides looks like it is sagging. I wonder if I can get this repaired without surgery. Is there something that could be injected into my cheeks to fill it out? Is anything like that permanent?
Answer: Yes you can definitely get something injected into the cheeks to fill them out and these would simply be filler injections. The most popular filler injection is a hyaluronic acid filler such as Restylane or Juvederm but you could also use Radiesse which is calcium based or even Sculptra. If desired you could also consider fat grafting since we can use a rather significant amount of volume from fat grafting and a portion of this can be considered a permanent filler. There have been permanent fillers on the market and most likely there will continue to be these options and for cheek augmentation I certainly can consider using these products to add volume to the cheeks. Another option would be cheek implants if your anatomy would benefit from such a procedure. Ultimately as you can see there are many options for your problem and that is why I feel a consultation with an experienced board certified facial plastic surgeon would allow you to select the best option for you.
Question: I heard that the injectable filler, Sculptra, can last 2 years. Is this true? Is this the only filler that lasts this long, and what can it improve?
Answer: Sculptra can definitely last two years or even longer, and in my personal opinion, I feel that it is best used as an overall volumetric enhancement of the midface, but I certainly know of others who use it in other areas of the face as well, including the smile lines. Other fillers that can last this long are Radiesse, which is calcium-based, though I do not think that it is nearly as reliable in its longevity as Sculptra is. Realize also, that the hyaluronic acid fillers, Restylane and Juvederm, can also last 2 to 3 years in certain individuals, but that is a relatively small percentage of the overall patient population that we see, and we cannot predict which patients will get this increased longevity of these filler products. Ultimately, I think fillers need to be highly customized for each individual’s desires, needs, and anatomic features, but overall I think that the hyaluronic acid fillers are the most reliable fillers on the market today.
Question: I am looking for a way to add more definition to my cheeks. Are implants a good choice for this, or are there any other options?
Answer: Implants are a great way to add definition to your cheeks and are a permanent way to provide more volume to this area. Other options would include injectable fillers, such as Restylane and Juvederm or even Radiesse for a significant, yet temporary answer to this problem. Some patients will decide to do injectable treatments to see if they like the result and if they do, they will then opt for a more permanent surgical cheek implant augmentation.
Question: I have heard some fillers like Radiesse, can cause lumps in the treatment area. How can this be avoided?
Answer: I personally have definitely seen lumps from Radiesse injections and this is usually when we are trying to fill a relatively small crease or wrinkle and we are placing the filler in the actual dermis of the skin. Occasionally we may hit a hair follicle or a sebaceous gland and some of the filler then tends to try to go up towards the surface of the skin. This can lead to a very small, sometimes red nodule that essentially needs to be expressed for it to resolve. This can be avoided by using the Radiesse for deeper folds or for volumetric enhancement of the face where the filler can be placed quite deep in the soft tissue and the risks of having any of these nodules is virtually eliminated. I would then use a hyaluronic acid filler for the smaller lines and folds since the risks of these nodules is extremely small with this type of filler material.
Question: What percent improvement can I expect in the wrinkles around my nose and mouth after my first treatment of Radiesse?
Answer: Depending on how deep your folds are you can expect nearly 100% improvement in the folds as long as an appropriate amount of the filler material is used. Essentially, what we always want to try to provide is what we call complete correction for patients regarding injectable fillers. That means we want to get rid of as much of the depression or fold or line as possible since visually if we only improve it by 50% that is certainly not going to be horribly appreciated by the patient, but if we can completely get rid of the fold or line that is obviously visually quite distinct and will please the patient.
Question: Can you explain what Radiesse is and what it is good for treating? How long do the results last?
Answer: Radiesse is a calcium-based filler material that is essentially calcium hydroxyapatite which is the same chemical composition of bone in a micronized size and then this is placed within a gel matrix so that it can be injected through a needle. Once injected, the small particles cause the body to wrap collagen around them and this then maintains the volume as long as the particle is present. Over time the body dissolves the calcium-based particle and this can take anywhere from a few months to a few years. Therefore the longevity of Radiesse in most the patients is somewhere around a year, but can be more or less depending on the patient.