What is Radiesse® and How is It Used?
One of the most significant changes in thinking about facial rejuvenation in recent years has been the recognition that loss of facial volume is as important as the descent of facial skin and muscle in the “aging face”. Today, surgical and non-surgical procedures on the face must include consideration of restoring facial volume. As you age, your face develops unsightly hollows and shadows especially visible in overhead light. Restoring volume is as much about obliterating shadows as it is about changing or restoring shape. While there will always be a role for surgery in the “aging face”, restoring facial volume with a volumizing filler is a very good first step.
*Each patient is unique and individual results may vary.
Radiesse® is a volumizing filler that also stimulates new collagen growth in the deeper layer of the skin, the dermis. It is composed of microspheres made up of naturally occurring calcium and phosphate molecules in a compound known as calcium hydroxyl apatite, a normally occurring substance that can be found in bone. It augments your soft tissues but will not form bone in those areas. It is not an animal derived product.
Its effect is immediate, and noticeable improvement commonly lasts 9-14 months.
Dr. Bentkover has been using Radiesse® successfully since 2003 and has injected well over 1200 syringes. He is a member of the Radiesse® Medical Education Faculty. He teaches board certified facial plastic surgeons, general plastic surgeons, dermatologists and oculoplastic surgeons how to inject the product safely and effectively
Radiesse® is our preferred facial filler for:
More correctly called the melo-labial creases or cheek-lip grooves, these creases between the cheek and the upper lip deepen as you age. Some of this is from loss of volume in the fold and some from the “mound” beside the fold actually thickening with the descent of facial tissues. By replacing some of the volume in the fold, we can often create a more youthful appearance. Radiesse® is particularly well suited for this role, because it is implanted in the fatty tissue just under the skin. It plumps the skin from below and also stimulates collagen formation in the deep layer of the skin, the dermis. The new collagen growth adds to the long-term affect.
For creases that are more of a “fine line” we usually use a hyaluronic acid filler like Restylane®, Perlane®, or Juvéderm®. These creases are more confined to the dermis and are amenable to one of these so-called “dermal” fillers. If a crease has both a deep component from loss of volume and a dermal component, we sometimes place Radiesse® deep just under the skin and a dermal filler above it in the dermis. This is called “layering” a filler.
The cheeks under the eyes and under the tear trough
Surgeons call this area the mid-face. As you age your facial soft tissues (skin, subcutaneous fat, orbiatal fat, and the supporting muscles of the face) descend in a roughly vertical fashion. This can cause flattening over the bones under the eyes and loss of some of the volume over your cheekbones. It actually makes your lower eyelid look longer in the vertical dimension. Even people with so-called “high cheek bones” lose some of that height due to loss of soft tissue volume overlying the bones. Radiesse® can be used to replace some of this volume, to give you back your cheeks and even rejuvenate your eyes. In this case it is injected just over the bone in strategic locations to augment the cheeks and/or mid-face area. It can also be used to augment naturally flat cheeks. Alternative treatments like permanent cheek implants or a mid-face lift may also be right for you, but Radiesse® is a great place to start. Some of our patients choose to go on to a surgical procedure, but many also choose to just stay with periodic Radiesse® injections. As you might also expect from our description above of how the nasolabial folds and mounds are affected by aging, we often inject Radiesse® in the cheeks at the same time that we use it to fill these folds. Injections in the two areas work in conjunction to give a more youthful, fuller mid-face and under eye area. It gives a more balanced look, and adding volume under your eyes makes you look more awake.
The tear troughs (the angled depressions in the lower eyelid just under the eye and to the side of your nose) are usually best addressed by a lower lid blepharoplasty with fat transposition. In this procedure, the fat of the eyelids is repositioned into the tear trough. If you want a more temporary fix, however, there we generally use a hyaluronic acid like Restylane®, Perlane®, or Juvéderm®, often diluted.
These creases below the corners of your mouth are a great place for Radiesse®. We can also use it to fill a deep crease above the chin, to increase the size or projection of the chin, or to fill the depression of your chin in front of unsightly jowls. This is a very common use for Radiesse®. It will not eliminate jowls bur can camouflage them. A face lift or a mini-lift can give you your jaw line back.
Generalized loss of volume in the face and deep facial depressions
Depressions in the subcutaneous tissue from scars or an overall loss of volume of the upper and lower face can be improved with Radiesse®. It is also approved by the FDA to treat the loss of volume related to HIV medications, called lipo-dystrophy. Using Radiesse® to fill sunken temples or hollows above the brow can return a youthful appearance to the upper face and even raise the outer brow slightly. It can also be used to add emphasis the jaw line.
Formerly known as Radiance®, Radiesse® consists of minute calcium and phosphate-based particles called microspheres. The microspheres are suspended in a water-based gel. These microspheres are similar to minerals naturally found in the body and throughout nature, so no allergy testing is needed. These microspheres are fully absorbed by the body over time, and the body is left only with new naturally occurring collagen that may have been stimulated by the injection of the product.
Are you a candidate for Radiesse®?
Candidates for Radiesse® include anyone who is beginning to notice facial wrinkles, folds, and lines. Women and men generally between the ages of thirty five and sixty-five whose concern is primarily facial creases, loss of volume or deep facial depressions may benefit from this product. Younger adult patients find it beneficial for facial sculpting to give the appearance of larger, more striking cheekbones or to increase mid face volume. It can be used as a preview to see what the affect might be on your face for a cheek or midface implant, chin implant or mid-face lift.
Radiesse® is not recommended for lip sculpting or enlargement. That is better done with a hyaluroinc acid filler like Restylane®, Perlane®, or Juvéderm®.
How long will Radiesse® last?
Most patients have one treatment every 9-14 months, but those who require more volume may benefit from a “top off” 10-12 weeks after the initial treatment. This also seems to prolong the ultimate affect of the filler by stimulating collagen a second time
What is the treatment procedure for Radiesse®?
Our Radiesse® patients are very important to us and are treated with the same close follow-up, compassion, and courtesy as our surgical patients. This is a real medical treatment. It is best and most safely performed by a physician with residency and/or fellowship training in facial aesthetics appropriate board certification, someone who really understands the complex anatomy of your face. It can take one or more office visits, depending on the amount of treatment you need.
There is an immediate, noticeable effect and a long-term effect. Radiesse® sits in a carrier gel that takes 10-12 weeks to go away, leaving the true augmentation from increased subcutaneous volume and new collagen in the dermis. As already mentioned, most patients have one treatment every 9-14 months, but those who require more volume may benefit from a “top off” 10-12 weeks after the initial treatment. This also seems to prolong the ultimate affect of the filler by stimulating collagen a second time. The filler is injected just under the skin or just over the facial bones. It lasts longer in areas where it is injected just under the skin. Radiesse® can be mixed with a local anesthetic to minimize discomfort. Dr. Bentkover also uses anesthetic nerve blocks in the face to numb injection sites and topical anesthesia if needed.
The Radiesse® injection procedure can take fifteen minutes or even less, but we do not like to rush it. Plan to be in our office about an hour. Careful preparation with topical or injected local anesthesia and an ice mask for 10-15 minutes afterwards adds to you comfort. You can expect a mild burning sensation for a few minutes. The ice mask helps this go away. You can go back to work afterwards, but we do not advise it. You will have some mild to moderate swelling and sometimes some mild bruising. We would rather you go home and continue the ice.
A significant advance in filler injection technique has been the use of blunt cannulas (i.e. blunt needles) placed through a small, anesthetized area in the skin. This leads to less bruising and avoids the risk of injuring or even injecting a small blood vessel that supplies the skin or other vital facial structures. While a very rare complication, such injury is a risk with all facial fillers.
What is the recovery time?
As with any facial filler injection, there can be redness, bruising or swelling at the injection site after treatment. It can take a few hours to a few days for noticeable swelling or bruising to resolve. You should avoid physical activities for twenty four to thirty six hours after treatment and avoid unprotected sun exposure.
As with every facial filler, rare complications can occur. With Radiesse® these can include the appearance of small lumps or nodules and persistent redness. In most cases this goes away over time.
What do I do if I experience bruising?
Ice, ice and more ice. It is also advisable that you avoid blood thinners as well as herbal supplements that can thin your blood before and after the treatment. Aspirin, ibuprofen and other NSAID’s, warfarin, St. John’s wart, gingko biloba, garlic, high doses of vitamin E, and ginseng can cause bruising. Drinking pineapple juice for a week before and after the treatment helps prevent bruising; it contains bromelein. If you have any questions about bruising as it relates to medications or other preparations you may be taking, please call us at 508-363-6500 or email us at [email protected]
Bruising should subside within 10 days. With our new “cannula” technique, there is less bruising. Bruising is most common in the marionette crease area, because the skin is very tightly adherent to the muscles in that area.
Radiesse® is a long acting, volumizing, temporary filler. In our experience, noticeable improvement commonly lasts 10-14 months, but you should not let all the product go away before coming in for more; that just does not make sense. Treatments will need to be repeated over time to maintain your correction. How long the correction lasts varies from patient to patient and can change over time. The correction slowly dissipates as the calcium and phosphate are absorbed. How long it lasts also depends on where the product is placed. Subcutaneous injections last longer than injections placed just over the bone. As you continue to age, alternative treatments may become advisable in addition to or instead of a filler, including face lift, mini-face lift and implants. Initially and even after surgery, however, there still may be a role for Radiesse®.
Radiesse® comes in syringes of 1.5cc, 0.8 cc and 0.3cc. You and Dr. Bentkover will determine the number of injections and syringes needed to accomplish the desired end result. Most patients require one or two full syringes to accomplish a reasonable result. Dr. Bentkover will advise you on how many syringes he thinks you will need initially and at subsequent injection sessions. His goal is a natural and significant improvement in your appearance. He has been using this product since 2003 and will not recommend it if he feels it will not help you. However, he might recommend more volume than you think you need. A facial plastic surgeon views your face in three dimensions, and Dr. Bentkover’s recommendations may address significant volume deficiencies you do not realize can be helped.
There is immediate improvement. Over the course of about 10-12 weeks the cellulose carrier gel that helps Radiesse® flow through the syringe goes away leaving the calcium and phosphate microsphere augmentation and new collagen for the true result. That is why we re-check you at that point to see if you need more volume or volume in other parts of your face. You should expect close follow up.
This is a very low risk procedure. All injections in the face have some degree of risk; however, significant complications are extremely rare. Driving to the office for the treatment probably carries more risk. Redness is usually gone in a few days. Swelling is usually gone in 2-10 days. The appearance of small lumps or nodules and persistent redness is also rare and, in most cases, this goes away over time. The worst possible complication of all facial fillers can occur if a filler gets into a blood vessel. This can cause injury to the skin above or structures supplied by that blood vessel. That is why we use blunt needles (called cannulas) to inject. To learn more about filler safety you can go to the Injectable Safety website, http://www.smartbeautyguide.com/procedures/injectables.
The cost of Radiesse® ranges widely across the country. We believe that Radiesse® should be administered only by a board certified facial plastic surgeon, plastic surgeon, cosmetic dermatologist or oculoplastic surgeon. It is a medical treatment. Our prices are very competitive, and in many cases, lower than with much less experienced physicians. You should never base your decision on where to have any medical treatment based solely on price. Safety, credentials, and physician experience are much more important. We are happy to give you our pricing over the phone. We often run specials and buying two syringes for a treatment is less expensive than purchasing them separately.
*Please do not plan on having your injection of Radiesse less than 8 weeks before a special event or vacation. While complications are rare, they can occur.