I think facial filler is great as you age. You can do facial filler in a subtle, natural way so you just look “refreshed” and not like a distorted star on a reality TV show. But what filler to use? It is confusing as a patient. There are different types: hyaluronic acid, hydroxyapatite, Sculptra. There are different brands. Different thicknesses. It could be overwhelming.
But there are some kinds of filler I never use. I don’t like fillers made of foreign materials or ones that leave scar tissue or a permanent residue in the face. Radiesse is one I do not use. There was an article in this month’s Aesthetic Plastic Surgery Journal August 2024 on “A Structured Approach for Treating Calcium Hydroxylapatite Focal Accumulations.”
If you use a hyaluronic acid filler (Juvederm, Voluma, Restylane, Lyft, RHA), if you have a nodule or don’t like how it looks, you can reverse the filler using an enzyme injection.
For other fillers, the nodules can’t melt away. This article is talking about how to treat calcium hydroxylapatite nodules.
- Level 0- no intervention. This is for asymptomatic nodules. They let time and the body’s natural degradation take effect.
- Level 1- mechanical dispersion techniques like massage are used. Microneedling is sometimes used.
- Level 2- alternative modalities like treatment with steroids and 5FU and lasers
- Level 3- last resort- calcium chelating agents, manual removal, and surgical excision.
I am not going to go into the rest of the journal article, as I don’t use Radiesse as a filler. But reading this journal article reminded me why. Any filler runs the risk of forming a nodule. I like the HA fillers better as they are easy to reverse if that happens. I also like that they do not leave a residue in the tissue.
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