Radiesse Rescue: A Preliminary Study for a Simple and Effective Technique for the Removal of Calcium Hydroxyapatite–Based Fillers

Abstract

Background Radiesse, or Calcium Hydroxylapatite (CaHA), is a semi-permanent, biodegradable injectable filler that provides immediate aesthetic improvement, while also stimulating neocollagenesis for biologic effects. The physical properties of CaHA make it difficult, if not impossible to remove. Unlike some of the hyaluronic acid (HA) based fillers, CaHA cannot be easily dissolved. Objectives We present a simple and reliable technique for debulking and removing excess CaHA in the event of nodule formation, vascular compression, or overcorrection. Methods An 18-gauge needle is used to make an incision near the filler excess. A 1 mm diameter grater-type mico-liposuction cannula (Lipocube, Inc., London UK) is attached to a 5-10 ml syringe under negative pressure. The cannula under syringe suction is used in a back-and-forth, reaming motion beginning in the base of the material and gradually moving toward the surface until the desired effect has been achieved. Identification of the CaHA can be established and removal confirmed with ultrasound (Clarius, Inc., Vancouver, BC, Canada) if available. Results Although nodules, excess material and vascular compression secondary to CaHA are very rare occurrences, we have treated four patients with excess material and/or nodules. In one, the prominent cheek filler was reduced and a 1cm nodule that was palpable in the buccal region was eliminated. In the other three other patients, the palpable excess material was easily removed, in two at the time of injection and in the third, 6 months later. No patient required repeat treatment or replacement. Conclusions CaHA is an important synthetic filler due to its ability to lift, augment and regenerate tissue without eliciting an immune response, but its use has likely been limited due to difficulty of removal. This removal technique is shown to adequately remove excess CaHA filler but is not applicable to inadvertent intravascular injection.

A practical guide to selecting facial fillers

“…by the senior author, Cohen et al 21 In brief an 18G needle is used to puncture the skin, a "grater" type cannula is inserted to ream and aspirate the injected filler, with the objective of correcting contour deformities.…”

“…Due to the biological composition of the alternatively mentioned fillers, they cannot be reversed using hyaluronidase. A novel method to remove a CaHA (can theoretically be applied to PMMA) filler has been described by the senior author, Cohen et al 21 In brief an 18G needle is used to puncture the skin, a “grater” type cannula is inserted to ream and aspirate the injected filler, with the objective of correcting contour deformities.…”

Ultrasonographic Patterns of Calcium Hydroxyapatite According to Dilution and Mix With Hyaluronic Acid

“…C alcium hydroxyapatite (CaHA) is a well-known FDA and EU-approved cosmetic filler and supposedly a collagen biostimulator of the skin. [1][2][3][4][5][6] It is commonly used in the face and neck, besides other corporal segments, to restore volume and sagging skin as well as to promote the generation of collagen. 7,8 The commercially available formulation (Radiesse ® , Merz Pharma GmbH & Co. KGaA) comprises 30% synthetic CaHA microspheres (diameter of 25-45 m) suspended in a 70% aqueous sodium carboxymethylcellulose gel matrix and could be injected undiluted or diluted.…”

“…Calcium hydroxyapatite (CaHA) is a well‐known FDA and EU‐approved cosmetic filler and supposedly a collagen biostimulator of the skin 1–6 . It is commonly used in the face and neck, besides other corporal segments, to restore volume and sagging skin as well as to promote the generation of collagen 7,8 .…”