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Facial WastingFacial Wasting
           
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diminishing results or improper protocol
Nov 11, 2011

i really like my doctor but am beginning to wonder if she is using the proper technique to inject Sculptra and Radiesse. I first started using Sculptra in 2002 with another doc. before finding a local doc who could perform the procedure. I like Radiesse because of the instant results, but where I used to get treatments 3 or 4 times a year, counting my next appointment in mid November, I'll have gone for seven this year. Some treatments have been for two vials. Recently I received two vials of radiesse on August 3. Sept. 8th was to be a sculptra treatment but because hollows had reappeared under my cheeks we switched to Radiesse again. By the first of October I had a hollow area under one cheekbone and am starting to develop one under the other by now, the end of October. I understand the product's lifespan varies according to individual, but this seems extrememely short lived especially when I had more long lasting results in the past. The same doc has always injected the Radiesse. Does RAdieese simply stop working as well with time? What can my doc and I do to maximize the results from these products as they are very expensive and time consuming to administer? Thank you for your time and expertise.

Response from Dr. Pierone

The most common scenario that I see is insufficient volume replacement with Radiesse. The immediate results may look ok, but Radiesse produces variable degrees of tissue swelling that may produce an illusion of greater volume. Once the tissue reaction subsides, the lack of adequate volume replacement becomes noticeable and the hollowed areas come back. It is not uncommon to require 4 to 10+ syringes of Radiesse for full correction of mild-to moderate lipoatrophy

One can get more volume correction from Radiesse if the injection is done into the deep dermis/subdermal junction. However, the risk of nodules and contour irregularities increases when the product is injected in this tissue plane. Subdermal injection is safer and produces less bruising as well.

There are other variables as well. Some people are maintained on regimens that contain thymidine analogues (AZT, DDI, D4T) that continue to produce fat cell loss. Weight loss can also play a role in some cases. But in general, Radiesse does not lose its effectiveness over time.

Although not approved for lipoatrophy, Artefill is a permanent filler and has been used for treatment of lipoatrophy. In my opinion, it represents a better solution for lipoatrophy; especially for someone who has been through the facial filler treatment mill with multiple sessions of absorbable fillers.

Good luck!



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