What is the treatment for Radiesse (calcium hydroxylapatite) nodules?

Treatment of Radiesse Nodules

The most effective treatment for Radiesse (calcium hydroxylapatite) nodules is mechanical removal using a microliposuction technique with a grater-type cannula under negative pressure. 1

Understanding Radiesse Nodules

Radiesse is a semipermanent, biodegradable injectable filler composed of calcium hydroxylapatite (CaHA) microspheres (30%) suspended in an aqueous carrier gel (70%). While it provides immediate aesthetic improvement and stimulates neocollagenesis, complications such as nodule formation can occur.

Unlike hyaluronic acid fillers, Radiesse cannot be easily dissolved with an enzyme, making management of complications more challenging.

Diagnostic Approach

Before treatment, confirm the diagnosis:

• Palpate the area to identify the location and size of nodules
• Consider ultrasound imaging to confirm the presence and exact location of CaHA material 1
• Rule out other potential causes of nodules (infection, granuloma formation)

Treatment Algorithm

First-line Treatment: Mechanical Removal

For palpable nodules or excess material, the following technique has shown effectiveness:

1. Make an incision near the filler excess using an 18-gauge needle
2. Attach a 1-mm-diameter grater-type microliposuction cannula to a 5-10 mL syringe
3. Apply negative pressure with the syringe
4. Use a back-and-forth reaming motion starting at the base of the material
5. Gradually move toward the surface until desired correction is achieved 1

This technique has been successfully used for:

• Prominent cheek filler reduction
• Removal of palpable nodules in the buccal region
• Immediate correction of excess material during injection
• Delayed treatment of nodules (up to 6 months post-injection) 1

Alternative Approaches

If mechanical removal is not feasible:

1. Intralesional Steroid Injection:

   • Can help reduce inflammation and size of nodules
   • Use with caution to avoid tissue atrophy

2. Massage:

   • May help distribute the material more evenly
   • Most effective for recent injections before complete setting of the product

Prevention of Nodules

To minimize the risk of nodule formation:

• Inject Radiesse in small, calculated doses
• Avoid superficial injections (place in supraperiosteal space or subcutaneous layer)
• Consider reconstituting the product to increase versatility and minimize adverse events 2
• Avoid injection in areas prone to nodule formation (lips have been particularly problematic)

Follow-up Care

After treatment of Radiesse nodules:

• Monitor the area for complete resolution
• Assess for any signs of infection or other complications
• Consider ultrasound imaging to confirm complete removal if clinically indicated

Important Considerations

• This removal technique is not applicable for inadvertent intravascular injection 1
• No long-term or delayed-onset adverse events have been reported in patients followed for up to three years after Radiesse injection 3
• Unlike some other fillers, Radiesse has not been associated with granuloma formation in long-term follow-up studies 3

The mechanical removal technique offers a reliable solution for managing Radiesse nodules with good outcomes and minimal need for repeat treatments.