Thank you for your email. Complaints about filler injections, Restylane, Radiesse, and Juvederm are the most common type of email I receive. One problem I believe is that so many untrained people, including non-physicians are injecting them.

Technique and experience are very important for a good result following the injection of a soft tissue filler like Restylane, Radiesse, Juvaderm, Cosmoplast, commodore, sculpture and others. It looks easy on the sales promotion videos but I can tell you from experience that filler injection requires meticulous technique.

I would not have any injection into the lump caused by the filler. Cortisone can cause tissue atrophy and proliferation of blood vessels. I would not have any injection-some recommend Hyaluronidase but I do not do it.

In my experience all fillers restylane, radiesse, and juvederm dissolve with time and massage so I recommend you massage the lump and be patient.

I have never heard of intra oral injection inside the mouth. I worry about the possibility of infection by bacteria in the mouth. If you experience redness and swelling I suggest you see your doctor.

I also do not inject around the eye- injecting juvederm, restylane, and radiesse around the eye is dangerous in my opinion.

For further information on soft tissue fillers or facial rejuvenation read Save Your Face or contact me. Also sign up for my free email newsletter for news on fillers and other new technology for facial rejuvenation.

Thank you,

Dr Seckel

Concord, Massachusetts

Boston, Massachusetts

Reply:

Thank you and I will listen. I’ve been massaging only problem with that is because it’s right under the eye it gets a bit sore because the skin is sensitive and it’s just a delicate area. Funny as it sounds I used to do skin care and I swear there are sooo many doctors out there who claim to know what they’re doing and they don’t use the proper technique and then you get these results grrrr but thanks again for your input I will be patient. I should have just had Titan facial tightening if anything, Sherri

Thank you for your email. The new soft tissue fillers like Juvederm, Restylane and Radiesse are excellent solutions for early facial aging changes such as the marionette lines, Nasal labial fold lines and thin lips. See photo below for lip rejuvenation with a filler:

Juvederm and Restylane are fillers made of Hyaluronic Acid and are a great improvement over the collagen based fillers like Zyderm and Zyplast. The Hyaluronic Acid fillers cause very little tissue reaction and do not require allergy testing like the collagen based fillers. This is a great advantage. Radiesse is also non allergenic but is made of a different compound, calcium hydroxyl apatite. Radiesse generally lasts longer than Restylane, 9-12 months as opposed to 4-6 months for Restylane.

Juvederm is the newest filler and is an excellent product. Juvederm is Hyaluronic Acid which has been modified to last longer than Restylane and many patients are experiencing results that last 9-12 months, much longer than Restylane.

I have been very happy with Juvaderm in my Boston and Concord practice because of the longer duration of the result. I use Juvederm, and Radiesse to correct nasal labial fold lines and marionette lines and use Restylane to plump the lip for lip rejuvenation and to correct thin lips

I also like the consistency of Juvederm as Juvederm is a gel and passes into the tissues more easily. As important Juvederm is malleable and can be massaged and the position modified once in the tissues after injection.

I found that Juvederm and Restylane have less tendency to produce lumps after injection than Radiesse. Restylane also has this beneficial characteristic.

Juvederm is more expensive than Restylane, $750.00 for Juvaderm as opposed to $600.00 for Restylane, but the extra cost is worth it in my opinion because the Juvaderm lasts probably twice as long.

Soft tissue fillers like Juvederm, Restylane and Radiesse are very popular today. They are safe and effective.

The most important thing for you is to find a doctor who has experience and can inject the filler properly.

Soft tissue filler injection requires experience and skill to get a good result. If the Juvaderm injection is not done properly you will not see a result or worse may see lumps.

I also do not inject Juvaderm, Restylane or Radiesse around the eye to correct dark circles under the eyes. It is dangerous to inject anything with a needle around the eye and the companies do not recommend it.

To learn more about Juvederm, Restylane, Radiesse and other fillers and correction of nasal labial fold lines, marionette lines and lip rejuvenation read Save Your Face or contact me. Please visit my clinical website drseckel.com to see photos and learn the details of soft tissue filler injection.

Thank you,

Dr Seckel
Concord, Massachusetts
978-369-4499

I am sorry to hear of your problem following Restylane injection around the eye for eyelid rejuvenation and to treat dark circles under the eyes. As you know from reading my blogs I do not do Restylane injection around the eye because I believe there are many risks to the eye and the companies that make the fillers do not recommend soft tissue filler injections around the eyes.

If the dark color is simply residual bruising it should eventually go away. Bruising, especially bruising around the eye can take 6-8 weeks to resolve so I would give it more time and use a concealer like Covermark or Dermablend.

Another possibility is that the Restylane was injected too superficially near the surface of the skin. When this happens a dark discoloration can occur. I do not know how long this type of discoloration can last. If this has happened to you all you can do is wait until the Restylane dissolves completely which can take up to 6 months. I do not know if this type of discoloration is permanent-I just have not seen this, have only heard about it.

I also recommend that you visit the very informative website devoted specifically to dark circles under the eyes where you will find many helpful suggestions.

Please feel free to email me your photos and I will try to give you a more informed opinion.

For more information on dark circles under the eyes, eyelid rejuvenation and non-surgical facial rejuvenation read Save Your Face or contact me.

Sincerely,

Dr Seckel

Boston, Massachusetts

I strongly urge you not to have surgical removal of the soft tissue filler bumps caused by Radiesse. The scars would be worse than the bumps.

Even though it has been a year since the Radiesse was injected into your face it is still very likely that the Radiesse will dissolve. I recommend that you massage the lumps 3 times a day and be patient. There are many patients who have had filler lumps after a year after Radiesse injections in the face and the Radiesse has eventually dissolved.

For more information on fillers and non-surgical facial rejuvenation read Save Your Face or contact me.

Thank you,
Dr Seckel

Boston, Massachusetts

Results of fat injection into the eyelid have not been good in my opinion and complications including lumps under the eyes, ectropion and injury to the eyeball have been reported. I do not use this technique for that reason. I also do not inject fillers around the eyes as I believe it is dangerous to do so, and the results are usually disappointing and temporary.

I use a transconjunctival laser blepharoplasty with arcus marginalis release and fat repositioning (through the inside pink part of the eyelid) to correct dark circles under the eyes. This modern plastic surgery Blepharoplasty technique is the best solution I have found for permanent correction of dark circles under the eyes in my practice.

For more information on dark circles under the eyes, fillers, blepharoplasty and plastic surgery read Save Your Face or contact me.

Thank you,

Dr Seckel

Boston, Massachusetts

Botox is the best and most effective treatment for wrinkle removal of worry lines, frown lines, forehead lines and crow’s feet. Fillers like Restylane or Radiesse are best for the Nasal labial fold. I use skin tightening systems LuxIR and Aluma with FACES. Other skin tighetning systems are Titan, Refirme, and Thermage

Fraxel works well for pigment and acne scars but is disappointing for wrinkles. For wrinkle removal and removal of fine lines other than those mentioned above I do a procedure called the ActiveFX laser skin peel using b the new Active FX laser made by Lumenis.

Please find a board certified Plastic Surgeon or Dermatologist–you should read my book Save Your Face-chapter 10-Dont Let Just Anyone Touch your Face–it will tell you how to find a good doctor.

To learn more about non-surgical facial rejuvenation visit my clinical site in Boston.

For more information on laser skin rejuvenation, wrinkle removal, skin tightening and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

I am terribly sorry to hear of your unfortunate experience. Unfortunately board certification in Plastic Surgery is no guarantee. This emphasizes the importance of consumer education and is what I am trying to achieve with this blog and my book Save Your Face. Hopefully others will learn from your misfortune and be able to avoid what has happened to you. As you now know I have been writing for some time that I believe filler injections around the eyes are dangerous and should be avoided.

It would help me to give you a better opinion about the advisability of a blepharoplasty if you could send me a digital photo of a front and side view of your eyes which demonstrates the effect of the Radiesse® injection on your eyelids.

The hopeful thing about your situation is that the soft tissue filler Radiesse® will eventually dissolve. I do not think it will take 2 years. I do believe the Radiesse® will be substantially lessened by 6 months and mostly gone by 9-12 months.

I am not comfortable with doing any intervention at this point to remove soft tissue filler material-steroid injections, Hyaluronidase enzyme injections, or other intervention at this point will potentially make things worse.

Surgical intervention in the form of a blepharoplasty may eventually be an option but I need to see your photos. The safest way to remove soft tissue filler material during a blepharoplasty would be the transconjunctival laser blepharoplasty approach removing the material from underneath the eyelid, however this would not address the issue of the swollen stretched eyelid skin.

Therefore, if, after an acceptable time interval waiting for the filler material to dissolve and the skin to tighten, surgical intervention is deemed necessary, some form of external incision may be required. This could either be a direct excision of the excess skin and residual Radiesse®, which would leave a scar at the bottom of the lower eyelid, or possible a standard lower blepharoplasty through an incision under the eyelashes modified to remove any residual Radiesse®.

These are very complex surgical decisions and need to be thought through carefully and I would need to see and examine you personally before making a recommendation. The major concern in addition to external scarring is the possibility of ectropion or change in eyelid shape that could occur with any external approach to removing the Radiesse®.

The good thing and the most important thing for you to focus on now is that you will improve with time. I know it is very difficult for you, but I caution you about pushing for intervention at this point in time. You will improve and hopefully not require surgical intervention.

Have you contacted Bio-Form-they need to be informed of your experience? Radiesse® is an excellent product, when used appropriately, I use it almost exclusively for the Naso-labial fold. An experience like this needs to be brought to their attention.

For now I recommend massaging the palpable Radiesse® with your finger several times a day. In my experience massage will speed the dissolution of the product.

I would be happy to review your photos confidentially if you wish to send them.

For more information on fillers, blepharoplasty and non-surgical facial rejuvenation read Save Your Face or contact me.

Sincerely,

Dr Seckel

Boston, Massachusetts

Soft tissue fillers work very well for the deeper Nasolabial Folds–IF they are injected by an experienced physician who knows how to do it–technique is VERY important–find a doctor who is experienced and does filler injections daily. I always recommend asking your friends who have had a good experience for a referral.

Fillers like Restylane and Radiesse work well for deeper lines like the Nasal-labial fold. They do not work well for very superficial lines like the smile lines further out on the cheek—often if fillers are used out on the side of the cheek they can create lumps and swell around the lines making them look worse. Fillers also will not correct the deep lines right next to the corner of the mouth-these are caused by the pull of the smile muscle.

However for the lines beside the nose running down to the mouth soft tissue fillers usually work very well.

I use Radiesse to fill the nasal labial fold lines-it works better and lasts longer but is more expensive than Restylane (900 as opposed to 600 for Restylane) but I think it is worth it.

For more information on nasal-labial folds, fillers and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr Seckel

Boston, Massachusetts

Soft tissue fillers like Restylane usually work very well when injected into the Nasal Labial fold lines and the Marionette lines. Occaisionally the soft filler injection can cause lumps as you describe.

The soft tissue filler Restylane will dissolve in time-at most 3-4 months. My approach would be to wait for the Restylane to dissolve and not inject hyaluronidase-Hyaluronidase could cause other problems and make things worse.

Vigorously massage the lumpy areas in your nasal labial fold lines, -you can spread the material around and make it less obvious.

To learn more about soft tissue fillers visit my clinical site in Boston.

For more information about fillers and non-surgical facial rejuvenation read Save Your Face or contact me.

Dr. Seckel

Boston, Massachusetts

I do not use the incisional plastic surgery method to remove nasal labial fold lines because the procedure leaves a scar in a very visible location. Also this
operation flattens the cheek and gives a very noticeable abnormal
appearance to the cheek.

A partial face lift called a midface lift helps the nasal labial fold and the use of an injectable soft tissue filler like Restylane orRadiesse also can be very helpful.

Fat injection works for lip enhancement but it is very tricky to get it
just right-35-60% of the fat dissolves so you must overcorrect-I have seen
some patients who have too much and have had to have it removed.

A newer lip rejuvenation procedure called suture lip augmentation-or lip advancement is done through small incisions on the inside of the lip so there is no visible scar.

This procedure not only makes the lip fuller but also pushes the pink lip
upward shortening the length of the white lip from the nose to the lip
which corrects the lengthening of the lip seen with aging.

For more information on lip rejuvenation and plastic surgery visit my Boston Plastic Surgery Website, read Save Your Face or contact me.

Thank you.

Dr Seckel

Boston, Massachusetts