Radiesse is an injectable dermal filler used to restore volume and stimulate long-term collagen production. It is composed of Calcium Hydroxylapatite (CaHA) microspheres suspended in a gel carrier, which provides immediate contouring results. While generally considered safe, the appearance of lumps, bumps, or nodules in the treated area is a recognized complication. These irregularities can range from temporary swelling to firm, persistent nodules that require intervention. Because Radiesse is a non-dissolvable filler, managing these lumps differs significantly from treating those caused by hyaluronic acid fillers. A correct diagnosis from a licensed provider is the first step toward effective resolution.
Understanding Why Radiesse Lumps Form
Lumps following Radiesse injection can be classified based on their cause and time of onset. The earliest and most common type is acute post-injection swelling or edema, which is a temporary inflammatory response to the needle trauma and the filler material itself. This type of lump is soft and typically resolves naturally within one to two weeks of the procedure.
A second category of lumps results from the filler’s physical properties and injection technique. If the product is injected too superficially into the skin, or if it is not adequately dispersed by the injector, these firm microspheres can accumulate in a localized bolus, leading to a palpable or visible nodule.
The most complex type is the late-onset nodule, often appearing months or even years after the initial treatment. These firm lumps are usually granulomas, which form as the body mounts a chronic inflammatory or foreign-body immune response to the CaHA particles. The body encapsulates the filler material with fibrous tissue, creating the persistent, hard nodule.
Immediate Steps and Non-Invasive Management
When a patient notices an irregularity, the first action should always be to contact the injecting provider for an evaluation. For many early-onset lumps, the provider may recommend a period of observation, as acute swelling and mild unevenness often resolve as the initial gel carrier is absorbed by the body. This observation period generally lasts one to two weeks, allowing the body’s natural post-procedure inflammation to subside.
In cases where the lump is suspected to be a superficial accumulation of the CaHA product, the provider may instruct the patient to perform gentle, localized massage. This mechanical dispersion technique aims to manually break up the clustered CaHA microspheres and spread them more evenly within the tissue. The massage must be performed exactly as directed by the practitioner, as improper technique can potentially worsen the issue.
Applying a cold compress immediately after the procedure can help mitigate initial swelling. For lumps that persist beyond the initial two weeks, continued patient-administered care is generally ineffective, and professional intervention becomes necessary.
Professional Treatment Options for Resolution
Treating a persistent Radiesse lump requires specialized techniques because the CaHA material cannot be dissolved with an enzyme like hyaluronidase, which is used for hyaluronic acid fillers. The primary non-surgical professional treatment involves intralesional injections aimed at softening or breaking up the material.
One common approach is the injection of a sterile solution, such as saline, directly into the nodule. This technique creates an in situ dispersion, diluting the concentrated CaHA particles and making them easier for the body to metabolize.
For inflammatory nodules and granulomas, a combination of intralesional corticosteroids (such as triamcinolone or dexamethasone) is frequently used. Corticosteroids reduce the localized inflammatory response and inhibit the excessive collagen and fibrous tissue growth that surrounds the filler particles. These injections are often combined with 5-Fluorouracil (5-FU), a drug that acts as an anti-fibrotic agent by inhibiting the fibroblasts responsible for producing the dense scar tissue.
These pharmacological treatments typically require a series of injections spaced several weeks apart. In some cases, the provider may employ mechanical disruption techniques, such as injecting the nodule with saline followed by focused mechanical vibration or microneedling. If a nodule is recalcitrant to all non-surgical methods, the final option is surgical excision, where the lump is removed entirely through a minor procedure.
When a Lump Signals a Serious Complication
While most lumps are cosmetic or inflammatory issues, it is important to recognize signs that indicate a potentially dangerous medical event requiring immediate attention. The most serious risk with any dermal filler is vascular occlusion, which occurs when the filler material blocks a blood vessel, restricting blood flow to the surrounding tissue. Symptoms of vascular occlusion often appear immediately or within hours of the injection.
Signs to watch for include sudden, severe pain that is disproportionate to the injection site discomfort, and a blanching or whitening of the skin in the treated area or nearby. This pallor can progress to a mottled, dusky, or purplish discoloration, and the skin may feel cool to the touch due to lack of circulation. Changes in vision are also an urgent sign, particularly following injections near the nose or eyes.
The development of an infection is another serious complication, though it is usually delayed by several days. Signs of infection include increasing warmth, spreading redness, significant swelling, and tenderness at the injection site, possibly accompanied by pus or a fever. Any sign of intense pain, color changes, or fever necessitates immediate contact with the provider or emergency medical care to prevent long-term tissue damage.