In the world of injectable fillers, there’s one that’s having a major moment. While Radiesse certainly isn’t the new kid on the block (it’s been around since 2006), it’s become a bit of a breakout star of late. Doctors laud it for its unique ability to offer some of the immediate filling benefits of hyaluronic acid fillers such as Restylane and Juvéderm, along with the long-term, biostimulatory effects of Sculptra. (While HA fillers have been shown to boost collagen synthesis too, the non-HAs make this their primary mission.) Similarly, its distinct properties mitigate the likelihood of ending up with so-called “filler face,” and new indications—the FDA recently approved the use of Radiesse(+), a version that contains lidocaine, for jawline augmentation—add to the lengthy list of versatile ways in which doctors can use it. Here, doctors explain exactly why they’re reaching for Radiesse more and more these days.
1. The results are both instant and long-term
The effects of hyaluronic acid fillers are virtually instantaneous. Sculptra, on the other hand, takes three to four months to work. Radiesse hits the sweet spot in the middle, offering the best of both worlds. Radiesse provides an immediate plump as well as the more gradual volume gains incurred by collagen production, explains Dr. Jordan Terner, a board-certified plastic surgeon in New York City, who adds that this is a major pro for patients. (While it’s not as much of an instant change as you see with HA fillers, it is enough to make a noticeable difference.) The filling effect is a result of the gel carrier in the product, which starts to break down after about three months, he adds. But at that point, the collagen-stimulating effects of the calcium hydroxyapatite (what Radiesse is made of) kick in, he says.
2. It’s a good way to avoid “filler face”
There’s been a backlash against HA fillers recently, a move away from the doughy, cartoonish appearance that can often come with overfilling. Because HA gels attract and bind water—thereby swelling the skin—“there’s only so much hyaluronic acid that can sit in the face before you end up looking puffy,” explains Dr. Kay Durairaj, a board-certified facial plastic surgeon in Pasadena, California. “Using only hyaluronic acid fillers can end up being very limiting, which is why it’s so nice to have a biostimulatory filler, such as Radiesse, in the armamentarium.” Dr. Terner agrees, adding that it’s a particularly good choice for very thin patients, who are even more likely to quickly end up with “pillow face” from hyaluronic fillers. “Radiesse provides more of a natural look,” he explains.
3. It stimulates the production of both collagen and elastin
“Radiesse and Sculptra, both, trigger the production of new collagen. No one knows exactly how they do so, but it likely has something to do with the immune system recognizing it as a foreign body,” explains Dr. Durairaj. “What makes Radiesse special is that it also stimulates elastin production. Again, we don’t know the exact mechanism of action, but we do know that histological studies of treated areas show increased elastin.” And while both proteins are essential in their own right, it’s the combination of the two that ultimately is the secret to healthy, youthful skin.
4. Radiesse lasts a long time, and its effects are cumulative
According to Dr. Terner, most of his patients come back for Radiesse injections every 8 to 12 months (although they can last up to a year and a half). However, “the collagen-stimulating benefits are cumulative and add up over time,” he says. After three or four years of that cadence, most patients ultimately are able to go longer in between treatments, sometimes coming back only every two years, he explains.
5. Versatility: there are many places and ways to use it
“I use Radiesse everywhere and on everyone,” says Dr. Terner. More specifically, both doctors we spoke with rave about it for rejuvenation and augmentation of the midface. Dr. Durairaj says she loves using it to contour the cheekbones, because it provides structure and support and creates a very sculpted look. Both experts also love it along the jawline: “It’s the only thing I will use for jawline enhancement,” says Dr. Terner, again because it imparts crisp angles without swelling or looking doughy over time.
Radiesse also works well off the face. Dr. Terner uses a dilute form for hand rejuvenation, noting that, in his experience, it has less potential for nodule formation (which would be very visible under the thin skin on the hands) than Sculptra does. Dr. Durairaj likes using a hyperdilute form to address crepey skin on the neck, décolletage, upper arms, and knees. Diluting it tones down some of the filling properties so that you’re just getting the collagen-stimulation benefits; it also allows you to get a more diffuse spread of the product across larger areas, improving overall skin thickness and texture, she explains.
While Drs. Durairaj and Terner don’t believe that diluting (or hyperdiulting) Radiesse enhances its biostimulatory properties, Dr. Shereene Idriss, a board-certified dermatologist in New York City, disagrees. “The thinking is that the dilution makes the calcium hydroxyapatite particles smaller and finer overall—which, in turn, makes it better able to stimulate the fibroblasts and trigger neocollagenesis,” she explains.
Dr. Durairaj and Dr. Terner also favor Radiesse for injectable butt augmentations, since patients get to see that immediate benefit from the filling effects.
Radiesse should never be injected around the eyes or in the lips; in these areas, you want the softness and fluidity of a hyaluronic acid filler. Additionally, Dr. Duraijraj doesn’t like using Radiesse in the temples or the nose, due to the vascularity of these areas. To that point…
One big caveat: Radiesse is not reversible
“Radiesse has been around for over 15 years, but people have been scared of its lack of reversibility and dissolvability,” says Dr. Durairaj when asked why the filler is just now gaining major momentum. As with any injectable filler, it comes with the risk of vascular occlusion; there’s also a potential for nodule formulation. “Radiesse is an amazing product—but only in the skilled hands of advanced injectors who have a very good knowledge of anatomy. This isn’t something for new injectors to use. The inability to dissolve it can make this dangerous if it’s placed incorrectly,” she cautions.
Dr. Terner notes that while there is some talk that hyaluronidase (the enzyme used to break down HA fillers) may help disperse a Radiesse occlusion, it’s hardly a failsafe. Some studies are being done, to see if injectable sodium thiosulfate could work as a reversal agent for Radiesse; however, all the doctors we spoke with were quick to note that this is also by no means an easy out.
“Sodium thiosulfate is a chelating agent used to treat calciphylaxis, a condition where people have calcium deposits in their body,” explains Dr. Idriss. “We know that it can break up calcium particles, but more research is needed to determine exactly how safe and effective it is to ‘undo’ Radiesse. It’s certainly not the home-run hit that hyaluronidase is for HA fillers,” she says. Dr. Durairaj agrees: “We can’t conclude that sodium thiosulfate can dissolve Radiesse, and research has shown that it can even cause necrosis of the surrounding tissue,” she says. “It should be used with caution, if at all.” Point being, it’s paramount to seek out experienced, well-trained injectors when it comes to Radiesse.
