Is it a common procedure to mix Radiesse with saline to fill small lines and wrinkles?

My doctor mixed saline with Radiesse and injected the solution to the smile lines on my face, including on some lines in the middle of my cheek (that used to be dimples). I looked up the procedure she performed on the internet but haven't found anyone that is doing it. Is it a standard procedure? She said that, by mixing saline with Radiesse, it acted like Sculptra (it wouldn't create volume, but it would make the wrinkles disappear).

Doctor Answers 8

Diluting Radiesse

It is not common to dilute Radiesse when injecting into the face. However using diluted Radiesse for augmenting the back of the hands is an off-label indication that can give great results. The dilution allows the Radiesse to spread more evenly. I have never done this in the face but imagine it should work well. The diluted Radiesse may not give the same long term correction as the water content will dissipate completely and quickly. Hope this answers your question.


Santa Monica Dermatologist
5.0 out of 5 stars 1 review

Doctors may be innovate with filler techniques to improve results for their patients

Thank you for your question. I understand you’d like to know if it is common practice to mix Radiesse with saline before injecting it into small lines and wrinkles, including your smile lines. Your doctor explained that by diluting Radiesse with saline, it would make the wrinkles disappear without creating volume.
As someone who is very experienced with fillers and has tried different innovations with fillers, I can certainly give you some guidance on this matter. To give you a little about my background — I am a Board-certified cosmetic surgeon and a Fellowship-trained oculofacial plastic and reconstructive surgeon, practicing in Manhattan and Long Island for over 20 years. I have been using injectable fillers since the early days when Zyderm and Zyplast, the original collagen, were still the popular choice. Today, in my practice, I regularly use a whole range of fillers from Restylane, Juvederm, Voluma, Radiesse, and Sculptra, so I certainly understand your doctor’s thinking in trying to use Radiesse like Sculptra.
Now, first and foremost, let us define some terms. Sculptra is a suspension of material called poly-L-lactic acid, and the way the body responds to it is based on a certain amount of collagen response by placing this material in a certain area diffusely. Radiesse, on the other hand, is a suspension of calcium hydroxylapatite, which is made up of very fine particles, but when placed is fairly robust as a filler.
It is important to understand that physicians, especially the more creative and innovative types, will consider a palette of possible options to give their patients the best results possible. Most physicians certainly have their own individual way or style of doing treatment; otherwise, everyone would simply be doing procedures in the same repetitive manner, much like a factory worker. Certainly there are protocols and standards that should always be followed, but when it comes to solving problems innovatively, certain tweaks and changes must be made.
To illustrate this, when we use hyaluronic acid fillers in our practice, we place them quite deeply — between the bone and the muscle. Typically, hyaluronic acid fillers are used as dermal filling and are placed at the skin level. However, when I place hyaluronic acid filler at the bone structural level, it creates fullness, definition, and angularity that is unparalleled to that which is achieved through the standard methods of using fillers. While our method may be questionable at first to some, we have established the safety, predictability, quality, and unique benefit of the result.
So if your doctor is being innovative and creative, and they are conscientious of quality and safety, I don’t think you should be suspect of their actions just because they aren’t doing the same as everybody else. I advise you to talk to your doctor and ask if she feels that this method will result in favorable outcomes, if she has done this type of approach with other patients, and what their outcomes were like. I think full disclosure and straightforward honesty with the patient are very important comes to being creative and innovative. It is important that both sides understand that the doctor is doing something outside of the box, and that there is a possibility that the result may not be as predictable or consistent has the standard textbook procedure.
That said, it’s important to have a relationship of trust with your doctor. Of course, if you don’t feel like you can have this type of open and trustworthy relationship with your doctor, or if you don’t have confidence in them, then just don’t do the procedure and simply seek a second opinion. It’s also important not to assume that all doctors are doing the same procedures in the same manner because, like I mentioned earlier, doctors approach problems with their own individual style based on various degrees of experience.
I hope that was helpful and I wish you the best of luck!

Amiya Prasad, MD
New York Oculoplastic Surgeon
4.3 out of 5 stars 61 reviews

Radiesse - is diluting it ok?

Thank you for asking about your Radiesse.

Yes, it is accepted to dilute any filler with saline to make it easier to work with.
That said, I do not use Radiesse for lines but for folds.
Every surgeon had a different approach - wait and see if you like the result.

Always see a Board Certified Plastic Surgeon.
Best wishes - Elizabeth Morgan MD PHD FACS

Mixing Radiesse

What you're describing is pretty common, though I imagine the practice varies among physicians.  I commonly mix Radiesse with lidocaine to dilute/ make it thinner in my practice, as I prefer a thinner, more malleable product for finer/ more superficial lines.  I perform such mixing in a sterile manner, and used it in an off-label fashion with Radiesse and some hyaluronic acid dermal fillers.  Good luck with your treatment!  

Inessa Fishman, MD
Atlanta Facial Plastic Surgeon
5.0 out of 5 stars 1 review

Not a common practice

I have used radiesse for 10 years and have never mixed it with saline. It is a common and necessary practice to mix radiasse with lidocaine, although the newer versions of radiasse make this unnecessary. The best thing about radiasse is its "g prime" or lifting ability, which will be lost if diluted with saline. 
Although mixing it with saline is not dangerous, it does change its properties, and i assume your injector was using it as a fine line filler or collagen stimulator by diluting it. we have other products such as restylane silk for this purpose. 
In general injectors have personal preferences based on their experience, and if you like your results, it is likely his preparation was appropriate in your case. Good luck!

Neda Vanden Bosch, MD
West Palm Beach Physician
5.0 out of 5 stars 9 reviews

Radiesse with saline

Some physicians will mix Radiesse with lidocaine although a newer formulation of Radiesse called Radiesse (+) has the lidocaine premixed. 

It but not be unreasonable, however, for a physician to dilute the Radiesse with saline. It just comes down to physician preference and comfort with the product. 

Radiesse question

No, I don't think it is common to mix radiesse with saline. I have heard of some physicians using saline to try to disperse lumps of Radiesse. 

Is it common to mix Radiesse with saline?

I would not say that it is common to dilute Radiesse with saline, but there are some physicians who may prefer to do this.  My personal preference is not to dilute it, but there is not a problem with doing this.  

Michael I. Echavez, MD
San Francisco Facial Plastic Surgeon
4.5 out of 5 stars 18 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.