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

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!

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. 

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.