Should I continue Radiesse? Results not noticeable and it's expensive. (Photos)

Question

I (39F) have had deep neck lines for years and finally decided to treat them. I've had two Radiesse treatments so far (April and then 8 weeks later) but see no improvement and am hesitant to spend another $800 on a third. My injector recommended Radiesse over Botox, saying it would improve both the lines and my skin texture. I didn't think my skin texture was an issue, but the added benefit sounded worthwhile. I was told I'd need three treatments, 4–6 weeks apart, at $800 each. My second treatment ended up being 8 weeks after the first because I got sick. At my second appointment, the office didn't notice the longer interval until I mentioned it, which made me question how closely they were following the treatment plan. They said 8 weeks was still okay, just slightly less ideal, so I proceeded. That treatment was July 16, and my third is scheduled for August 3. My neck looks essentially unchanged, except I now notice some skin droopiness that I don't remember seeing before. I have gained some weight from birth control since starting treatment, and at 39 it's possible this is unrelated and simply aging, but together these factors make me hesitant to continue. I'd appreciate opinions on whether a third treatment is likely to be worthwhile. Photos attached (I couldn't find a great before photo, so please keep that in mind).

Anna Chacon, MD, FAAD · Answer

I can understand why you're feeling hesitant. When you've already invested significant time, money, and hope into a treatment, it's frustrating to look in the mirror after two sessions and feel that your neck looks essentially unchanged.

A few things stand out from your description.

First, Radiesse is not usually my first choice for treating established horizontal neck lines. Diluted or hyperdiluted Radiesse is often used as a collagen stimulator to improve skin quality, crepiness, and mild laxity over time. It tends to work gradually by stimulating your own collagen production, and the improvement can be subtle, especially in photographs.

If your primary concern is deep horizontal neck lines, those lines are often caused by a combination of:

repetitive neck movement,

underlying muscle attachments,

skin thinning,

and sometimes volume loss directly within the crease.

In those cases, Botox alone is usually not very effective for the lines themselves unless there is significant platysmal muscle activity contributing to them. Treatments that often produce more noticeable improvement include soft hyaluronic acid filler placed directly into the horizontal lines, microneedling or radiofrequency microneedling, fractional resurfacing, or a combination approach depending on the depth of the creases.

Regarding the 8-week interval, I would not consider that a major reason for treatment failure. Collagen stimulation is a relatively slow biologic process, and an 8-week gap instead of 4-6 weeks is unlikely to make the difference between a successful and unsuccessful outcome. However, I do understand why the office's lack of awareness about the timing made you question how carefully the treatment plan was being followed.

The new droopiness is more difficult to interpret. Radiesse itself does not typically cause significant sagging, but when skin quality treatments do not produce the expected tightening effect, patients sometimes become more aware of pre-existing laxity. Weight gain, hormonal changes from birth control, and normal aging can also make the lower face and neck appear softer over a relatively short period of time.

The most important question is: Have you noticed even a small trend toward improvement since April?

If the answer is "yes, but it's subtle," a third session might provide additional collagen stimulation and could be reasonable if your injector still believes the tissue is responding.

If the answer is "no, I truly cannot see any meaningful improvement at all," I would be cautious about proceeding automatically with a third $800 treatment simply because it was part of the original package or plan.

At 39, with deep neck lines that have been present for years, I would generally expect some visible softening after two properly performed treatments, even if the final result is not dramatic. The fact that you are struggling to identify any improvement suggests that either:

the treatment is not the best match for your specific type of neck lines, or

the expected benefit was overestimated during the consultation.

Before spending additional money, I would ask for standardized before-and-after photographs taken by the office under the same lighting and neck position. Patients are often surprised by subtle improvements that are hard to appreciate day to day, but if even the standardized photos show minimal change, that would support reconsidering the treatment plan.

Based on what you've shared, I would not assume that a third Radiesse session is guaranteed to produce a dramatic improvement. It may still offer some gradual skin-quality benefit, but for long-standing deep horizontal neck lines, I would want to reassess whether a different treatment strategy would be more effective and cost-efficient rather than continuing a series that has not yet produced results you can appreciate.

Should I continue Radiesse? Results not noticeable and it's expensive. (Photos)

Answers (1)

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