Radiesse is an excellent filler with a very low risk of side effects if used appropriately and injected carefully. It is made of tiny microspheres of hydroxylapatite, 30%, in a gel carrier, 70%. As the gel is absorbed the body produces collagen that contributes to the volumizing effect, making it quite long lasting.
Its best use is for deep nasolabial folds, corners of the mouth and in the cheeks. Because the material is white, it can appear through the skin as a whitish nodule if injected too close to the skin. In the lips, it can clump up and come to the surface of the lip as a white nodule. For this reason I do not use it in the lips or in very thin tissue where it may be visible, such as near the lower eyelids.
I like to use a limited amount, 1-2 cc per session, and gradually build up the cheeks or correct the folds. This way the entire duration of the filler is extended and one can get better idea of how much is needed and achieve the optimal contour gradually. If too much is used at once, the swelling appears obvious, and I like patients to leave the office without anyone telling that a procedure has been done.
Bruising is a possible side effect of any facial injection. I now use the "Magic Needle" or hollow blunt cannula that greatly lowers the incidence of bruising.