RADIESSE

Radiesse dermal filler contains microspheres of calcium hydroxylapatite (CaHA), a biocompatible substance also found in bones, suspended in a water-based gel carrier. The body absorbs the gel and metabolizes the CaHA over time. In the meantime, these microspheres act as a scaffold that promotes new collagen formation and dermal remodeling.

Compared to hyaluronic acid-based injectable fillers, the calcium-based microspheres in Radiesse make it “a thicker, firmer material, which should be placed in thick skin or directly over bone for the best results. The cheeks and jawline are ideal for this filler,” says Dr. Tansavatdi.

Pros

• This dermal filler immediately adds volume and improves contours while boosting new collagen and elastin production, to subtly firm skin and improve its elasticity.
• In Radiesse reviews on RealSelf, patients who say it’s “Worth It” saw softer smile lines, more defined cheekbones, or an improved jawline, with natural-looking results. 
• Numerous clinical studies back up the benefits and safety of Radiesse injections. 
• Radiesse Plus contains lidocaine, to help reduce discomfort during and after treatment. 

Cons

• Radiesse side effects can last as long as your filler does. Unlike hyaluronic acid–based fillers like Juvéderm and Restylane, Radiesse can’t be dissolved with hyaluronidase if you don’t like your results or have a complication: the results (good or bad) last for 12 to 18 months, until the gel naturally breaks down.
• While side effects are rare, potential complications include cellulitis, nodules, and necrosis (tissue death) if the filler is accidentally injected into a blood vessel. 
• RealSelf members who say it’s “Not Worth It” reported results that were less noticeable than they expected or experienced side effects.

Related: 5 Reasons Why Radiesse Is Getting So Popular

• Average Cost:
• $1,237

• Range:
• $600 - $3,701

Your total cost will depend on your provider’s credentials and level of experience, their practice location, and the number of syringes needed to achieve the look you want.  

If the price you’re quoted is significantly lower than the average cost, your provider may lack the experience to safely perform your treatment—or the filler may be diluted. Make sure you trust your injector’s skill and know what kind of product you’re getting. 

See our complete guide to Radiesse costs

The Radiesse photos in our gallery have been shared by the provider who performed the procedure, with the patient's consent.

Most treatments take about 20 minutes. Here’s what to expect at your appointment.

• Your provider (ideally a board-certified dermatologist or plastic surgeon, or a highly trained nurse injector on their staff) will start by discussing your goals to determine if Radiesse filler is the best option for you. They should also let you know how many syringes you’ll need and how much your treatment will cost.
• You may want to request topical numbing in the treatment area, to make the injections more comfortable, or opt to receive Radiesse Plus, which contains the numbing medication lidocaine.
• The area will be cleaned, to prevent infection.
• Treatments are usually performed with the patient in a sitting or semi-sitting position, which allows the provider to inject the desired sites while the effects of gravity influence the skin.
• Once you’re comfortable, your provider will inject the filler below the surface of your skin using a thin needle or cannula.
• They will inject one or more syringes of filler, depending on how much volume you want and how many treatment areas are involved.
• Afterward, your provider may massage or manipulate the filler, contouring and adjusting the volume to create an optimal result.

RealSelf Tip: To help reduce bruising, avoid blood thinners like nonsteroidal anti-inflammatory medication, including aspirin and ibuprofen, as well as vitamin E, fish oil, omega-3 fatty acids, and alcohol for a week before your procedure. Using Radiesse Plus, which contains the anesthetic lidocaine, can also help constrict blood vessels and slow blood flow to injection sites, reducing the risk of side effects.

Related: Injectable Bruises? Here’s How to Handle Them Without Hiding Out.

You’ll be able to resume most of your normal activities right after your appointment. Just avoid strenuous exercise, pressure to the treated area, and direct sunlight for 2 to 4 days after your procedure.

You may have some swelling, redness, and bruising at the injection site for a few days. An ice pack can help reduce swelling and redness, and most of the swelling should resolve within a week.

You’ll immediately see more fullness and smoothing of wrinkles and folds, with continued improvements over the coming weeks as your natural collagen and elastin production ramps up.

Radiesse results are not permanent, but they are long-lasting. They typically last 12 to 18 months—longer than some hyaluronic acid-based fillers, but not as long-lasting as other biostimulatory fillers, such as Sculptra or Bellafill.

You’ll need to book annual touch-ups to maintain your results.

Side effects of Radiesse are rare. A three-year study found that “the durability and safety of Radiesse compare favorably with other injectable fillers.” There were also no adverse or delayed-onset events in a follow-up study of 102 people.

Another paper finds that adverse events after this treatment are rare and typically result from technical errors.

However, your provider should alert you to these potential risks.

• About 2% of people develop cellulitis, a bacterial skin infection that’s a risk with any injection, if the skin isn’t properly cleaned with alcohol before injection.
• Lumps under the skin are also possible.
• Allergic reactions are not common, since the formula is biocompatible, but they can happen. Itchiness and/or severe swelling around the injection site merit a trip to your doctor.
• If accidentally injected into a blood vessel, all dermal fillers carry a risk of vascular occlusion that can block blood flow, potentially leading to tissue death. There isn’t yet a tried–and–true protocol for dissolving non-HA fillers like this one, which makes it especially important to choose a well-trained provider with deep knowledge of facial and hand anatomy. Injections from a board-certified dermatologist, plastic surgeon, or another physician are usually safest. Providers who offer various facial rejuvenation treatment options but spend a considerable portion of their week performing injectable cosmetic procedures, using a variety of fillers, will be the most experienced.

Avoid this treatment if you’re pregnant or breastfeeding or have a bleeding disorder.

Juvéderm and Restylane are hyaluronic acid–based (HA) dermal fillers that also restore volume and smooth skin. They have thinner formulas that can treat areas that Radiesse can’t, such as the lips and under-eye area. 

Dr. Reichel likes to mix a very tiny amount of Radiesse in with her favorite hyaluronic acid filler for under-eye treatments. “I call this ‘eyebrite,’ as the Radiesse removes the Tyndall effect (bluish discoloration) sometimes seen with straight hyaluronic acid placed under the eyes.”

Generally, HA fillers are best for plumping superficial to moderate lines and wrinkles, while Radiesse is the better choice to soften deep folds, like smile lines (aka nasolabial folds), the creases that extend from the sides of the nose to the mouth. A clinical trial comparing the results of Radiesse and Restylane found that when injected into nasolabial folds, Radiesse showed better results and longer-lasting improvements over time. It’s also a better choice for hand rejuvenation.

Again, an advantage of HA fillers is that they can be dissolved by hyaluronidase, if you don’t like your results or have a complication.

Sculptra, a poly-L-lactic acid (PLLA) filler, is often injected more deeply into the skin. It can create definition and restore facial volume but, like Radiesse, isn’t recommended for use in the lips or under the eyes. 

Providers are increasingly using Sculptra off-label to lift the butt, smooth the neck, reduce wrinkles on the body, and minimize the appearance of cellulite dimples.

Another advantage to Sculptra: results can last for over two years. 

Sculptra works by stimulating the body’s natural collagen, and it can take two to three months to see a significant increase in volume. Therefore, “Radiesse might be better if you want a more immediate improvement, as Sculptra takes a while to make the body produce more collagen as a response to its insertion,” says New York City dermatologic surgeon Dr. Ronald Shelton. “You would probably need more than one treatment with Sculptra, several weeks apart, but probably only one treatment with Radiesse.” 

Some expert injectors may mix the two products together to achieve even better results.

Botox is not a dermal filler: it’s a neuromodulator that blocks the nerves in the muscle at the injection site. By temporarily relaxing the muscle and keeping it from moving, Botox can soften or smooth wrinkles for up to four months. 

These two injectable treatments can be very complementary.

Haneke, Eckhart. “Managing Complications of Fillers: Rare and Not-So-Rare.” Journal of Cutaneous and Aesthetic Surgery, Oct–Dec. 2015.

Van Loghem, Jani, MD, Yutskovskaya, Yana Alexandrova, MD, Werschler, Wm. Philip, MD. “Calcium Hydroxylapatite.” The Journal of Clinical and Aesthetic Dermatology, Jan. 2015.

Daines, Steven M., MD, Williams III, Edwin F., MD. “Complications Associated with Injectable Soft-Tissue Fillers: A 5-Year Retrospective Review.” JAMA Facial Plastic Surgery, 2013.

Bass, L.S., Smith, S., Busso, M., McClaren, M. “Calcium Hydroxylapatite (Radiesse) for Treatment of Nasolabial Folds: Long-Term Safety and Efficacy Results.” Aesthetic Surgery Journal, March 2010.

Jacovella, Patricio F. “Use of Calcium Hydroxylapatite (Radiesse) for Facial Augmentation).” Clinical Interventions in Aging, March 2008.