Radiesse is a novel cosmetic dermal filler prepared with microspheres of calcium hydroxylapatite in a water-based gel carrier. Unlike traditional hyaluronic acid-based fillers, Radiesse has a dual mode of action: it acts to immediately restore volume while simultaneously stimulating endogenous collagen production for longer-lasting structural improvement. Radiesse is especially useful for deep wrinkles, loss of facial volume, and skin laxity, hence finding a place in the armamentarium of aesthetic practitioners.
What is Radiesse?
Due to the peculiarity of its action, Radiesse is considered a biostimulatory filler. Its active ingredient, calcium hydroxylapatite, is biocompatible and biodegradable; moreover, it is naturally present in human bone and teeth. Each microsphere has a diameter of approximately 25-45 microns, thus ensuring excellent integration within tissues for a long time.
Unlike purely volumizing fillers, Radiesse acts on two levels:
- Immediate Volumization: The immediate volumetric effect is due to the gel matrix that corrects deep wrinkles and folds immediately after injection.
- Collagen Stimulation: In time, the CaHA microspheres will act as a scaffold for fibroblasts, thus initiating neocollagenesis, leading to the production of Type I and Type III collagen, which improves skin elasticity and thickness.
This dual action of Radiesse sets it apart from other fillers and makes it ideal for patients who want to see immediate and long-lasting effects. According to studies published in the Dermatologic Surgery Journal, Radiesse can maintain aesthetic results for 18–24 months, which is well beyond many hyaluronic acid-based fillers.
How It Works
Immediate Effect
Upon injection, the gel carrier in Radiesse has a physical plumping effect, filling in creases and restoring volume to sunken areas. The immediate correction it provides is especially helpful for patients desiring correction of the nasolabial folds, marionette lines, and midface hollowing. For example, treatment of the nasolabial folds requires 1–2 mL of product per side, depending on the extent of volume loss.
Collagen Biostimulation
The more long-term aspects of Radiesse depend on its action of causing an increase in the body’s natural collagen production. While the body gradually metabolizes the gel carrier, the CaHA microspheres remain in their position to promote fibroblast activity. Over a 12-week period, these fibroblasts lay down a thick matrix of collagen fibers responsible for structural support of the dermis. Clinical trials have recorded an increase in dermal thickness as high as 30% over a period of 3 months.
Optimal Injection Depth and Technique
For optimal effectiveness, Radiesse must be placed at an optimal depth either in the dermis or subdermis. Linear threading, bolus injection, and retrograde fanning are some of the techniques employed to distribute the material evenly and avoid nodularity. Ultrasonography studies have shown that improper techniques lead to irregular results, and therefore, the practitioner’s skill level is crucial.
Areas of Treatment
Facial Contouring
Radiesse works best where there is profound volume loss or structural deficits. Based on its sculpting and contouring, it is particularly well-suited for the following indications:
- Midface Rejuvenation: Radiesse rejuvenates the malar and submalar regions, restoring volume and creating a youthful lift. A typical midface treatment requires 2–3 mL of product.
- Jawline Definition: The filler enhances mandibular contouring, improving the appearance of a weak or undefined jawline. About 1–2 mL per side can be enough to produce a noticeable result.
- Chin Augmentation: Radiesse can simulate the result of surgical implants by improving the projection of the chin and remodeling the lower face.
Wrinkle Reduction
Radiesse proves to be particularly effective for the softening of static lines, such as the nasolabial folds and the marionette lines. In clinical evaluations, 40–50% improvement in wrinkle severity could be observed within 2 weeks of treatment.
Hand Rejuvenation
Radiesse is currently the only FDA-approved filler for hand augmentation. It works by adding volume to the dorsal hands, thereby masking some of the veins and tendons, which are some of the most noticeable signs of aging. Hand treatments generally require 1.5–3 mL per hand.
Radiesse Advantages
Long-Term Effects
While hyaluronic acid fillers are short-acting, their effect usually lasts about 6–12 months, the biological activity of Radiesse produces longer-lasting results. Its effectiveness in producing collagen will sustain the cosmetic effect even when the material has already been metabolized. The Journal of Cosmetic Dermatology states that 75% of patients showed continued improvement at 18 months.
Increased Collagen Production
Radiesse enhances the production of Type I collagen for tensile strength and Type III collagen for skin elasticity. Indeed, histological tests have demonstrated an increase in 25% collagen density 12 weeks after injection, which, in simple terms, is a firm and resilient skin.
Tissue Integration
The unique composition of CaHA microspheres allows for smooth integration with surrounding tissues, minimizing the risk of migration, besides providing a natural look and feel. Comparative studies have demonstrated that Radiesse is superior in yielding smooth, even results over other fillers in areas of the cheeks and jawline.
Procedure Steps
Pre-Treatment Consultation
A proper consultation is invariably required for individualizing the treatment. The practitioner will assess skin laxity, wrinkle severity, and volume loss. For example, a patient with advanced facial aging may require the combination of Radiesse with other modalities, such as botulinum toxin or PDO threads.
Injection Process
The process of injection is quite simple and takes 30–60 minutes. The key steps include:
- Administration of Anesthesia: Topical anesthetic cream is applied to minimize discomfort. Radiesse is often blended with lidocaine to enhance comfort for the patient.
- Precise Placement: Material placement is done in layers using a fine-gauge needle or cannula for appropriate distribution.
- Massage and Shaping: Light massage post-injection to the treated area smoothens the product to the desired contour.
After Treatment
Patients are instructed to avoid strenuous activities, alcohol, and excessive sun exposure for 24–48 hours. Mild swelling and bruising are common but resolve in a few days. Clinical follow-ups are at 2 weeks to assess the outcomes and any concerns.
Expected Results
There is an immediate improvement in facial volume and wrinkle reduction, although the full enhancement may take 2–3 months as collagen ramps up. For example:
- Nasolabial Folds: 45–55% reduction in wrinkle severity within 2 weeks.
- Cheek Volume: An immediate volumetric increase of 15–20% post-treatment, further improving over 3 months.
- Skin Firmness: A 25–30% increase in skin elasticity measurable after 12 weeks.
More than 1,000 patients have been studied, showing a 90% satisfaction rate at 6 months and 85% retention of aesthetic results at 18 months.
Safety & Side Effects
Although Radiesse is a relatively safe drug, proper injection techniques are strictly advised to avoid complications. Common side effects include the following:
- Localized Reactions: such as redness, swelling, or bruising usually resolve on their own in 7–10 days.
- Nodules or lumps: Improper placement could result in a few palpable lumps that may necessitate correction.
Serious complications, including vascular occlusion, are very rare but do highlight the requirement for a competent practitioner. Advanced imaging modalities, including Doppler ultrasound, are being used more and more to further enhance the safety of injections.
