What Is Radiesse
Radiesse is a biostimulatory injectable filler based on calcium hydroxylapatite (CaHA), a biocompatible synthetic mineral naturally present in human bones and teeth. Unlike temporary fillers that merely add volume, Radiesse offers a dual action: immediate volumetric correction and progressive stimulation of natural collagen production.
The product consists of 30% CaHA microspheres (25–45 microns in diameter) suspended in a 70% aqueous carboxymethylcellulose gel. After injection, the carrier gel gradually dissipates, while the microspheres form a scaffold that stimulates fibroblasts to produce new collagen.
Radiesse has been FDA-approved since 2006 for the correction of moderate to severe facial wrinkles and folds, as well as for HIV-associated lipoatrophy. More than 5 million syringes have been distributed worldwide without significant safety concerns.
Mechanism of Action of Radiesse
Radiesse works through direct interaction between CaHA microspheres and dermal fibroblasts—a process known as mechanotransduction.
Immediate phase
The gel provides an immediate 1:1 volumetric correction, visible at the end of the treatment session.
Fibroblast activation
The microspheres come into direct contact with fibroblasts and activate their mechanoreceptors. This mechanical stimulus triggers the production of collagen and other extracellular matrix components. Studies show that this activation begins within 72 hours.
Progressive neocollagenesis
Activated fibroblasts produce type I collagen (thick, mature) and type III collagen (thin, newly formed). Histological studies demonstrate a significant increase in type III collagen following treatment.
Elastin production
Animal studies show increased elastin expression starting from week 4, with a higher density of elastic fibers compared to control groups.
Angiogenesis
Tissue stimulation also promotes the formation of new blood vessels, improving nutrient delivery to the tissue.
This regenerative mechanism differs from that of poly-L-lactic acid (PLLA), which requires an inflammatory response. CaHA directly activates fibroblasts without significant immune activation.
Biodegradation
The microspheres are gradually broken down through phagocytosis and passive dissolution over a period of 12 to 18 months. The released calcium is naturally metabolized by the body.
Ideal Candidates for Radiesse
Radiesse is suitable for individuals seeking facial volume restoration and improved skin quality with long-lasting but non-permanent results.
You may be a good candidate if you:
- Have moderate to severe volume loss (cheeks, temples, nasolabial folds)
- Want both immediate volume and long-term improvement
- Seek results lasting 12 to 18 months (sometimes up to 24 months)
- Have normal to thick skin
- Understand that optimal results require deep injection
Radiesse may not be suitable if you:
- Are allergic to CaHA or any product components
- Have active skin infections in the treatment area
- Are pregnant or breastfeeding
- Have bleeding disorders or are taking anticoagulants
- Seek lip or periorbital treatment (safety not established)
Treatment Areas With Radiesse
Face — deep areas:
- Nasolabial folds
- Marionette lines
- Cheeks and cheekbones
- Hollow temples
- Chin
- Jawline
- Pre-jowl area
Body:
- Backs of the hands
- Décolletage (when diluted)
- Buttocks (non-surgical augmentation with hyperdilution)
Areas to avoid:
- Lips (risk of nodules)
- Periorbital area (safety not established)
- Very superficial areas or very thin skin (risk of visibility or nodules)
How a Radiesse Session Works
Preparation:
Radiesse is supplied ready to use in syringes of 0.3, 0.8, 1.3, or 3 mL. Since 2009, Radiesse+ with 0.3% lidocaine has been available to improve patient comfort.
For certain applications (hands, décolletage, neck), the product may be diluted (1:1) or hyperdiluted (>1:1) for broader tissue dispersion.
Before treatment:
A topical anesthetic cream may be applied 30–45 minutes beforehand. Aspirin and NSAIDs should be avoided for 7 days prior to treatment.
During the session:
Radiesse is injected deeply into the dermis or subcutaneous layer using a fine needle (25–27G) or a cannula. Small aliquots are placed and gently massaged for even distribution.
Duration: 15 to 45 minutes, depending on the treated area.
Sensations:
Thanks to lidocaine, discomfort is minimal (average pain score 1.9/5). Patients typically report pressure or mild stinging.
Number of Sessions Required
Most patients achieve satisfactory results with a single session. A minor touch-up may be performed after 2–4 weeks if needed.
Initial treatment: 1–2 syringes (1.3 mL) for nasolabial folds; more for extensive volume loss.
Touch-up: 0.5–1 additional syringe if required.
Maintenance: every 12–18 months. Results may last up to 24 months in some cases.
Radiesse Results: A Realistic Timeline
Immediately:
The gel provides instant volume (approximately 70% of the initial effect).
Days 1–7:
Swelling and mild bruising may occur. The carrier gel begins to dissipate.
Weeks 2–4:
Swelling resolves completely. CaHA maintains volume. Collagen production begins.
Months 1–3:
Neocollagenesis becomes visible. Studies show increased collagen production from week 4 onward.
Months 4–9:
Peak results. Improved skin texture and firmness.
Months 12–18:
Average duration of effect. Results gradually diminish after 12 months, sometimes persisting up to 24 months.
Patient Satisfaction With Radiesse
Clinical studies show high satisfaction rates:
- 87–90% report good to excellent results
- 85% satisfied in prospective studies
- Average score at 3–6 months: 4.16/5
- Average score at 12 months: 4.15/5
Most appreciated benefits:
- Immediate volume correction
- Longer duration compared to HA fillers
- Progressive improvement in skin quality
- Favorable safety profile
Side Effects and Complications
Common:
- Bruising (≈5%)
- Redness (very common; temporary)
- Swelling (2–7 days)
- Tenderness
- Minor hematomas
Less common:
- Nodules (most reported; ~3%)
- Asymmetry or contour irregularities
- Persistent redness or inflammation (1–2%)
- Overcorrection (1%)
Rare:
- Granulomas (very rare)
- Infection
- Vascular occlusion (extremely rare with proper technique)
- Excessive immune reactions
Nodule management:
- Level 0: observation
- Level 1: massage
- Level 2: saline injection + massage
- Level 3: sodium thiosulfate
- Level 4: corticosteroids (triamcinolone)
- Level 5: ablation or surgical removal
Radiopacity:
CaHA is visible on CT scans and X-rays. Patients should inform healthcare providers. Studies show Radiesse does not interfere with diagnostic interpretation.
Radiesse vs Other Injectables
Versus hyaluronic acid (HA):
- HA: temporary (6–12 months), reversible with hyaluronidase
- Radiesse: 12–18 months, non-reversible, biostimulatory
Versus poly-L-lactic acid (PLLA / Sculptra):
- PLLA: requires reconstitution, deep injection, massage, delayed results
- Radiesse: immediate and progressive effect, simpler technique
Unique Advantages of Radiesse
- Dual mechanism: volume + collagen stimulation
- Ready to use, no reconstitution
- High viscosity with strong lifting capacity
- Proven safety (20+ years of use)
- Suitable for all Fitzpatrick skin types
- Biocompatible and biodegradable
How to Optimize Results
- Choose an experienced practitioner with anatomical expertise
- Avoid high-risk areas (lips, periorbital region)
- Massage as instructed after treatment
- Use daily SPF 50
- Avoid heat for 24 hours (sauna, intense exercise)
- Maintain good hydration
- Be patient—collagen formation takes months
Combining Radiesse With Other Treatments
- Fractional radiofrequency (RF)
- Botulinum toxin
- Hyaluronic acid (superficial areas, lips)
- Microfocused ultrasound
Same-day combination treatments are considered safe according to studies.
Choosing the Right Practitioner for Radiesse
Safety depends directly on practitioner expertise. Errors such as superficial injection or improper technique are the main causes of complications.
A qualified practitioner:
- Has extensive experience with Radiesse
- Understands facial anatomy and injection planes
- Injects deeply (subcutaneous or deep dermal)
- Uses correct technique and volumes
- Discusses risks and realistic expectations
- Provides appropriate follow-up care
Complications are rarely product-related and are usually technique-related.
Price of Radiesse in Belgium
Prices vary depending on the practitioner, area treated, and required volume.
Per syringe:
- 0.8 mL: €350–€450
- 1.3 mL: €450–€600
- 3 mL: €900–€1,200
Typical treatments:
- Nasolabial folds: €450–€900 (1–2 syringes)
- Cheeks/temples: €900–€1,500 (2–3 syringes)
- Hands (both): €800–€1,200 (2 syringes)
- Jawline: €900–€1,500 (2–3 syringes)
These are aesthetic treatments and are not reimbursed.
Conclusion
Radiesse offers a unique combination of immediate volume correction and long-term collagen stimulation. Its effectiveness, safety profile, and versatility explain its long-standing popularity among practitioners and patients.
Success depends on three key factors:
- An experienced practitioner
- Realistic expectations
- Proper aftercare
When used correctly, Radiesse delivers reliable results with high patient satisfaction.
