Radiesse: calcium hydroxylapatite for volume and collagen stimulation

This page covers one product from the family of collagen stimulators (biostimulators). The general page explains the differences between the materials; here we detail what is known about Radiesse itself.

What is Radiesse, and how does it work?

Radiesse is an injectable made of tiny microspheres of calcium hydroxylapatite in a carrier gel. The gel provides immediate volume and is absorbed over the following months, and the microspheres serve as a "scaffold" around which the skin produces new collagen¹. That is why it is considered both a filler and a collagen stimulator. There are two versions: standard, and with a local anesthetic (lidocaine)².

Which areas is it approved for?

The US FDA first approved Radiesse in 2006 and has expanded its indications over the years²:

Other uses, for example highly diluted injection to tighten the skin of the neck, arms or abdomen, are off-label⁸⁹.

What did the controlled trials show?

• Nasolabial fold: In a trial of 205 patients, Radiesse was compared with three hyaluronic acid fillers. After 8 months, more folds were improved in the Radiesse group, and a smaller amount of material was needed³.
• Back of the hand: In a controlled trial with an untreated group, 75% of patients improved by at least one grade after 3 months, and the improvement was generally maintained for up to 12 months. No effect on hand function was found⁵.
• Jawline: In a controlled trial, 93 of the 123 injected patients (about three quarters) improved by at least one grade after 12 weeks, a significantly higher rate than in the control group, which had not yet been treated⁴.

Please note: The back-of-the-hand and jawline trials are the trials on which the approvals for these indications were based, and their follow-up lasted about a year. A 2024 systematic review concludes that the evidence supports use in the cheeks, the jawline and the nasolabial fold, but that there are still no controlled trials of diluted injection¹.

How long does it last?

According to the American Academy of Dermatology, calcium hydroxylapatite usually lasts six months to a year, and it also provides immediate filling¹⁰. A systematic review described an effect of 12 to 18 months¹¹. How long the effect lasts depends on the area, the amount and each person's body.

What about diluted use to stimulate collagen?

Diluted injection of Radiesse, aimed at stimulating collagen and tightening the skin rather than filling volume, has become common, but it rests mainly on consensus recommendations. The international consensus itself defines it as a new off-label use⁸. Two systematic reviews from 2024, in the face and the body, state that this use is not yet supported by controlled trials¹⁹. One exception is the décolletage, where the 1:2 dilution was approved in the United States in 2026². How it is done in practice, in which areas and what to expect, on the diluted Radiesse page.

And for acne scars?

Yes, Radiesse is also used in the skin, for broad, depressed acne scars, mainly in combination with laser. In a randomized trial with 160 patients, adding Radiesse to CO2 laser improved the result compared with laser alone¹². In narrow, deep scars the response is weaker¹³. Use for scars is outside the registered indication. Details of the studies and suitability by scar type: Radiesse for acne scars.

What are the risks?

The common effects are swelling, bruising, redness and tenderness in the area, which usually resolve within days⁶. Things that are important to know:

• It cannot be dissolved with an enzyme, unlike hyaluronic acid¹¹.
• Injection into the lips and the lining of the mouth is not approved, and may cause lumps⁶.
• Vascular occlusion is a rare complication of all fillers, and a case of necrosis with calcium hydroxylapatite has also been reported¹¹.
• In thin or dark skin, injecting too superficially increases the risk of side effects⁸.
• The material is visible on CT, and not always on X-ray. In a study it did not obscure other structures and did not look like a pathological finding, but it is worth mentioning it before an imaging test¹⁴.

Who is it not suitable for?

According to the FDA, the safety of fillers is unknown in pregnancy, during breastfeeding and under age 22. Active inflammation or infection in the area is a reason to postpone. Bleeding disorders, severe allergies or an allergy to local anesthetics should be mentioned before the treatment¹⁵. Do not stop an anticoagulant medication on your own.

What is its registration status in Israel?

Radiesse is listed in the Israeli Ministry of Health's medical device registry (AMAR) under two entries: "Radiesse filler" (registration 21220014, valid until February 28, 2030) and "Radiesse filler with lidocaine" (registration 21220013, valid until January 31, 2030). The manufacturer is Merz North America, the registration holder is Alphamedix Ltd., and the registered indication is "filler, aesthetics", for use by a physician in a clinic⁷. The entry does not specify areas, so diluted use or use in areas not studied in trials is off-label.

What are the alternatives?

When the goal is immediate volume that can be corrected, hyaluronic acid is the natural alternative. When the goal is gradual improvement in skin quality, there are other collagen stimulators, such as poly-L-lactic acid, described on the general page. For skin laxity, another option is absorbable threads.

How is it done at Dr. Dana's clinic?

At the clinic of Dr. Dana Buchbut, a physician with 16 years of experience in aesthetic and hair medicine, Radiesse is one of four collagen stimulators available. It is chosen after a personal examination, according to the area and the goal, with an understanding of the advantages of each material. The versatility of Radiesse, from immediate filling to long-term collagen stimulation, allows it to be integrated into a personalized treatment plan. Dr. Dana keeps up with new technologies and research in the field, and continues to follow the treatment after the injection.

Terms on this page: Biostimulator · Hyaluronic acid · Diluted Radiesse · Vascular occlusion · Sculptra (PLLA) · Absorbable threads · Full glossary

The information on this page is general and for education only. It does not replace an examination, diagnosis or personal medical advice. A decision about treatment is made only after an examination.