Wendy Lee, M.D.
Radiesse is a semi-permanent dermal volumizer approved for subcutaneous use in patients with oromaxillofacial defects, and in radiological and vocal cord procedures. It has recently become popular for use in cosmetic non-surgical enhancements of the face and will soon be FDA approved for this indication.
Radiesse is made from 25-45um calcium hydroxyapatite spheres reconstituted in an aqueous gel. The product is packaged in an over-filled 1mL syringe and has a consistency similar to the other available dermal fillers. It is also available in a 0.3 mL syringe which is good for touch up treatments. It injects very easily and creates immediate results. After injection, as the water is absorbed by the body, new collagen synthesis is stimulated around the hydroxyapatite spheres to create a long lasting effect, reportedly one to two years.
Radiesse is intended for injection into the subcutaneous tissues (deeper than most products). If injected too superficially, extrusion of the material is possible. The company has thousands of treated patients included in their treatment trials, none of which suffered from serious complications.
The actual injection seems to cause more pain than traditional fillers as the material actually splits the tissue planes. To avoid this downside, an anesthetic block can be given through the gums or directly over the infraorbital nerve, depending on the area to be treated. Not all patients will require a block. It is dependent on pain threshold. As the aqueous gel carrier is resorbed, patients may notice a slight decrease in the fill volume. As new collagen is synthesized, the volume increases once again. Initially the material can be palpated beneath the skin. With time as the body produces its own collagen, the areas treated soften and feel very natural. Small touch ups may be required one month after the initial injection. Thereafter, retreatments should only be necessary every one to two years and may not require the amount of product that was originally used.
In comparison to other dermal fillers, Radiesse injects very smoothly. It does require a larger needle (25g) given the size of the particles in the product. The increased size of the needle may add slightly to patient discomfort, but the needle does not clog.
Radiesse has produced great results as a volume replacement product in the nasolabial folds, marionette lines and oral commissures. It also works well for cheek and chin augmentation and to decrease the appearance of jowls by filling in along the jaw line. It can be used to fill in areas on the nose to decrease the appearance of ‘humps’. It is not recommended for injection in the lips because it may create lumps. The cost to the physician is between $200 - $300 per 1mL syringe and the cost to the patient runs between $800 and $1000 per 1mL syringe.
