Radiesse: State of the Art and Dilute Radiesse

Abstract

Background Radiesse is a calcium hydroxylapatite (CaHA)‐based filler first FDA‐approved in 2006 for the treatment of human immunodeficiency virus‐associated lipodystrophy and moderate to severe facial wrinkles, particularly the nasolabial folds. It has since expanded into new formulations and has been approved for jawline contouring and treatment of dorsal hand volume loss. CaHAs provide the basis of the filler's appeal, inducing biostimulation of stromal components including collagen, elastin, and vasculature. The carboxymethylcellulose gel carrier gives the filler its notoriously stiff volumizing effects, intended for deeper placement, typically in the subdermal and supraperiosteal planes. Since its inception, innovative efforts have been ongoing to take advantage of the filler's biostimulatory effects without its volumization. Objectives To describe novel uses of dilute, hyperdilute, and HA‐mixed CaHA filler. Methods A review was performed on current available literature and consensus guidelines. Conclusions Diluted and hyperdiluted Radiesse allow for widespread treatment, providing patients the dermal rejuvenation they desire, without the firm volumizing effects seen with undiluted product. This has led to an explosion in off‐label use including treatment of skin laxity of the face, neck and decolletage, arms, abdomen, buttocks, and thighs. Clinicians have also begun combining the CaHA filler with hyaluronic acid‐based fillers to induce skin regeneration while providing a more flexible and softer volume replacement. Radiesse' uses continue to evolve with alterations in the original formula, allowing for increasingly customized product to meet each patient's individual needs.