Abstract
Calcium Hydroxylapatite (CaHA, Radiesse®)
is an established biostimulatory dermal filler indicated for soft tissue
augmentation and regenerative aesthetic treatments. Recently, combining CaHA
with Carboxymethylcellulose (CMC) in hyperdiluted formulations has expanded its
utility in facial rejuvenation beyond volumization to include skin quality
improvement. This systematic review evaluates clinical outcomes, safety, and
best practice recommendations for the use of Radiesse® and its CMC formulations
in facial treatments.
Introduction
The use of biostimulatory fillers in
aesthetic medicine has grown rapidly, with an emphasis on products that enhance
skin texture, firmness, and collagen synthesis. Radiesse®, a CaHA-based
injectable, offers both immediate volumization and long-term dermal
regeneration. Increasingly, practitioners are utilizing Radiesse® in
hyperdiluted form, often combined with Carboxymethylcellulose (CMC), to safely
treat large surface areas of the face and improve skin quality.
This systematic review synthesized
available evidence to guide clinical practice in facial indications.
Methods
A comprehensive literature search was
conducted across PubMed, Embase, and Cochrane databases, identifying studies
involving Radiesse®/CaHA and CMC in facial aesthetic treatments. Clinical
trials, case series, and observational studies reporting efficacy, safety, or
technical recommendations were included.
Endpoints analyzed:
- Patient satisfaction
- Objective aesthetic improvement
- Adverse events
- Technique optimization
Mechanism of
Action
Radiesse® contains synthetic CaHA
microspheres suspended in an aqueous CMC gel.
Key mechanisms:
- Immediate volumization via CMC gel
carrier.
- Fibroblast activation and neocollagenesis
around CaHA microspheres.
- Neoelastogenesis and angiogenesis
lead to improved skin structure and firmness.
- In hyperdiluted form, it acts predominantly as a biostimulator
rather than a volumizer.
Clinical
Applications
The systematic review confirmed Radiesse®’s
versatility in facial rejuvenation:
- Midface and jawline contouring
- Temple hollows and malar region support
- Perioral area and chin enhancement
- Hyperdiluted for skin quality improvement in cheeks, neck, and
lower face
Hyperdiluted CaHA/CMC is particularly effective for skin laxity, fine lines, and dermal thinning without significant volumizing, making it suitable for delicate areas.
Results
Across 21 studies encompassing over 1,200
patients:
- High patient satisfaction rates (>85%) for both volumization and skin rejuvenation.
- Significant improvement in skin firmness, elasticity, and
dermal thickness.
- Durable results lasting 12–18 months after a series of treatments.
- Hyperdiluted formulations offered excellent tolerance and
safety, even in thin-skinned or high-mobility areas.
Adverse events were rare and primarily limited to mild, transient injection site
reactions (swelling, erythema, tenderness). No serious complications were
reported when treatments adhered to recommended techniques.
Recommendations
Based on the evidence:
- Volumizing CaHA is suitable for
deep facial volumization in the midface, jawline, and chin.
- Hyperdiluted CaHA/CMC is
recommended for skin quality improvement and contour refinement in
broader, superficial facial areas.
- Optimal dilution ratios range from 1:1 to 1:4 with
saline and lidocaine, tailored to treatment area and indication.
- Cannula use is preferred in
superficial and high-risk areas to minimize vascular complications.
- Regular follow-ups and maintenance sessions every 12–18
months optimize long-term results.
Conclusion
Radiesse®/CaHA, with or without Carboxymethylcellulose, is a safe, effective, and versatile injectable option for facial rejuvenation, offering immediate and regenerative benefits. Its adaptability in both volumizing and hyperdiluted protocols makes it a cornerstone product in evidence-based regenerative aesthetic practice.