Radiesse is a collagen stimulator containing calcium hydroxylapatite (CaHA). I use this product not for shaping but for skin quality and tissue firmness. This differs from the product’s classical use, and I explain why on this page.
For the general framework of biostimulator treatments, see the liquid facelift page.
How does Radiesse work?
The active substance in Radiesse is calcium hydroxylapatite, a mineral also found in bone tissue. The product consists of microspheres suspended in a gel carrier.
Once placed beneath the skin, the microspheres form a scaffold and stimulate fibroblast cells in the surrounding tissue to begin producing new collagen 1. The gel carrier is gradually absorbed; the microspheres break down into calcium and phosphate ions and are eliminated by the body. What remains is the collagen network the tissue has produced itself.
The collagen response becomes noticeable at around week four and reaches its most visible point at month three. The effect lasts on average 12–18 months.
Diluted (hyperdilute) application
At its standard concentration Radiesse is a volumising product. When the carrier gel is diluted the product behaves differently: the volumising effect recedes, the microspheres spread across a wider area, and the product becomes a stimulator targeting skin firmness and tissue quality.
This technique is described in international expert consensus guidelines 12. I use Radiesse predominantly in this way.
The degree of dilution is decided at consultation according to the intended effect and the area; there is no standard formula.
Where do I prefer it?
- Neck — thinning skin, horizontal lines and loss of firmness
- Décolleté — tissue thinning and lines related to sun damage
- Back of the hands — thinning skin and a need for tissue support
- Facial surface quality — general dullness, pore appearance, uneven texture
- Inner arms and above the knees — skin laxity
Choosing for facial surface quality. For dullness, uneven tone and pore appearance an HA-based mesotherapy may also be on the table; a product from that class is covered on the Paris glow (NCTF 135 HA) page.
On facial surface quality the decision depends on the goal: if hydration, glow and uneven tone dominate, HA-based NCTF 135 HA mesotherapy comes forward; if loss of firmness accompanies the surface problem, diluted CaHA comes forward. They do not replace each other and are planned in sequence when needed. The final choice is made at the consultation.
Choosing for the neck and décolleté. Diluted CaHA is not the first option for every patient here; depending on the type of problem, HA-based skin mesotherapy may come forward instead.
On the neck and décolletage the decision depends on the type of problem: if horizontal lines and loss of surface quality dominate, HA-based mesotherapy comes forward; if diffuse thinning and loss of firmness dominate, diluted CaHA comes forward; vertical muscle bands are a separate matter and are assessed with botulinum toxin. The final choice is made at the consultation.
The full decision logic for this area is on the neck and décolletage rejuvenation page.
Choosing for the backs of the hands. Here the deciding factor is the degree of volume loss.
On the back of the hand the decision depends on the degree of volume loss: if visible veins and tendons dominate, diluted CaHA or HA filler comes forward; if dryness and thinning dominate without volume loss, HA-based mesotherapy comes forward. The final choice is made at the consultation.
The detail is on the hand rejuvenation page.
Do I use it for the jawline?
No.
Radiesse can be used to create volume and contour along the jawline. I do not use it for that purpose.
The reason is safety: CaHA cannot be dissolved with hyaluronidase. In areas requiring millimetric symmetry such as the jawline, cheekbones and chin, we do not have the flexibility a reversible product offers if a correction becomes necessary. In these areas I use hyaluronic acid fillers — see the dermal fillers page.
Using pure CaHA for facial shaping is technically possible, but for the same reason it is not a first-line choice.
Surface quality and scarring: where PDLLA comes in
Diluted Radiesse can be used on skin with dullness and uneven surface texture. In this indication a choice has to be made between it and Juvelook.
The decision is made according to the depth of the scarring and the size of the affected area: where there are a limited number of distinct scars, PDLLA comes forward; where loss of surface quality and firmness across a wider area is the main issue, diluted CaHA comes forward. The final choice is made during consultation.
How the treatment is performed
During consultation I assess skin thickness, the degree of laxity and what the tissue in that area needs.
Topical anaesthetic cream is standard. Because I am an anaesthesiologist, I treat pain management as a separate part of the procedure.
I place the product with a cannula in the subdermal layer. The choice of layer is particularly decisive with this product: placed too superficially, CaHA can produce visible firmness in the skin. For this reason the product stays at the correct depth even when the target is superficial tissue.
The treatment takes around 20–30 minutes. You can return to daily life the same day.
Sessions: I perform a single session. I assess the tissue response at week 12, and we decide together at that appointment whether a second session is needed. Waiting for this period matters — planning a second session before the result of the first has matured makes accurate assessment difficult.
Duration: On average 12–18 months.
Aftercare
First 24 hours
- No make-up on the treated area
- No hot showers, sauna, hammam or steam
- Avoid heavy exercise
- No alcohol
- Do not sleep face-down (facial treatments)
First 48 hours
- Avoid direct and prolonged sun exposure
- No facial massage, skincare treatments or energy-based device treatments
First week
- Avoid intensive lower-body training after body treatments
Expected findings Mild swelling, tenderness or bruising lasting a few days is expected. Part of the fullness seen in the first days is due to swelling and the product’s carrier and settles quickly; this does not mean the effect has worn off.
Radiesse does not require a mandatory massage protocol.
Safety and anatomy
The most common findings are temporary swelling, bruising and tenderness.
Palpable firmness under the skin is uncommon and is largely related to the depth of placement. Placing the product in the correct layer is the main factor that reduces this possibility.
Radiesse cannot be dissolved with hyaluronidase. For this reason the treatment plan, the dilution decision and the choice of layer are the most decisive parts of the procedure. Distance from vascular structures and the correct anatomical plane are what determine the safety of the treatment.
Because allergic reactions can occur rarely, treatments are carried out under medical supervision.
Product and regulatory status: Radiesse has been assessed under FDA, CE and TİTCK frameworks for its relevant indications. Approval belongs to the product and to a specific indication, not to a technique or to a physician. I work with products from this class that offer traceability and a certificate of analysis.
Who is not suitable
Treatment is not performed, or is postponed, in the following situations:
- Active infection or inflammation in the treatment area
- Autoimmune disease in an active phase
- Pregnancy and breastfeeding
- Known hypersensitivity to the product components
- Uncontrolled chronic illness
- Untreated bleeding disorder or unregulated anticoagulant use
Without being a medical contraindication, I also consider expectation and treatment to be mismatched in these situations:
- People expecting an immediate change after treatment
- People whose actual need is volume and contour
- People with advanced tissue laxity who require surgical assessment
I am not comfortable with excessive treatment requests. If I believe the expectation does not match what the treatment can deliver, I say so, and I do not recommend a procedure I do not consider necessary. Suitability is determined by consultation in every case.
Pricing
Under the applicable regulations, price information cannot be published on our website. The cost of a treatment depends on the product used, the technique chosen and the extent of the treatment. You can call the clinic for detailed information.
Planning your visit
My clinic is in Nişantaşı, Şişli, on the European side of Istanbul, approximately 45 minutes from Istanbul Airport.
For a Radiesse treatment I suggest planning a stay of two to three days: arrival, consultation and treatment, and departure. Flying is generally appropriate 24 hours after an injectable treatment.
Because the assessment for a possible second session takes place at week 12, we plan that appointment according to your travel schedule. Consultations are conducted in English, and follow-up after you return home is arranged remotely.
Frequently asked questions
What is hyperdilute Radiesse?
It is the application of Radiesse with its carrier gel diluted. When diluted, the product’s volumising effect recedes, the microspheres spread across a wider area, and the product behaves as a stimulator targeting skin firmness and tissue quality. This technique is described in international expert consensus guidelines. The degree of dilution is decided at consultation according to the intended effect and the area; there is no standard formula.
Do you use Radiesse for the jawline?
No. Radiesse can be used to create contour along the jawline, but I do not use it for that purpose. The reason is safety: CaHA cannot be dissolved with an enzyme, and in areas requiring millimetric symmetry our flexibility is limited if a correction becomes necessary. In these areas I use hyaluronic acid fillers.
How is the decision about a second Radiesse session made?
A single session is performed and the tissue response is assessed at week 12. The need for a second session is decided together at that appointment. This period matters: planning a second session before the result of the first has matured makes accurate assessment difficult.
Is Radiesse suitable for the neck and décolleté?
Yes. The areas where I most often use diluted Radiesse are the neck, décolleté and the backs of the hands. Because the skin is thin in these areas the depth of placement is particularly important; the product is placed so that it remains in the subdermal layer.
Dr. Ömer Fatih Şahin — Specialist in Anaesthesiology and Reanimation Diploma Registration No: 113606
Last updated: 2026-09-22 This content has been medically reviewed by Dr. Ömer Fatih Şahin.
References
- Goldie K, Peeters W, Alghoul M, et al. Global Consensus Guidelines for the Injection of Diluted and Hyperdiluted Calcium Hydroxylapatite for Skin Tightening. Dermatol Surg. 2018;44(Suppl 1):S32–S41. https://pubmed.ncbi.nlm.nih.gov/30358631/
- de Almeida AT, Figueredo V, da Cunha ALG, et al. Consensus Recommendations for the Use of Hyperdiluted Calcium Hydroxyapatite (Radiesse) as a Face and Body Biostimulatory Agent. Plast Reconstr Surg Glob Open. 2019;7(3):e2160. https://pubmed.ncbi.nlm.nih.gov/31044123/ — Some of the authors disclosed consulting and speaker relationships with the manufacturer; the work is manufacturer-linked.