What is Radiesse?

RADIESSE (also known as liquid lifting) is, without doubt, one of the most renowned and utilized injections since its launch in 2004. During its 10 years of existence, around 4 million vials have been used all over the world guaranteeing its efficiency and safety. RADIESSE is the first filler with a calcium hydroxyapatite base, which allows the correction of wrinkles, volume deficiencies and contours. It is produced by MerzAesthetics, a German firm internationally renowned in the “top three” of aesthetic medicine on a global scale.

Why is it called liquid lifting?

Its success lies within its safety and efficiency. The calcium hydroxyapatite is a material which is completely inert which constitutes to the inorganic mould of our bones. Upon the skin, the crystals of calcium hydroxyapatite, measuring only 20 microns, are reabsorbed being substituted by collagen fibers in a way that, when placed in vectors (see below), over time, create a tridimensional collagen structure which stretches and supports the face. This is what some authors have called liquid lifting.  We can also place them deeper, just above and in contact with the bone, naturally allowing the increase in volume in the cheeks or chin area for example.

[alert_green] This is the great versatility and capacity of RADIESSE which has converted it into an indispensable injection within our daily medical practice in IMCF [/alert_green]

How and where does it work?

Cutaneous ageing and Radiesse:  vectorization; the face does not age evenly. We can distinguish between fixed areas and mobile areas:

  •  Fixed areas or zones (F1 y F3)

Zonas Fijas Radiesse

Fixed zones

These work as anchor points for the skin, the fat and the muscles. In these areas, the anatomical structures are permanently in their position and over time contribute to conserving the identity of the person.

  • Mobile areas or zones (M2)

Zonas móviles Radiesse

Mobile zones

Between the fixed areas of the face, we can find mobile areas which are less likely to support the effects of gravity.

  • • The susceptibility to movement is greater in the middle areas of the face (central zone) where the compartments of facial fat are located and little by little they start to detach and separate making room for the appearance of folds, lines and the loss of volume and contours.

Compartimentos grasos de la cara Radiesse

Fatty compartments of the face


  • Other ageing factors include flaccidity and laxity in the facial ligaments

Facial ligaments are structures of fibrous tissue which anchor and set in anatomical levels. They support the facial “mask” to the underlying skeleton. With ageing, these ligaments lose tension and elasticity which contributes to the signs of ageing. The principal facial ligaments are:

Ligamentos faciales Radiesse

Facial ligaments


1.- Orbitomalar ligament: its loss of function contributes to the appearance of the festoon malar bags.

Festones malares Radiesse

Festoon malar bags

2.- Zygomatic ligaments: their loss of restraint contributes to the appearance of nasogenian folds.

3.-  Cutaneous- masseteric ligaments. These ligaments go from the skin to the masseteric muscle, which is principle for chewing. The loss of function in this ligament makes way for a drooping in the oral corner and the appearance of marionette lines.

4.- Mental ligaments: are those responsible for the appearance of “jowls”: drooping of the cheeks which blur the contours of the jaw.




What is a vector?

In physics, a vector is a type of geometric representation to represent a physical magnitude defined by a point in the space where the magnitude is measured, as well as a module (or length), its direction (or orientation) and its sense.

Within facial ageing, the changes that occur in the face can be seen represented by “negative vectors of ageing” because the direction is negative (descendant and inward) These negative vectors of ageing have, as we have seen, an anatomical base making them predictable and common in all individuals.

A direction which is descendant and inward gives way to drooping and the loss of volume in facial contours.

Within global facial ageing, we mention tridimensional (3D) negative vectors with drooping:


–          Lateral

–          Vertical and

–          Deep: loss of volume

The technique of vectorization with Radiesse allows the correction of these negative vectors in an opposite direction, creating positive vectors and achieving to compensate the effects of gravity and the flaccidity of the facial ligaments, repositioning the fat compartments and the facial mask producing a lateral and vertical lifting but also proportioning a 3D correction through the repositioning of the lost volume. By contrast, the surgical lifting (unless complemented with lipofilling techniques) only achieves the correction of the vertical and lateral drooping. (2D)


Vectorización 2D y 3D

Vectorization 2D y 3D

The correction of these negative vectors with Radiesse can be done with needle or catheter technique.

Needle technique:  

a) subdermal injection in the vector technique. b) Supraperiosteal injection (above the bone) to enhance volume: cheeks and chin.

Niveles de Inyección

Levels of injection

–          The face is “mapped” or marked (see below) to determine the points for the deep injection (volume enhancer) and the areas to be treat: festoons, jowls…

–          We choose the anchor points in fixed areas F1 and F3. These anchor points should be superior and lateral to the zones that are to be treated. We stretch the skin from the chosen anchor point to make sure that we are acting upon the treating area.

–          Where the patient presents the most lateral (just before the ear) flaccidity or drooping, is where the first anchor point should be.

–          Once the superior anchor point has been selected, we select another inferior or medial closer to the treating area to obtain a better result.

*Correction of nasogenian folds
** Correction of marionette lines
*** Correction of “jowls”

Vectorización con aguja

Vectorization with needle

–          The injection of Radiesse is carried out at the level of the deep dermis which stimulates the synthesis of neo collagen in a way that the hydroxyapatite is reabsorbed. This produces a retraction and a lifting effect in the treating area with objective results which are both immediate and in the medium term (12-18 months).


Catheter technique 

Vectorización con cánula

Vectorization with catheter

–          Technically the use of catheters requires more ability from the technician. The advantage that comes from the use of catheters is that only two opening orifices are made on the skin through which the catheter is redirected to trace the marked vectors.


Summary of the benefits of the liquid lifting or Radiesse:


  • The Radiesse, injection with a base of calcium hydroxyapatite, a safe, effective and versatile product
  • Deeply injected, above the bone, allowing a natural enhancement in volume when compared with other injections (hyaluronic) which are injected more superficially.
  • Injected in the skin through the vector technique, allows a global facial treatment against flaccidity and drooping.
  • • A lesser quantity of Radiesse is required when compared to other fillers such as hyaluronic acid obtaining comparative results when compared in the same indication.