Radiesse, jawline to décolleté.

The trials: "Four centers enrolled 117 subjects with moderate to deep nasolabial folds. Subjects received CaHA on one side of the face and human collagen on the other … Seventy-nine percent of subjects had superior improvement on the CaHA side through 6 months … significantly less volume and fewer injections were needed for CaHA" (Smith 2007); "Sixty patients were enrolled at two medical clinics in Europe … At 12 months, 79% of CaHA folds were still improved or better versus 43% of NASHA folds … Blinded evaluators and patients preferred CaHA two to one" (Moers-Carpi 2008); 205 randomised patients, Radiesse against Juvéderm 24, Juvéderm 24HV and Perlane, "more effective and longer lasting than each HA in maintaining NLF augmentation" (Moers-Carpi 2007). The follow-up: "There were no long-term or delayed-onset adverse events in these 102 patients followed for three years, including no reports of nodules, granulomata, or infections" (Bass 2010). The newer product: 188 completers, investigator-rated improvement 84.04% against 78.72% for Restylane at 24 weeks (Pan 2025). The pooled safety: no difference from hyaluronic acid in haematomas or nodules across the randomised fold trials (Shi 2016).

Graded strong, as the nasolabial-fold guide grades it: three randomised comparisons, blinded evaluation, a year of controlled follow-up and three of safety. The older trials were run by the then manufacturer and the comparator collagen no longer exists, but the hyaluronic-acid head-to-heads are the comparison a patient actually faces, and Radiesse won them on duration. What it loses on is reversibility — the fold guide's reason for sending first-timers to hyaluronic acid still holds.

The trials: "This multicenter, controlled, single-blind study … included 114 subjects randomized 3:1 to CaHA treatment and untreated control groups … A total of 75% of subjects achieved ≥1-point improvement on the MHGS (p < .0001) at 3 months (primary end point); this response was generally maintained through 12 months. Proportions of subjects reporting improvement ranged from 98% (3 months) to 86% (12 months). There were no clinically significant differences between control and CaHA-treated subjects in any hand function measure" (Goldman 2018); "At Week 4, all Treatment group subjects (20/20) achieved a ≥1-point improvement on the MHGS compared with 0/10 (0%) of the Control group" (Bertucci 2015). The longer view: ten women followed a year, 80% of hands improved at nine months and 30–40% at twelve (Sadick 2011); 58 women treated one to four times over up to five years, 94.8% a grade better after the first session (Bartoletti 2024). The technique: diluted product improved collagen density, elasticity and ultrasound measures whether placed subdermally or in the deep fat lamina in a side-to-side comparison of 15 women (Figueredo 2020); the cannula runs in the dorsal intermediate lamina, lifted clear of the veins by pinching the skin (Kim 2021); 1.3 mL with 0.5 mL of lidocaine a hand was the original recipe (Edelson 2009). Imaging: "CaHA was seen to be present in 100% of hands in Month 1 X-rays and in 83.3% in Month 24 X-rays, but no bone obscuration was reported in any X-rays at any evaluated time point" (Moradi 2023).

Graded strong, as the hands guide grades it: two controlled trials with blinded grading, twelve months of follow-up and a regulatory indication. The biostimulator guide grades the hand moderate because the later randomised trials compared blends with each other rather than with nothing; on a page about this product, the pivotal trial is the one that counts. The hands guide covers the spots, the crepe and the sunscreen that the filler does nothing for.

The trial: "Healthy eligible patients with moderate or severe ratings on the Merz Jawline Assessment Scale (MJAS) were randomized 2:1 to treatment with CaHA (+) or to control. Patients in the control group remained untreated until week 12 … Treatment response rate (≥1-point MJAS improvement) was 93/123 (75.6%) for the treatment group and 5/57 (8.8%) for the control/delayed-treatment group at week 12 … A total of 76/113 (67.3%) patients who responded to treatment 12 weeks after initial injection also demonstrated persistent improvement 48 weeks after initial treatment" (Moradi 2021). The long-term report: "MJAS responder rates were 77.9%, 78.7%, and 62.9% at 12, 24, and 48 weeks post-treatment, respectively. Responder rate on the MJAS at 60 weeks was 74.6% for those who received retreatment and 43.5% for those patients who received only the initial and touchup treatments" (Green 2024). The consensus that preceded it sets out technique and volumes by stage of "oval loss" (Dallara 2014); a six-point supraperiosteal technique in 16 Asian women measured brow and tragus-to-mouth changes at 24 weeks (Wu 2025); the premixed Radiesse–hyaluronic blend took a clinician-rated jawline score from 2.12 to 0.68 at three months and 1.27 at twelve in 41 women (Fakih-Gomez 2022).

Graded moderate, as the jowls guide grades it: one randomised, evaluator-blinded pivotal trial and its own extension, against no treatment, by the manufacturer. It is a good trial and a regulator accepted it; one trial is still one trial. The jowls guide's point stands — this draws a straighter line under a jowl by filling in front of and behind it, and the tightening guide and the facelift are where a heavy jowl goes.

The trial: "Subjects (N = 116) were randomized to an immediate treatment group or to an untreated control group (crossed over at 3 months). Patients received CaHA injections in their cheeks, defined as the malar, submalar, zygoma, preauricular, and infraorbital areas … Mean total treatment volume (107 patients) was 4.7 mL of CaHA. At all points, physicians reported satisfaction of 75% or more, with 92% satisfaction at 12 months. Most patients also reported being satisfied at all time points, with 80% satisfied at 12 months. No serious adverse events occurred" (Moers-Carpi 2012). Practice: in 800 Italian patients the zygomatic and malar areas were the most treated sites, 86.7% by cannula (Muti 2015). Persistence: no product on MRI at 2.5 years, "but tissue volume remained increased, indicating a collagen-stimulating effect" — one patient (Pavicic 2015). The review of non-hyaluronic midface fillers: seven studies, "due to the gradual volumizing effects of PMMA, PLLA, and CaHA, patient satisfaction generally improved over time" (Trinh 2021). The hybrid's post-marketing study reports a midface responder rate of 82.8% at one month, "remaining high through Month 12", open-label in 140 people (Gritti 2025).

Graded moderate, as the volume-loss guide grades it: one randomised trial whose headline outcome is satisfaction, plus consistent practice data. The cheek trial's treatment area included the "infraorbital" cheek; current practice keeps this product on the bone and away from the thin skin under the eye, for the reasons in the last row of this chart.

The study: "This 18-month, prospective, open-label, multicenter clinical trial … enrolled 100 subjects (94 men and six women) … One hundred percent of assessable patients were rated as improved or better on the scale at every time point through 12 months; 91 percent were improved or better at 18 months. 'Yes' responses to all patient satisfaction questions ranged from 97 percent to 100 percent … skin thickness measurements at 12 months remained statistically better than those at baseline" (Silvers 2006). The series: 26 people, product mixed with local anaesthetic and adrenaline, "a stable result … in all the cases at the end of follow-up (3 months)" (Rauso 2013). Imaging in this population and in fold patients: visible on CT, inconsistently on X-ray, "no obscuration of underlying structures … and no evidence of CaHA migration" (Carruthers 2008). The ranking: "poly-L-lactic acid is the only filler agent with grade of recommendation: B. Other reviewed filler agents received grade of recommendation: C or D … calcium hydroxylapatite, with a Food and Drug Administration indication of subdermal implantation, may be best used deeply over bone for focal enhancement" (Jagdeo 2015).

Graded moderate: a regulatory indication resting on one large open-label study with near-universal improvement and no control group. The Sculptra guide grades the same indication strong for poly-L-lactic acid, which has the randomised trials; the two products are complementary here rather than rivals.

The controlled trial: "Eligible females were randomized to immediate or delayed treatment. Patients assigned to immediate treatment received up to three diluted Radiesse sessions … Patients assigned to delayed treatment remained untreated through Week 24 (primary endpoint) … Effectiveness was assessed by blinded evaluators … The Week 24 estimated responder rate (≥1-point improvement on the MAS Décolleté Wrinkles - At Rest) was 71.2% [95% CI: 61.4%, 79.4%] among treated patients compared with 6.3% [95% CI: 1.5%, 22.9%] among untreated controls … No interference attributable to diluted Radiesse was observed on post-treatment breast imaging" (Fabi 2026). The schedule study: up to three injection cycles "either 8 weeks apart (3 injection cycles) or 16 weeks apart (2 injection cycles) … Sixteen weeks after the last treatment, the response rate … was 73.5%" (Pavicic 2024). The biology: in 20 people with lax neck and chest skin, diluted product raised collagen I and III, elastin and vessel counts on biopsy at four and seven months, with cutometer and ultrasound gains (Yutskovskaya 2017). With microfocused ultrasound first, chest wrinkle scores fell from 2.6 to 1.1 at 90 days in a retrospective series (Casabona 2018). The approval: "treatment of wrinkles in the décolleté area in patients 22 years of age and older" (Merz 2026).

Graded moderate, as the décolletage guide and the biostimulator guide grade it: one randomised trial against no treatment and one randomised comparison of schedules, both the manufacturer's, a year of follow-up. It is the best-evidenced injectable for the chest and the only diluted use on any label. The breast-imaging finding matters: a radio-opaque product in the chest of a woman of mammography age was a reasonable worry, and the trial looked.

The evidence: "Treatment of marionette lines, chin, pre-jowl, and corner of the mouth also tends to respond with a high degree of efficacy" (Guida 2024); 22 patients given two sessions of 1:3 hyperdiluted product, "a significant improvement in cheek volume … and significant reductions in jowl volume, nasolabial fold depth, and marionette line depth" at day 150 on 3D imaging (Durairaj 2025b); ten women with a hyperactive mentalis and chin retrusion, "all subjects demonstrated at least a one-point improvement in ACPS … at both the one-month and six-month posttreatment visits" with toxin plus pre-periosteal Radiesse (+) (Barbarino 2024); 609 early patients treated in "the nasolabial folds, marionette lines, oral commissure, cheeks, chin, lips, and radial lip lines", 89% of respondents willing to repeat at six months (Jansen 2006); a split-face randomised study in which diluted product with or without ultrasound took marionette scores from 2.47 to 1.8 at fifteen months in 20 people (Yutskovskaya 2020). The caution: of the nodules in the safety review, "49% occurred in 'dynamic' areas" (Kadouch 2017).

Graded emerging, as the marionette guide grades it: the class has randomised fold trials, this use has series. The chin and pre-jowl, where the product sits on bone under quiet tissue, are anatomically the safer half of this row; the corner of the mouth is the half where the nodules were.

The study: "The study enrolled 10 subjects aged 32-68 years old. Physician GAIS scores of subject appearance at 1 month were rated as 'very much improved' in 80% and 'much improved' in 20% of subjects. Temple hollows were graded as 1 after treatment in 90% of subjects … estimates for subjects' perceived age were on average 4 years younger than their actual age" (Barbarino 2021). The consensus split: "CaHA should be placed in the interfascial layer for temple contouring" was among the statements the Pan-Asian panel could not agree on (Corduff 2021). The risk: visual loss after biostimulators includes temple injections (Young 2026), the temple was the site in 9% of 198 filler blindness cases (Foster 2025), and the expert consensus on Radiesse vascular events begins with "a thorough knowledge of facial vascular anatomy" (van Loghem 2020).

Graded emerging: a ten-patient open study. The volume-loss guide calls calcium hydroxylapatite "too firm for the temple and orbit" as a general rule and sends the temple to hyaluronic acid or, for diffuse hollowing, to poly-L-lactic acid, which now has a 174-person randomised trial there (the Sculptra guide).

The evidence: 50 patients of varying ages, "effective in improving skin thickness, laxity, and wrinkles in 95% of 30-40 year-olds, 80% of 40-60 year-olds, and 70% of >60 year-olds" by the author's assessment (Massidda 2023); 22 patients, 1:3, two sessions, significant 3D changes at day 150 (Durairaj 2025b); 36 participants in a single-session deep-plus-diluted technique with photographs at 90 days (Amaral 2024); a panfacial case series from a teaching course (Green 2025) and a layered-dilution protocol paper (Gladstein 2025); twelve women randomised to ultrasound-then-Radiesse or the reverse, the first order producing "a 143% relative increase in elastin coverage, compared with a 63% increase" (Doyle 2025); twenty people in a randomised split-face comparison with ultrasound, marionette, jawline and neck scores each about a third of a grade better at fifteen months (Yutskovskaya 2020). The reviews: "no randomized controlled trials have been published" (Guida 2024); the combined ultrasound-plus-Radiesse literature is "11 studies, mainly pre-post studies" (Amiri 2025); the consensus guidelines call themselves "preliminary guidelines for the novel off-label use" (Goldie 2018).

Graded emerging, as the sagging-skin guide, the collagen-loss guide and the biostimulator guide grade it: the biology is real on biopsy, the clinical evidence is uncontrolled, and the effect sizes where they are measured are fractions of a grade. "Tightening" here means a somewhat thicker, firmer dermis over months. The tightening guide grades the devices it is usually sold alongside.

The study: "A quasi-experimental longitudinal trial (before and after) was performed by enrolling 22 adult women with mild and moderate neck aging … two sessions of subdermal hyperdiluted CaHA (D0 and D45) … At D120, scores decreased in 86% (95% CI 68-99%) of the participants by at least one degree on the necklines scale and in 82% (95% CI 73-90%) for neck laxity … The mean dermal thickness increased by 15% (95% CI 8-21%) at D120. No severe adverse effects were recorded" (Trindade de Almeida 2023). The combination series: 47 subjects, "mean neckline score improved from 2.6 (moderate-to-severe lines) at baseline to 1.3 (mild lines) 90 days after treatment" with ultrasound then 1:1 diluted product (Casabona 2018). The biopsies: collagen I, III and elastin up at four and seven months in 20 people treated in the neck and décolletage (Yutskovskaya 2017). The guidance: "in thinner and darker skin, too-superficial injections of less diluted CaHA can lead to more adverse events" (Goldie 2018).

Graded emerging, as the neck guide grades it: open-label series and consensus, no controlled trial. It is a grade above poly-L-lactic acid on the neck, which that guide and the Sculptra guide grade limited because of nodules in the thin anterior skin; hyperdilution is what makes the difference, and it is also why the result is modest.

The series: "30 subjects … received injections with Radiesse (1.5 mL/arm) at two separate visits, 1 month apart … All (100%) of both subjects and evaluators were 'satisfied' or 'very satisfied' with treatment" (Amselem 2016); "Cutometry results for upper arm skin showed an increase in skin elasticity from 72 U at baseline to 82 U at Month 3 … Diluted CaHA resulted in an overall increase in dermal thickness of 26.7%" in the abdomen (Lapatina 2017); six women's arm-skin hydration up 12.2% on corneometry after one 1:4 session (Palo 2024); knees, "a significant reduction of KCSS at T1 … mainly in subjects with lower KCSS at T0", with swelling, bruising and "skin irregularities" lasting two to three weeks (Guida 2020). The split-body study: "the treated thigh and knee experienced significant improvement in qualitative clinician scales (p<0.01) … no significant changes were noted by quantitative measures. Adverse events were reported in 68 percent of patients, including mild bruising (n=12) and swelling (n=10)" (Juhász 2023). The review: hyperdilutions "on the neck, feet, arms, thighs, abdomen, and other body parts" are in "wide use with a good safety profile" and "have yet to be supported by randomized controlled trials" (Galadari 2024).

Graded emerging, as the upper-arms guide grades it. The split-body result is the honest summary of the field: a clinician looking at a photograph sees an improvement that the measuring instruments do not. The body-contouring guide and the arm lift are where loose skin with real excess goes.

The studies: "Subjects underwent three treatment sessions, receiving a total of 12 syringes of 1:1 diluted CaHA administered using a cannula-based subcision technique … Twenty-four subjects completed the study … a mean reduction of 54.0% in the number of visible dimples and 50.09% in dimple depth compared to baseline. The mean CSS score decreased by 4.29 points, representing a 43.92% improvement" (Durairaj 2024); "Twenty women (18-55 years old) with skin laxity and moderate-to-severe cellulite … MFU-V was applied … and immediately followed by subdermal CaHA injection (1 ml/buttock or thigh) … a 4.5-point improvement in mean overall score" (Casabona 2017); 61 women randomised to sequences of tissue-stabilised guided subcision, ultrasound and Radiesse, "the combination of three treatment modalities was shown to provide greater improvement in skin laxity … and skin dimpling … as compared to any combination of two modalities" (Bartsch 2020); seven individualised "buttocks beautification" cases (Teodoro 2023), ten women given Radiesse, toxin and hyaluronic acid in one session (Di Sessa 2025) and four severe-laxity cases with added ultrasound (Casabona 2022).

Graded emerging, as the cellulite guide grades the combination: open studies with large numerical improvements, a cannula doing subcision at the same time, and no arm that received the subcision or the ultrasound without the product. The cellulite guide grades shockwave and the subcision devices, which have their own controlled trials, a tier higher.

The series: "Subjects presented with red (n = 25) or white (n = 10) striae … CaHA filler was diluted 1:1 with lidocaine 2% … immediately followed by microneedling and topical application of 20% ascorbic acid … The mean (±SD) pretreatment Manchester Scar Scale scores were 12.0 (±0.8), decreasing to 7.1 (±1.4)" (Casabona 2017b); ten women, "the mean overall SDA score was 11.6 at baseline … 7.9 (P = 0.005) at 3 months, and 6.2 (P = 0.005) at 6 months" (Lim 2021); eight women, "mean MSS scores improved significantly from 14 ± 0.93 at baseline to 6.88 ± 1.64" (Saleh 2026). The review: "a total of 184 female participants" across seven filler studies of different materials and methods (Alsharif 2023).

Graded emerging: uncontrolled, small, and confounded by the microneedling, ultrasound or radiofrequency given with it. The Sculptra guide has the one randomised stretch-mark trial in this class, and it is ten women an arm.

The evidence: "Saucerized acne scars responded to treatment; ice-pick scars did not. Results lasted, at least to some degree, for 12 months" (Goldberg 2006); "A prospective, single-center, randomized controlled study was conducted on 160 participants … Group A received two sessions of CaHA (1-month interval) after AFL 1 month, while Group B received AFL monotherapy … scores decreased significantly in both groups (p < 0.001), with greater reduction observed in group A … comparable efficacy for boxcar and rolling scars … both of which showed superiority to icepick scars" (Chen 2026); 352 patients, "the combination of a diluted CaHA-based filler injection followed by FACL in separate treatment sessions yielded better aesthetic improvement compared with the other tested treatments" (Koren 2019); twenty women, both Radiesse alone and with ultrasound "safe and effective" at six months (Antonino 2021); ten patients given ultrasound then diluted product, scar severity improved at day 90 (Casabona 2018b).

Graded emerging, as the Sculptra guide grades poly-L-lactic acid for the same use: one sizeable randomised trial as an add-on to a laser that already works, single-centre and recent, and small studies around it. The resurfacing guide and the microneedling guide grade the devices themselves strong for scars.

The series: "This case series describes 4 patients on GLP1RAs who, despite rapid weight loss, maintained facial volume following treatment with hypderilute CaHA-CMC in the lower face … They lost an average of 24.3 ± 10.4 lb, equivalent to -9.2 ± 4.8% of baseline body weight, yet objective facial metrics remained stable or improved. Average cheek volume increased 9.8%, jowl volume declined 55.8%, nasolabial-fold depth decreased 46.2%, and marionette-line depth decreased 20.6%" — "Level of Evidence: 4" (Durairaj 2025).

Graded limited: four patients, retrospective, from authors who teach the technique. The Sculptra guide grades poly-L-lactic acid emerging for the same problem on a 41-person open-label study, and the volume-loss guide grades the combined stimulator-and-hyaluronic protocol emerging; both make the point that the face should be at the weight it will keep first.

The lips: "The only side effect observed was the development of easily treated nodules, reported by 42 of 338 of lip mucosa augmentation subjects (12.4 percent) and six of 163 of subjects (3.7 percent) who had treatment for radial lip lines. The proportion of subjects with lip nodules decreased to 8.8 percent when the implant volume was decreased" (Jansen 2006); "Seven patients had persistent visible mucosal lip nodules, 4 of whom required intervention" (Tzikas 2004); "Injection of CaHA into the oral mucosa and the lips is an unapproved indication and may result in nodule formation" (Pavicic 2013); in 13 women, granulomatous nodules appeared inside the mouth "distant from the site of injections, suggestive of filler migration" (Shahrabi-Farahani 2014). The vessels: "CaHA has at least 11 published cases of vascular occlusion causing visual impairment, most involving the nasal dorsum" (Young 2026); a healthy 48-year-old left with no light perception after a glabellar injection (Oh 2019); a 51-year-old blinded after injection of "the glabella and dorsum of the nose" who recovered light perception only (Vu 2018); orbital inflammation and restricted eye movement after a facial injection (Dagi Glass 2017); a zoster-like eruption after glabellar Radiesse (Sires 2008). The studies that tried: 24 women followed a year after nasal augmentation, volume 0.94 mL at twelve months and responders falling from 79% to 58% (Wang 2026); 40 women whose tear troughs improved a class with hyaluronic acid or Radiesse, lasting 10.1 and 12.8 months (Wollina 2014); 106 adults given a hyaluronic-acid blend with diluted product around the eye (Spada 2025).

Graded limited: series exist, the harm is documented, and nothing reverses it. The lips guide, the eye-bags guide and the dark-circles guide grade what does belong in those places, and every one of them is a product with an antidote.

The claim's source: "effective in improving skin thickness, laxity, and wrinkles in 95% of 30-40 year-olds, 80% of 40-60 year-olds, and 70% of >60 year-olds" — a single author's uncontrolled case series (Massidda 2023). What the biology studies enrolled: women "aged 35-45" for postauricular biopsies (Yutskovskaya 2014), "subjects with skin laxity in the neck and décolletage" (Yutskovskaya 2017), "photodamaged skin" (González 2019). What the reviews say about the whole hyperdilute field: no randomised controlled trials (Guida 2024).

Graded limited, as the 30s guide and the collagen-loss guide grade early biostimulators: no evidence, a plausible story, and an irreversible product.