Marionette [Nasolabial Fold Eraser] Radiesse Skin Booster Complete Guide.

I’ll first show you the before and after photos of the Radiesse treatment.

Before the procedure: April 3, 2023 – After the procedure: January 11, 2024

These photos were posted with consent and are original, unedited photos of the same person taken in the same location.

The effects of each procedure may vary, so please have a thorough consultation before the procedure regarding possible side effects (pigmentation, bruising, swelling, etc.).

If you’re interested in the German “wrinkle eraser,” Radiesse, please read this post carefully.

For areas where filler or Juvederm Voluma can be used, we customize the treatment according to your desired direction and design.

For example:

• Sunken under-eyes due to volume loss in the cheeks
• Deepening nasolabial folds
• Hollowing of the side cheeks as baby fat diminishes
• Shadowed, peanut-shaped contours

Both filler and Juvederm Voluma are excellent methods to improve these areas.

However, even I, who personally love and use these treatments, have never recommended filler or Juvederm Voluma for one particular area—the area around the mouth.

The reason is that the skin around the mouth is very thin and highly mobile.

If you use filler or Juvederm Voluma here, the marionette lines and frown lines can become exaggerated, creating an unnatural look.

For this reason, many dermatology clinics, including mine, have traditionally relied on skin Botox or skin boosters to improve fine wrinkles around the mouth.

Before and after Botox around the mouth

Of course, Botox for mouth wrinkles is a very effective treatment.

However, Botox literally reduces muscle movement or the movement of wrinkles, and it doesn’t fully address wrinkles that result from thinning of the skin itself.

Additionally, there are so many muscles around our mouth that move constantly…

If you receive Botox around the mouth, your muscle strength may weaken, making it very uncomfortable to speak, eat, or drink.

Until now, since this was the only method for treating wrinkles around the mouth, people had no choice but to endure the temporary discomfort and receive skin Botox around the lips.

Meanwhile, the product I had been truly waiting for has finally, finally been released.

So, what kind of product is Radiesse?

Radiesse was developed by MERZ, a German company also known to us for Ultherapy and Xeomin.

It is composed of 30% CaHA (Calcium Hydroxylapatite) and 70% CMC (Carboxymethylcellulose).

Each box of Radiesse contains 1 syringe, and each syringe holds 1.5 cc.

The particle size is approximately 25–45 μm, 50 μm, while Juvederm is 50 μm and Juvederm Voluma is around 80 μm. Considering this, the particles of Radiesse are relatively small.

So far, the global usage has reached 150 million units.

After FDA approval in 2006 and CE certification in Europe, it has been used for a long time.

Of course, I can’t only speak positively. Radiesse has had its share of painful failures.

About 10–15 years ago in Korea, Radiesse was known as a calcium filler, used undiluted in its original form, which could result in hard, lumpy areas that could only be removed surgically. Because of this, calcium fillers were feared and not very popular at the time.

However, in the U.S. and Europe, the same product had been used safely for years.

Even Sculptra, now widely known as a collagen booster, had its early issues 20 years ago. Back then, 5 cc was diluted in the vial, and reports of nodules and lumps emerged. Over the past 10–20 years, the dilution has been adjusted to 8–9 cc, greatly reducing the incidence of nodules.

Back when it was diluted to 5–6 cc, the complication rate was not 50%, but around 1–5%. With the current 8–9 cc dilution, it’s about 0.1%, or even lower when performed by an experienced practitioner.

If the hydration, storage, and procedure are properly managed, and the treatment is suitable for you, then even if you usually dislike fillers, Radiesse is worth considering.

Returning to Radiesse, recent techniques involve proper dilution, spreading it evenly, reducing lumps, and enhancing results while minimizing side effects. Over 20 years, the procedure has evolved significantly.

I was truly delighted to see Radiesse return as a skin booster.

Around the mouth

Back of the hand

In fact, Radiesse is even approved for treating back-of-hand wrinkles.

In Europe, where Radiesse is widely used, it is often described as:
“Erasing wrinkle, fold” — in other words, a wrinkle eraser.

There is a published study photo showing the skin surface of a wrinkle treated with Radiesse, which I’ll share with you:

Wrinkled surface vs. surface after Radiesse treatment

Clin Cosmet Investig Dermatol. 2019; 12: 771–784.

Even in the study, unlike fillers that plump up the concave base of fine surface wrinkles, Radiesse improves wrinkles in a way that is flat, tight, and smooth rather than raised.

And for those who have been waiting for Radiesse, as soon as it arrives, I immediately use it to treat:

• Nasolabial folds (smile lines)
• Back-of-hand wrinkles
• Neck wrinkles

Case 108
Radiesse: 2 syringes
Before the procedure vs. Immediately after the procedure

Immediately after the procedure

Of course, on this day, a skin booster treatment was also performed, so there are injection marks and redness on the cheeks and jaw.

Even with this level of swelling, bruising, and marks immediately after the procedure, you can return to daily activities right away.

For Radiesse, the number of sessions depends on the severity of the wrinkles, the area being treated, and the amount used, but generally 2–3 sessions are recommended at 1–3 month intervals.

In summary, Radiesse is suitable for:

1. Wrinkle areas where a slightly raised effect would look natural
   • Nasolabial folds (smile lines), glabellar lines (frown lines), around the mouth, neck wrinkles, and back-of-hand wrinkles.

Or,

2. If you want to improve wrinkles with a flatter, smooth, and closely-adhering line

Radiesse will work for you.

Filler, Juvederm Voluma, and now Radiesse…?!

For nasolabial folds (smile lines), there were previously two main options: filler and Juvederm Voluma. Now, there’s a new option called Radiesse.

Which one is best?

Well, all three have very distinct advantages and characteristics.

In the end, the best approach is to use all three appropriately and to consult at a clinic that specializes in these treatments before making a decision.

Filler and Juvederm Voluma, you need to be on your toes—I’m confident that Radiesse will become a new dark horse in this area.

Thank you!