A Second Act: The Art of Dilute Radiesse for Facial Rejuvenation
Today marks the second chapter in a patient's journey, continuing a story we began last week. In that session, we addressed her temples. Now, we turn our focus to the face itself, employing a technique that is both an art and a science: the use of dilute Radiesse. There is a crucial distinction in this world between "dilute" and "hyper-dilute." Anything greater than a one-to-one ratio of diluent to Radiesse is considered hyper-dilute. In this case, we are using a precise one-to-one ratio, which is dilute Radiesse. For those tackling textural concerns like acne scarring, a hyper-dilute concentration, such as one-to-two or one-to-three, becomes the tool of choice. But for volume restoration of the cheeks, mid-face, and jawline, this one-to-one formulation is our focus today. We'll be treating the right side of her face here, and if you stay with us until the very end, you will see the complete, uncut treatment of the other side as well.
The patient has been prepped with hibiclens and alcohol to ensure a clean field. For this dilute Radiesse, every syringe of Radiesse Plus—which already contains lidocaine for comfort—is paired with 1.5 cc's of saline as the diluent. In total, we are using two syringes of Radiesse for the face, meaning we blend three cc's of saline with the product. The material is mixed as recommended, and then we begin the application. The goal of dilute Radiesse is not to inject a bolus of volume, but to distribute the product evenly across the treatment area. This is achieved through a fanning technique using a cannula, entering and exiting with gentle, retrograde motions. You enter at a single point, then fan the material out as you withdraw, ensuring a smooth, even spread. This is the foundation of a successful treatment.
This patient is quite young, yet she has a metabolism that consumes volume. She "eats through" traditional fillers every couple of months. The decision to try hyper-dilute Radiesse was driven by a desire to restore more than just temporary volume. The biostimulatory power of Radiesse is meant to coax her own body into producing more collagen and elastin, offering a longer-lasting solution. Instead of constantly replacing volume, we are hoping to stimulate her own tissues to fill in the areas where she has lost fullness in the cheeks, mid-face, and jawline. The goal is a refreshed appearance, and we are hopeful the volume will return from within.
It is important to understand the philosophy behind dilution. When the primary goal is volume restoration, a one-to-one ratio is ideal because it still retains some volumizing effect while providing biostimulation. If the goal shifts to addressing textural concerns like acne scarring, fine lines, or the skin's overall appearance, you would increase the diluent, moving to a one-to-two or even one-to-three ratio, such as we do for the neck. The plane of injection here is immediately subdermal. Once you find that plane, the cannula glides in and out quite easily, allowing you to fan the product across the area. If you pop out of the plane, it can be harder to re-enter, but a quick revisit with the pilot needle solves that, and you continue.
We have created two entry points for this treatment: one for the lower face and one for the upper face. The goal is to achieve global improvement across the entire face. We are entering along the zygoma (the cheekbone) and fanning the dilute Radiesse into that zone. As we do this, the aim is to stimulate a robust collagen response, initiating neocollagenesis. The procedure is quite comfortable for the patient, thanks to the lidocaine already in the Radiesse and the additional lidocaine used to numb the entry points. Occasionally, a patient may feel a pinching sensation as the cannula passes through ligaments or pseudo ligaments, but overall, it is a very well-tolerated treatment. All injections are performed strictly in a retrograde fashion—only on the way out of the tissue.
This technique is a fantastic option for a wide range of patients: those who have lost volume, those with textural concerns like acne scarring, and those seeking improvement in fine lines and wrinkles. The beauty of aesthetic medicine is that every patient requires a unique plan, because our anatomy, goals, and deficits are all different. Hyper-dilute and dilute Radiesse offer a wonderful flexibility to create a tailored treatment plan that best addresses the individual's concerns. For this patient, the need is for collagen stimulation throughout her entire face, both upper and lower. Despite her youth, she has lost a fair amount of volume, and we hope to restore it and slow the signs of aging over time.
After the fanning is complete, we will give her a gentle massage to ensure the product is nicely integrated. Unlike some other biostimulatory products, this patient is not required to perform any massage after treatment—a significant advantage for patient compliance. We will see her back in four to six weeks for her third and final treatment. And now, as promised, we will continue the story by watching the complete treatment of the other side of her face. Stay tuned.