MD Radiesse BBL Evaluating Buttocks Beautification with Calcium Hydroxylapatite Fillers

Shapely buttocks have been a subject of interest for millennia. It is among the many indicators of beauty and attractiveness, representing beauty and allure across cultures. The year 2022 alone has witnessed a staggering 28,638 BBL (Brazilian Butt Lift) procedures, confirming increasing demand for procedures that improve the appearance of the buttocks and thighs. 

These procedures can include surgical implants, fat grafting, and biostimulatory fillers like calcium hydroxyapatite (CaHA). The buttocks and thighs suffer common complaints such as lipohypertrophy, lipohypotrophy, cellulite-induced skin irregularities, and gluteal sagging. While surgical procedures have been the primary option in the past, minimally invasive techniques like RADIESSE® BBL are becoming more popular due to their quick recovery time, natural-looking results, and positive patient experiences. As a result, healthcare providers are exploring innovative techniques and alternatives to meet patient demands for a more aesthetically pleasing gluteal appearance.

Key Takeaways

This article will help explore the beneficial effects of the RADIESSE® butt lift and its role in stimulating collagen and improving skin laxity. Other key takeaways include: 

  • Effectiveness of Radiess BBL in gluteal augmentation.
  • Mechanism of action of hyperdilute RADIESSE® BBL (HDR CaHA).
  • Pre-treatment and post-treatment considerations.
  • Appropriate case selection with specific assessments. 
  • Injection technique with region-specific concerns.
  • Adverse events.
  • Long-term effects. 

Mechanism of Action 

Simply put, CaHA microspheres act as a scaffold for bone growth and contribute to long-term tissue support. The action of RADIESSE® is somewhat similar to constructing a building or bridge. RADIESSE® comprises calcium hydroxyapatite (CaHA) microspheres suspended in a sodium carboxymethylcellulose (CMC) gel carrier. This molecule exerts its effects through a multi-step mechanism involving: 

1. Immediate Volume Augmentation 

Injected CaHA microspheres provide immediate filling and correction of soft tissue depressions. CMC gel carrier helps distribute CaHA microspheres evenly and enhances initial volume.

2. Collagen Stimulation

CaHA microspheres act as scaffolds to promote fibroblast proliferation for enhanced tissue remodeling. RADIESSE® can trigger increased production of collagen type I & III collagen and elastin to enhance skin firmness and elasticity. CaHA may also stimulate angiogenesis, delivering essential nutrients and oxygen to the skin. There is also an anti-inflammatory effect, as RADIESSE® appears to exhibit anti-inflammatory properties, potentially leading to faster healing and fewer side effects.

In hyper-diluted forms (using 1.5 mL of product with at least 1.5 mL of diluent), RADIESSE® exhibits minimal or no immediate volume enhancement due to the dispersal of the CMC gel. This approach makes it convenient to perform shallow injections to rejuvenate the face and other larger body areas. 

Ideal Candidates for RADIESSE® BBL

Individuals with stable mental and physical health, realistic expectations, mild to moderate sagging, healthy skin, and appropriate BMI are generally considered suitable for BBL with RADIESSE®. However, thorough pre-operative assessments are essential to ensuring optimal safety and outcomes.

Meticulous case assessment and selection are the mainstay of successful treatment results. Here are some factors worth pondering on.

  • A detailed medical history is mandatory to evaluate general health, body mass index (BMI), potential contraindications, and previous surgeries.
  • Assessing skin quality.
  • Understanding patient motivations, goals, and emotional well-being is vital to maintaining realistic outcomes and satisfaction.
  • Psychological evaluation to better understand body image perception and readiness for potential changes.
  • Avoiding medications that increase bleeding risk or interfere with anesthesia, quitting smoking, and undergoing specific tests like blood work, ECG, or imaging.

Getting informed consent is also mandatory before starting the procedure. This includes discussing the procedure’s benefits, risks, and alternatives, aids in a better understanding of the expected outcomes and complications, and strengthens the patient-clinician dynamic. 

In an investigative study comparing RADIESSE® efficacy against Hyaluronic acid-based fillers like JUVÉDERM®, about 90% of patients using RADIESSE® BBL reviewed better satisfaction levels than the latter. Another study involving 20 women with cellulite and skin laxity showed significant improvement in the cellulite severity scale after MFU-V and subdermal CaHA injection.

Pre-Procedure Preparations

Before beginning gluteal augmentation with RADIESSE®, a standardized material and patient preparation protocol is followed. RADIESSE® is diluted with normal saline to a specific ratio (1:6 or 1:1 to 1:4 for buttocks skin laxity and 1:1 or 1:2 for cellulite dimples) to aid optimal product spread within the gluteal tissue. This dilution encourages significant collagen and elastin production but at a lower per-tissue volume than concentrated forms. Conversely, lower dilution ratios may stimulate more collagen and elastin but require a larger overall product volume, which in return increases cost and procedural time.

Pre-injection agitation can best achieve optimal homogeneity of RADIESSE® solution. Local anesthetic containing lidocaine is also used for patient comfort. Marking the patient’s gluteal region in an upright position is best for delivering accurate treatment. 

RADIESSE® BBL Injection Technique

Injection volumes and depths are usually planned to provide optimal augmentation, contour refinement, and natural-looking results. In addition, injection sites are carefully selected based on individual patient anatomy and desired outcomes for optimal results. Commonly targeted areas include: 

  • The upper outer quadrants.
  • Central regions.
  • Lateral upper buttocks.

These areas can be precisely identified using anatomical landmarks such as the gluteal fold, posterior superior iliac spine, and the midline sacral dimple.

Injection Preparation


After sanitizing the insertion point, a 3mL syringe is used to inject 1mL of lidocaine at each insertion site. For RADIESSE® (+) 1.5ML WITH LIDOCAINE RADIESSE®, additional anesthesia might not be required. A pilot hole is created with an 18-gauge needle at the designated insertion site to confirm proper depth.

Injection Technique


  • Filler injections are typically targeted towards the subcutaneous tissue and deep muscular fascia.
  • An 18-gauge cannula replaces the needle for deeper placement and wider coverage.
  • Layering techniques ensure even distribution and smooth transitions. The asterisk, linear threading, and fanning techniques are preferred for their ability to create smooth transitions. 
  • Each injection starts with a 6ml bolus, followed by a 4ml retrograde injection to prevent product loss.
  • Cannulas are preferred for their flexibility and safety.
  • New syringes are attached while keeping the cannula partially inserted, with each injection spaced 2cm apart.
  • Bleeding is controlled by gauze pressure and a tegaderm patch.

Interestingly, the Brazilian Volume Injections with Body Augmentation using RADIESSE® (BVIBBL) is particularly useful in addressing four targets: hip dips, shelf, heart shape, and projection. While the general injection technique remains similar across these patterns, adjustments are made to cater to the specific anatomical region. 

Which is Better: SCULPTRA® or RADIESSE®?

Whenever the question of ‘RADIESSE® BBL vs SCULPTRA®’ arises, it’s important to understand that both fillers are at par and provide similar results. However, choosing one over the other largely depends on the individual case and the procedure’s feasibility with the particular filler material. Here is a quick comparison between the two:

MD Tabela1

RADIESSE® BBL Side Effects

When dealing with RADIESSE® bbl-associated side effects, prompt recognition and early intervention are the best methods healthcare professionals can use to ensure patient safety and avoid any undue complications. Besides, treatment outcomes can be improved by conducting a thorough pre-operative evaluation, following precise injection techniques and respecting anatomical landmarks, planes, and vital structures (nerves and blood vessels).

Similar to other BBL filler procedures, using RADIESSE® comes with potential side effects:

  • Hypersensitivity reaction (allergy + anaphylaxis)
  • Accidental injection into a blood vessel.
  • Infection.
  • Relapse of herpes breakout (in patients with a history of herpes).
  • Poor wound healing with risk of scarring.
  • Typical signs of inflammation including itching, pain, bruising, or swelling at the injection site.
  • Hyperpigmentation at the point of insertion. 
  • Possible reactions to anesthesia, including nausea, vomiting, headaches, respiratory arrest, etc.
  • Risk of keloids,  hypertrophic scars, or poor wound healing.
  • Possible product displacement in different tissues.

The clinician can take appropriate measures in the form of medications or physical interventions to mitigate adverse events following RADIESSE® use.


RADIESSE® is a promising, minimally invasive alternative for gluteal augmentation. However, only ongoing research and advancements can strengthen its safety and efficacy. Future studies should prioritize assessing long-term safety and efficacy, developing improved filler technologies, evaluating patient satisfaction and quality of life, and establishing standardized protocols and guidelines. Furthermore, streamlining injection techniques for depth, volume, and layering can help impart more long-lasting, natural results. Actively pursuing these avenues can ensure that RADIESSE® BBL, and dermal fillers in general, continue to evolve into a safe and effective option for gluteal augmentation and empower patients along the way.


How long does the BBL filler last?

RADIESSE® is a long-lasting aesthetic treatment for gluteal augmentation with temporary results. Its effects can last up to a year; patients usually schedule an annual touch-up appointment to maintain the treatment results.

Does RADIESSE® look better over time?

RADIESSE® can enhance the appearance of the treated area over time by stimulating collagen production. This gradual improvement is a significant benefit of the treatment.

How long does RADIESSE® BBL take to work?

It may take some weeks for the effects of RADIESSE® injections to be noticed. This is attributed to the diluted RADIESSE® used during the procedure. However, the result using RADIESSE® is not permanent and needs repeat visits. 

What are the side effects of RADIESSE® BBL?

Commonly noted RADIESSE® BBL side effects may include allergy, hyperpigmentation, swelling, bruising, redness, and discomfort. These are temporary and typically resolve within a few days.

What is the aftercare for RADIESSE® BBL?

Following post-treatment instructions is equally essential as the procedure itself. Here are some aspects to consider regarding RADIESSE® BBL aftercare:

  • Avoiding pressure on the operated area. 
  • Staying away from exercises that can potentially burden the gluteal region. 
  • Including a skincare regimen.
  • Staying on track with follow-up appointments.
How many vials of RADIESSE® for BBL are Required?

The number of vials needed for BBL with RADIESSE® varies among patients. On average, 4 to 10 vials are used to achieve the desired results. Typically, one syringe per buttock side per session is recommended.

What is better than RADIESSE®?

Gluteal augmentation can be achieved by several alternatives to RADIESSE®, including SCULPTRA® and other dermal fillers. Each of these offers unique benefits depending on patient needs and preferences. Consulting with a qualified practitioner can help determine the best option for you.

How Much Does RADIESSE® BBL Cost?

The cost of any cosmetic procedure largely varies with individual patient expectations and the extent of correction feasible. Additionally, the geographic location (of both the practice and the patient) and the cosmetic specialist’s expertise factor in pricing. For the most part, four to ten vials are adequate to achieve aesthetically pleasing results. 


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