When it comes to restoring facial volume, not every dermal filler was created equally. While hyaluronic acid fillers tend to get all the glory, their lesser-mentioned cousins, Radiesse and Sculptra Aesthetic are two alternative options that doctors use to plump, sculpt and rejuvenate the face.

Sculptra Aesthetic and Radiesse are both biostimulatory fillers that generally have longer lasting results versus more popular hyaluronic acid fillers. Both can be diluted to help with body skin crepiness, tightened and wrinkled skin improvement after several treatments.

There are two types of dermal fillers that provide volume replacement, hyaluronic acid-based fillers, and collagen biostimulators, such as Sculptra and Radiesse. These two types of fillers generally have their own characteristics, drawbacks, benefits, and application type. Biostimulators promote collagen growth through fibroblast activation, which is either inflammatory—like with Sculptra— or noninflammatory like Radiesse, depending on the involvement of a foreign body response. Over time, the formation of collagen has corrective benefits that extend the results of fillers over a long period of time, which is usually between one and two years.

Radiesse

Approved for use in various areas, Radiesse can treat marionette lines, the corners of the mouth, the pre-jowl fold, chin wrinkles and the hands. Radiesse is made of calcium hydroxyapatite gel (like crushed artificial bone) and immediate results are seen. Radiesse can be diluted or mixed with hyaluronic acid fillers depending on what is needed of the product. Results last for a year to 18 months, Radiesse is especially helpful and useful in patients who have begun to show signs of aging related facial bone and volume loss. It can be used to accentuate the bone structures of the face to emphasize the cheekbones, temples, and jawline.

Sculptra Aesthetic

Sculptra uses microscopic particles in the filler to stimulate collagen production within the skin to treat and correct moderate to severe facial wrinkles and folds. Sculptra is made of poly-L-lactic acid, which is essentially crushed up suture material, and stimulates collagen to form on the product to give volume. Results are seen after six weeks and can last up to two years.  It needs to be reconstituted in advance of injection and can be done in different dilutions depending on where it is needed. This boost in collagen is essentially an immune reaction to the filler that helps plump the area injected from within. Most patients require an average of three treatments spaced three to four weeks apart.

Sculptra has zero lifting or shaping ability as it’s not a filler. It is a pure collagen stimulator; all its effects come about through the stimulatory effect on Type 1 collagen, thus any effect is natural stimulation.

Which Longer-Lasting Filler Is Best?

As all the doctors we spoke to agreed, there is no “winner” when comparing the two fillers. The choice of which one to use comes down to the patients’ needs and the type of results they seek.

Radiesse provides instant improvement. Sculptra works only as a stimulatory filler. It is excellent for large areas but must be done over a series of treatments taking four to six months to achieve total correction. However, once correction has been reached, it tends to last longer than other fillers and requires less maintenance. Patients may also use Radiesse for instant improvement and combine with Scultptra for a slower gradual change.

We lose one percent of collagen each year and both Sculptra Aesthetic and Radiesse can help reverse that.

Radiesse has more utility as a rejuvenating tool. It can be used as supplied for facial shaping, broad-area collagen stimulation, hand augmentation and deep wrinkle and line filling. It can also be diluted to use like Sculptra. As it is highly viscous, it is not suitable for superficial placement. Thus, it is not recommended for areas with thin skin, such as the lips or lower eyelids, and should not be used for the treatment of fine lines and wrinkles.

Sculptra Aesthetic can mimic and replace volume loss in structures such as bone and fat, as well as improve skin texture.  I would characterize Sculptra as more of a ‘liquid facelift’ and Radiesse as an implant, providing sturdy reproducible results.

Radiesse and Sculptra can be used in very similar ways. Both ‘off label’ as a diluted form for global volumization of the face and even areas off the face. Both are good options for collagen production leading to tighter skin. Radiesse allows for more immediate results in volumization and Sculptra works longer at producing collagen.