Radiesse and Restylane are made of different materials, and almost every practical difference between them comes from that. Radiesse is calcium hydroxylapatite — a mineral built from calcium and phosphate — suspended in a gel. Restylane is not one product but a family of hyaluronic acid gels, each with its own FDA approval, its own approved area and its own trial.
The material decides whether a result can be undone. Hyaluronidase is an enzyme that breaks hyaluronic acid apart. It does nothing to calcium hydroxylapatite. A Restylane result can be reduced or removed on purpose. A Radiesse result cannot be dissolved, and there is no approved reversal agent for it.
"Not permanent" and "not reversible" are two different things, and Radiesse is the first without being the second. The gel carrier is absorbed over roughly the first two to three months. The microspheres are then broken down into calcium and phosphate, which the body handles through normal mineral metabolism. It fades on its own timetable. It just cannot be taken back on yours.
They also cover different parts of the face. Radiesse's approved areas are facial wrinkles and folds, HIV-related facial fat loss, the back of the hands, the jawline and the décolleté. The Restylane family spans lips, cheeks, chin, hands, under-eye hollows and temples — but named product by named product, not as a brand.
The microspheres are radiopaque, meaning they show up on an x-ray.
Restylane, Restylane-L, Lyft, Silk, Kysse, Refyne, Defyne, Contour and Eyelight are all 20 mg/mL. What differs between them is the crosslinking and the way the gel is made, not how much hyaluronic acid is in it.
The carrier is resorbed over roughly the first two to three months. The microspheres are colonised by fibroblasts and drive new collagen, then break down to calcium and phosphate ions.
Nasolabial folds and facial wrinkles: Restylane, Restylane-L, Lyft, Refyne, Defyne. Lips: Restylane, Restylane-L, Silk, Kysse. Cheeks: Lyft, Contour. Chin: Defyne (2021), Lyft with Lidocaine (2025). Back of the hands: Lyft (2018). Under-eye hollows: Eyelight (2023). Temples: Contour (2026).
Verbatim: "The safety and effectiveness for use in the lips has not been established. There have been published reports of nodules associated with the use of RADIESSE injectable implant injected into the lips."
Sodium thiosulfate circulates as an antidote. The largest preclinical study of it, run by Merz, found no degradation of the material in the lab or in animals and did find tissue necrosis. The supportive evidence is a 12-sample study in preserved pig skin plus case reports.
In the US this is an off-label use — dissolving filler is not one of hyaluronidase's approved indications.
In the nasolabial fold trial, at 6 months 78.6% of Radiesse-treated folds scored at least a point better than the control-treated fold on the same face. In the extension, 102 of the original 117 people were followed up to 39 months, and 40% of folds assessed at 30 months or later were graded "improved" or better — which means 60% were not. Jawline: 75.6% responders at week 12 against 8.8% of untreated controls, with about 67.3% of initial responders still counted successful at week 48. Décolleté: 71.2% responders at week 24 against 6.3%, last measured at week 84.
Restylane in lips: 59.3% still improved at week 24, against 31.1% untreated. Lyft in cheeks: 75.7% at month 12 — but the untreated group scored 57.4% at the same visit. Kysse in lips: 60% at week 48. Eyelight under the eye: 63.5% at month 12 against 11.1%. Defyne in the chin: 73.7% at week 48. Contour in cheeks: 62.8% at week 48.
The honest first answer is time. The material degrades, and the effect fades over months.
For a lump or an over-corrected area, the published options are mechanical: saline injected into the area with a cannula, used to break the aggregate up as well as to dilute it. One case report describes a woman with delayed neck nodules after hyperdilute Radiesse in whom fine-needle saline injections did little, and switching to a 22-gauge cannula for combined saline delivery and mechanical disruption cleared them after five treatments, with no recurrence over two years. That is one patient, and the senior author consults for Merz among other manufacturers. Beyond that the literature describes steroid injections for inflammatory lumps, antibiotics if a biofilm is suspected, and surgery as a last resort.
There is a benchtop study in which cellulase — a different enzyme — cleared simulated calcium hydroxylapatite blockages in artificial vessels where hyaluronidase barely moved them. It was a laboratory model, one of its authors works for Merz, and no cellulase product is approved for this. It is not an antidote you can ask for.
Radiesse is radiopaque. That is why the 2015 hand approval carried a mandated post-approval study of whether the product obscures hand bones on x-ray across repeat treatments.
It also drove the debate around the décolleté. When an FDA advisory committee looked at fillers in the décolletage in August 2025, its stated concerns included interference with breast cancer screening, and filler nodules being mistaken for suspicious masses on imaging or the reverse. The décolleté indication was approved in March 2026 after that meeting, which trade press reported at the time. If you have had Radiesse in the chest area, tell whoever is imaging you.
Hyaluronic acid does not carry this issue in the same way, though separate MRI work has found hyaluronic acid filler still detectable years after injection in a small selected group of patients — persistence on a scan, not a lasting cosmetic effect.
In Radiesse's nasolabial fold trial, nodules occurred in 0.9% — one person — the same as in the control arm, with no granulomas. In the three-year extension of 102 people there were no nodules, granulomas or infections. But the jawline trial recorded injection-site mass in 10.9%, and the hand labelling states in its own words that Radiesse "may cause nodules, bumps or lumps in the dorsum of the hand (12% reported this event) and can last up to a 1 year." The area changes the number.
On the Restylane side the equivalent figures come from each product's own trial. In the Lyft cheek study, 49% of treated people had at least one adverse event, most commonly injection-site haematoma at 18.1%, with a median duration of 11 days or less.
These rates were collected in different ways — diary cards, investigator reports, different definitions — so they are not a league table.
The last year a professional society published filler fees was 2023. The American Society of Plastic Surgeons reported an average surgeon fee of $715 for hyaluronic acid fillers and $901 for non-hyaluronic acid fillers, a group it defined as Radiesse, Sculptra, Bellafill and Renuva.
Read those numbers carefully. They are per procedure, not per syringe. They exclude facility fees. They pool many products and every facial area into one figure, they come from plastic surgeons rather than the dermatology offices and med spas that inject a large share of filler, and they are three years old. No society publishes a current per-syringe price for either product.
Go to an emergency department or call 911 for any of these after any filler injection:
Sudden change or loss of vision in either eye
Sudden severe pain, or pain out of proportion to the procedure
Skin turning white or blanched, then dusky, grey or mottled
Weakness, drooping, slurred speech or any stroke-like symptom
These can mean filler has entered an artery. Time is measured in hours. This matters more, not less, with Radiesse: when hyaluronic acid blocks a vessel, high-dose hyaluronidase is the emergency treatment, and there is no equivalent for calcium hydroxylapatite. Do not wait for pain to tell you — in a survey of experienced injectors reporting their own intravascular injections, pain was mild or absent in 47% of events.
Swelling is still increasing after the first few days instead of settling
A lump appears or will not settle
Redness is spreading outward from the injection site, or you develop a fever
Tenderness, firmness or swelling appears weeks or months later, especially after an illness, a vaccination or dental work
The product looks like it has moved from where it was placed