My source for all things skincare:
What is the name of your device that you purchased for this?
Radiesse is a proprietary product made by Merz Aesthetics, and authentic versions are typically not manufactured in China. What youāll find on Chinese platforms are Radiesse-style fillersāoften calcium-based or poly-L-lactic acid alternativesāmarketed for similar aesthetic uses. Quality, sterility, and safety standards may vary widely.
About diluting Radiesse - itās simple only in videos. If done incorrectly the mixture will start foaming (and has to be discarted). Also itās easy to make a mistake with injection depth. In other words, itās not for amateurs for sure. Itās a difficult filler to work with.
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I am discussing the DermoElectroPoration here - yes, self injecting is something I would be extremely leery about.
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Ah - that is true for all of Annis Dangās productsā¦ they are all knock-offs.
While for some things the knock-offs might be fine, itās really hard to tell, or discern āgoodā from āless goodā or ābadā products. Here is a CGPT5 summary of this issue:
AI Summary of Issues with Knockoffs:
This is an excellent, nuanced question ā and it touches on pharmaceutical manufacturing quality, biomaterial chemistry, and regulatory oversight.
Letās unpack it carefully.
1. What Radiesse (by Merz Pharma) Actually Is
Radiesse is a class III medical device made by Merz Aesthetics (Merz Pharma, Germany).
It is composed of:
- 30% calcium hydroxylapatite (CaHA) microspheres ā smooth, spherical particles ~25ā45 Ī¼m in diameter
- 70% aqueous carboxymethylcellulose (CMC) gel carrier
It is non-animal, biocompatible, and biodegradable ā the CaHA microspheres provide scaffolding for fibroblast-mediated neocollagenesis, while the gel provides temporary volume.
The product has:
- Stringent particle size control (narrow distribution)
- Surface charge optimization
- Low endotoxin and impurity load
- Sterility assurance via validated gamma sterilization
- Extensive ISO 13485 / EU-MDR / FDA 510(k) quality validation
So although the chemical formula (Caāā(POā)ā(OH)ā) looks simple, how it is processed and stabilized in the CMC matrix is highly engineered.
2. Is CaHA āEasy to Replicateā?
Chemically ā yes.
Biologically and medically ā not remotely.
Basic synthesis
Producing CaHA powder (for lab ceramics or dental bone grafts) is straightforward: mix calcium and phosphate salts under controlled pH, precipitate, dry, and sinter. Many labs in China, India, or Europe can do this cheaply.
But for dermal filler use
You must precisely control:
- Particle size (25ā45 Ī¼m) and distribution width
- Surface morphology (smooth, non-porous)
- Zeta potential (electrostatic charge affects aggregation and inflammation)
- Purity / residual salts
- Endotoxin levels (<0.5 EU/mL)
- Sterility and pyrogenicity
- Uniform suspension in the CMC gel carrier
These factors require pharmaceutical-grade synthesis, ultrafiltration, cleanroom processing, validated sterilization, and multi-lot biocompatibility testing (ISO 10993).
Those quality controls are the difficult ā and expensive ā parts. The chemical recipe is public; the reproducible, safe biomaterial is not.
3. Likely Differences with āKnockoffsā or Unapproved Imports
| Parameter | Merz Radiesse | Typical Unregulated Copy (China / gray market) | Clinical Implication |
|---|---|---|---|
| Particle size control | Tight (25ā45 Ī¼m) | Broad (5ā80 Ī¼m) | Irregular particles ā uneven injection, lumping, granulomas |
| Surface finish | Smooth, uniform | Often rough / porous | Higher macrophage activation, nodules |
| Purity / endotoxin | Pharmaceutical-grade, batch tested | Often unknown | Inflammatory reactions, sterile abscesses |
| CMC carrier stability | Optimized viscosity, resorption profile | May separate or clump | Uneven results, injection resistance |
| Sterility validation | Gamma sterilization, ISO 11137 | Variable / unverified | Infection risk |
| Regulatory oversight | CE mark, FDA 510(k), post-market surveillance | None / fake certificates | No recourse for adverse events |
| Shelf stability | ā„2 years validated | Often untested | Loss of performance, microbial growth |
So while the CaHA chemical formula is simple, replicating the biomaterial quality and sterility of Merzās product is complex and capital-intensive.
4. Safety and Clinical Consequences of Using Knockoffs
Real-world reports (from dermatology and plastic surgery societies, esp. in Asia and South America) have documented:
- Nodules / granulomas
- Inflammatory reactions
- Skin necrosis from vessel embolization
- Inconsistent degradation
- Poor or short-lived results
This happens because the knockoff products may:
- Have non-uniform microsphere sizes, which can clog microvessels
- Contain residual ionic contaminants
- Use improper gel carriers
- Or be non-sterile (contaminated during manufacturing or repackaging)
Even if some counterfeit CaHA products appear similar visually, their in vivo rheology, tissue response, and resorption can differ drastically.
5. Chinaās Role in CaHA Production
China has a strong biomaterials industry (for bone grafts, dental ceramics, etc.), so technical capability exists.
However:
- Many domestic CaHA-based āfillersā are approved only under local NMPA (formerly CFDA), not FDA/EMA.
- Some are legitimate Chinese brands (e.g., Biohyaluxās CaHA-based fillers) with real local clinical data.
- But many gray-market āRadiesse-likeā products (sold on non-medical websites) are counterfeit, relabeled, or illegally exported.
Even if the manufacturer can technically make CaHA microspheres, replicating the precise Radiesse microstructure and carrier performance requires proprietary process controls and expensive equipment.
6. Expert Summary
Chemically easy, biologically hard, clinically dangerous if unregulated.
- The CaHA molecule itself is not unique, but the particle engineering, purification, and sterile suspension technology in Merzās product are difficult to duplicate safely.
- Counterfeit or low-cost CaHA fillers may cause serious inflammatory or vascular complications.
- Authentic Radiesse remains the benchmark CaHA filler, backed by >200 clinical publications and 15+ years of safety data.
Bottom Line
- Radiesse (Merz) is a precision-engineered biomaterial, not just ācalcium powder in gel.ā
- While CaHA synthesis is simple, achieving the same purity, uniformity, and tissue biocompatibility requires Merz-level GMP infrastructure.
- āKnockoffsā are therefore high risk, even if they appear chemically identical.
- For any CaHA-based filler, regulatory approval + traceable supply chain are non-negotiable markers of safety.
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I just canāt imagine buying knockoff anything from China and injecting it into myself, lol. They have every incentive in the world to cut corners and pretty much no incentive to make a good product. If you want Radiesse, why not just use Radiesse?
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I agree, for me the risk/reward trade-off is not worth it. Iād pay the extra money for the real FDA-approved product.
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How and where do you use it? Do you self-inject? Do you dilute it? Which technique do you use?
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I will actually try Radiesse just to see if the results are different. Obviously the real deal is more expensive. Because calcium hydroxilapatite doesnāt take rocket science to produce, I figured Iād give the cheapest Chinese version a try and Iām blown away by the results. I do suspect theyāre not the original product though so out of curiosity I plan on getting the original when I run out of my stock. Very much doubt it will be noticeably different though but Iād like to be wrong and find out I can get even better results. Definitely no granulomas or any such problems so far.
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I donāt dilute it, it already has lidocaine in it. Use it on jaw line, chin area, marionette lines, and hands by sharp needle. Works well.
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āLive fast, die young, and leave a beautiful corpseā
Should be
āLive fast, die old, and leave a beautiful corpseā
Thatās my goal LoL!
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FYI dermoelectroporation will NOT work with undiluted radiesse as itās too viscous and āchalkyā ā almost like cement. It has to be diluted at least 1:1 to work, but for me the 1:1 semi dilution does provide some subtle volume.
What can be used straight up is Sculptra, which is very watery when properly constituted. I think anyone in need of volume above all else should prioritize Sculptra over Radiesse.
I wouldnāt self inject either under any circumstances because Iām not competent with injection and donāt want to learn on myself. But more power to those who know what theyāre doing. To me the dermoelectroporation replaces the need for a skilled injector but it DOES require good knowledge of the materials being used, what can and canāt go where.
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I was not talking about demoelectroporation. Iām very familiar with the product (have been using it for over 15 years). I use it in the original form with lidocaine. There are 2 types available, with lidocaine and without. I buy the one with lidocaine. If applied correctly, itās very smooth and lasts long. 1.5 ml (1 syringe) is enough for the my lower face and the same amount covers both hands. 2 syringes, 1.5 ml each, cost approximately $300 with delivery. If you choose to do it professionally, the cost is usually $600+ per unit.
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So people using it with electroporation devices would not, I assume, need the lidocaine?
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Hereās something interesting about skin I learned a while ago:
Scar tissue is composed of the same protein collagen as the tissue that it replaces, but the fiber composition of the protein is different; instead of a random basketweave formation of the collagen fibers found in normal tissue, in fibrosis the collagen cross-links and forms a pronounced alignment in a single direction.
So, the way collagen fibers are arranged is partly to blame for the presence of scars. Is there a way to physically alter the arrangement? It seems maybe āyesā:
Mechanical, structural and chemical guidance cues have all been shown to regulate alignment of fibroblasts and collagen in vitro , and prior studies have proposed that each of these cues could regulate anisotropy of infarct scar tissueā¦
What about the effects of vibrating plates? I have tried those at gyms before (some LA Fitnesses have vibration plates), and then later read that they may affect the structure of skin ā e.g. tightening it. I was mostly interested in the effects of these on muscle, since I had heard they can give you a workout without a lot of effort (basically, the plates move your body a little, and your muscles try to correct, to maintain balance; and these constant corrections work the muscles); but then I had also read that they might increase collagen production, maybe even tighten skin. Here is one that shows potential benefit in women with cellulite (thankfully, men donāt get cellulite, as our collagen fibers are different):
In the regression subgroup cellulite returned to initial values soon after cessation of treatment, whereas in the continuous application subgroup, cellulite remained diminished.
(Authors declare no conflicts of interest.)
I have also read that they can help with lymphatic drainage, which can further improve the appearance of skin.
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Theyāve also found another way to minimize or eliminate scaringā¦Verteporfin for Scar-less Skin Repair, and Hair Transplant Growth
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Yes, itās correct! Itās a little less expensive than the one with lidocaine.
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Itās interesting but I never tried that.
I asked a friend who professionally works with Radiesse about diluting it with CytoCare or another HA based product instead of saline or lidocaine. She said it could be risky. Then I double checked it with AI and got the following:
Standard Dilution Practice
Radiesse is typically diluted with:
ā¢ Sterile saline: for viscosity reduction
ā¢ Lidocaine: for patient comfort during injection
These diluents are inert, well-characterized, and maintain the integrity of CaHA microspheres, which are responsible for collagen stimulation.
What About CytoCare?
CytoCare is a hyaluronic acid-based mesotherapy cocktail containing vitamins, minerals, and amino acids. While some practitioners experiment with combining it with Radiesse, this is:
ā¢ Off-label and unstudied by Merz
ā¢ Not supported by formal compatibility data
ā¢ Potentially risky due to unknown interactions between CaHA and HA complexes, preservatives, or bioactive additives
Risks of Mixing with CytoCare
ā¢ Chemical instability: HA and CaHA have different pH and ionic properties
ā¢ Microsphere dispersion: Additives in CytoCare may interfere with CaHA scaffold formation
ā¢ Unpredictable tissue response: No histological studies confirm synergistic or safe outcomes
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I did a similar search and saw similar warnings. What overrode me was seeing a practitioner mention heās been experimenting with using NCFT 135ha as a solvent for Radiesse and getting better clinical outcomes with his patients than when using saline. So I tried it with it and loved the result. One time I was out of NCFT 135ha and used Cytocare. Still got very good results, but I am a bit biased towards NCFT 135 ha ā it seems to agree with my skin a bit better generally. My interpretation of ChatGPTās similar warning to myself was that itās being conservative because the combo hasnāt been officially studied by Merz. It stands to reason theyād want to keep their studies and recommendations simple as they canāt predict the outcome from all sorts of reactions that might or might not happen between the hydroxilapatite and any of the components of these cocktails. So your mileage might vary. Iām very satisfied with my results so Iām tipping off anyone who might want to try it, that in my experience it works well. Of course the most standard and safe way to use it is simply with saline.
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Oh, one thing I forgot to mention was that scars are more than just a curiosity to me. I recently had surgery, and have scars on my head, near my left ear. Fortunately, they didnāt cut my hair, or else Iād look like part Frankenstein on the left side (itās apparently not uncommon these days not to cut hair for certain kinds of head or brain surgery); though, the length of the scar is small. My hair is fairly thick, so it masks the scar almost completely.
About a week ago, I was talking to my department head, and he said, āwhere are your sutures?ā Almost like he didnāt believe I even had surgery. I had to pull the hair back from my ear so he could see the staples ā and those staples were cut a day after that, and they kind of broke apart. So, itās even less visible than it was before.
I had a haircut today, and I told the woman cutting my hair not to be alarmed by the scar near my ear, and explained that I had had surgery. She tried to be extra-careful when cutting that part of my hair, so she wouldnāt injure me.
Given the rate of healing and progress, I wouldnāt be surprised if in a month or two, my scars have healed almost completely, and that you would never even know I had surgery, even if you pulled back the hair and looked very close. I fell like Iām kind of lucky in that regard.
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