Both in our Larkspur spa and at home across Marin and San Francisco, we offer Hyaluronic acid and Radiesse for biostimulators as well as Jeuveau and Botox for Neuromodulators.

It depends on the area and what you're trying to fix. Hyaluronic acid filler is the choice for lips and anywhere requiring fine, precise placement or the ability to reverse. Radiesse is better suited to structural work: jawline definition, cheeks, temples, and hands. Diluted, Radiesse also works as a skin-quality treatment for the jawline, neck, and décolleté, improving firmness and texture rather than adding volume. Radiesse is not used in the lips. Most patients over 40 do best with a combination, using Radiesse to rebuild foundation and HA filler to refine specific features.

Hyaluronic acid filler can be dissolved. Radiesse cannot. HA filler is reversible with an enzyme called hyaluronidase, which breaks it down within a day or two. That's a genuine safety advantage and part of why we favor HA for the lips and under-eye area. Radiesse has no dissolving agent, so it has to be allowed to metabolize on its own over 12 to 18 months. This is exactly why we treat conservatively and build in stages rather than doing everything in one visit. If you're new to injectables and nervous, we'll typically start you with HA so nothing is permanent while you decide what you like.

Plan on three to seven days before you'd want to be photographed. Swelling peaks around 24 to 48 hours and settles over the following week. Bruising is the variable one: some patients have none, others bruise noticeably, and cheeks and lips bruise more readily than the jawline. Avoid alcohol, ibuprofen, aspirin, and fish oil for several days beforehand if your physician allows, and arnica helps some patients. You can return to work immediately. Skip strenuous exercise, saunas, and hot yoga for 24 hours. If you have an event, book three weeks out rather than one.

Radiesse typically lasts 12 to 18 months. Hyaluronic acid filler ranges from about 6 to 18 months depending on the product, the area treated, and how much movement that area sees. Lips metabolize filler fastest because they move constantly. Cheeks and temples hold the longest. Radiesse tends to last longer than most HA fillers because part of what you're left with is your own collagen rather than product. Metabolism, exercise level, and age all shift these numbers, so treat them as ranges rather than promises. We'll usually see you at four weeks after your first treatment to assess and refine.

Hyaluronic acid fillers add volume; Radiesse adds volume and then rebuilds your own collagen. HA fillers like Juvéderm, Restylane, and RHA are made of a gel that holds water and sits where it's placed, giving you an immediate, predictable result you can see the day of. Radiesse is calcium hydroxylapatite microspheres suspended in a gel carrier. You get immediate volume from the gel, but over about three months that carrier absorbs and the microspheres act as a scaffold that stimulates new collagen and elastin. So HA filler is correction, and Radiesse is correction plus structural rebuilding. In practice we often use both in the same plan, because they solve different problems.