New Biomarker Study Reveals Broader Regenerative Effects of RADIESSE

A new study published in the Journal of Cosmetic Dermatology is helping redefine how clinicians understand skin regeneration, showing that healthy skin structure depends on a far more complex extracellular matrix (ECM) ecosystem involving elastin, proteoglycans, glycoproteins, vascular support and tissue organization.

The six-month placebo-controlled biomarker study examined how RADIESSE (calcium hydroxylapatite-carboxymethylcellulose, or CaHA-CMC) influences multiple structural components of the skin – not just collagen alone.

Researchers found significant stimulation across several key ECM proteins, alongside measurable improvements in solar elastosis, a hallmark of sun-damaged skin.

Kate Goldie, Gabriela Casabona, Niamh Corduff, Alec D. McCarthy, Kristina Riegel are the researchers behind this work.

A More Complete View of Skin Aging

The extracellular matrix acts as the skin’s structural framework. While collagen provides tensile strength, other proteins and molecules are equally important for elasticity, resilience, hydration and tissue organization.

The study evaluated several components, including collagen, elastin, fibulin-5, decorin and versican.

Researchers also assessed skin thickness, elastosis and microcirculation using ultrasound imaging and histologic analysis.

According to the authors, the goal was to better understand whether RADIESSE stimulates “a coordinated ECM ecosystem” rather than isolated collagen production alone.

One of the Most Comprehensive Human Biomarker Studies in Aesthetic Medicine

The prospective study enrolled 10 adults undergoing abdominoplasty procedures. Participants received subcutaneous injections of undiluted RADIESSE, as well as 1:1 and 1:2 diluted formulations, alongside saline controls. Tissue samples were analysed at 14 days, 3 months and 6 months post-treatment.

The findings demonstrated significant extracellular matrix remodeling across multiple biological pathways.

Collagen Induction

All RADIESSE dilutions showed significant collagen stimulation versus saline controls at every measured timepoint, with collagen levels peaking around three months.

The 1:1 dilution demonstrated the strongest overall collagen response. This included 31.8% greater collagen staining versus saline at 3 months and sustained collagen increases through 6 months

Elastin and Elastic Fiber Remodeling

Beyond collagen, researchers observed elastin induction surrounding CaHA microspheres at both 3 and 6 months.

Importantly, the study also identified increased expression of fibulin-5, a protein essential for elastic fiber assembly and maturation. The authors note that fibulin-5 supports the formation of properly organised elastic fibers associated with functional skin resilience and recoil.

Improvements in Solar Elastosis

One of the study’s most clinically relevant findings involved improvements in elastosis – structural degeneration associated with chronic sun damage.

Using high-frequency ultrasound imaging, researchers found statistically significant improvements in elastosis at six months for both undiluted RADIESSE and the 1:1 dilution.

The proportion of patients with continuous elastosis decreased substantially following treatment, particularly with the 1:1 dilution.

Increased Skin Thickness and Microcirculation

The study also reported measurable increases in skin thickness and enhanced microcirculation over time.

At six months the skin thickness improved by 15.7% with the 1:1 dilution. Microcirculation was also augmented in 100% of patients treated with the 1:1 formulation.

Researchers suggest these vascular improvements may reflect increased perfusion and tissue remodeling activity within the skin.

Why These Findings Matter

The study reinforces a growing shift in regenerative aesthetics: skin quality is not determined by collagen alone.

Instead, youthful skin appears to rely on coordinated interactions between structural proteins, elastic fibers, proteoglycans and vascular support systems working together within the extracellular matrix.

The authors conclude that RADIESSE stimulates collagen “within the context of a larger ECM ecosystem,” supporting broader tissue regeneration and improved skin structure.

Notably, the researchers identified the 1:1 dilution as the most effective balance for extracellular matrix regeneration and skin quality improvement.