Radiesse is sometimes offered for hollows under the eyes, and a reader looking it up meets clinic pages describing the treatment as routine. The US label for Radiesse says the opposite of routine: its safety and effectiveness around the eye "has not been established". This page sets out what the label says, what the published reports on under-eye use describe, the complications on record and what has never been tested, as of 3 November 2026. It does not describe how the treatment is done and does not say whether anyone should have it.
For Radiesse itself — the particles, the five approved uses and the full safety record — see Radiesse; for the diluted form, hyperdilute Radiesse. The same question for poly-L-lactic acid is answered on Sculptra under the eyes.
What the label says
Radiesse's labeling, in the version filed with the March 2026 décolleté approval (P050052/S162) and the 2021 jawline approval (S129), lists among its precautions: "Safety and effectiveness in the periorbital area has not been established." The five approved uses are moderate to severe facial wrinkles and folds, HIV-related facial fat loss, the backs of the hands, jawline contour (Radiesse (+)) and, diluted 1:2, the décolleté. The area under the eye is not one of them.
The same labeling carries the warning every US filler label carries: injection into a blood vessel in the face can cause "temporary or permanent vision impairment, blindness, cerebral ischemia or cerebral hemorrhage, leading to stroke, skin necrosis". It tells injectors to stop at once if a patient reports a change in vision. The area around the eye is where that risk is most discussed, because of the arteries that connect to the eye.
Why the under-eye skin is a hard place for a particle filler
The skin of the lower eyelid is among the thinnest on the face. A material placed too close to the surface can show as a lump or a pale or yellowish ridge. Calcium hydroxylapatite is made of microspheres, it is visible on CT scans, and — unlike hyaluronic acid — no enzyme dissolves it. A 2012 paper in the journal Orbit proposed a way of dealing with Radiesse placed too superficially in the lower eyelid (PMID 22731869). Those three properties are why it is usually described as an off-label, specialist use there.
What the published series report
A PubMed search on 3 November 2026 for calcium hydroxylapatite or Radiesse with periorbital, tear-trough, infraorbital, under-eye or lower-eyelid terms returned 43 records. Read title by title, most are reviews, technique papers, case reports of complications, or studies of the cheek and temple that mention the eye area. Two report outcomes of under-eye treatment, and both are retrospective chart reviews:
| Study | Patients | What was reported | Limits |
|---|---|---|---|
| Hevia, Dermatol Surg 2009 (PMID 19614938) | 301 treated in the infraorbital region, diluted product (85 at a 1:2 dilution, 216 with a smaller amount of lidocaine added) | bruising 10%, swelling 2%, redness 1%; "no overcorrection"; patients described as satisfied | one practice; no control group; satisfaction not measured on a stated scale in the abstract |
| Bernardini et al., Ophthalmic Plast Reconstr Surg 2014 (PMID 24398484) | 63 patients, 127 eyelids, at oculoplastic clinics in Italy, Turkey and Argentina | 36.5% needed a second correction at one month; 92% satisfied overall at one month; dark circles "satisfactorily treated" in 68% of those with them; pseudoxanthelasma in 22 eyelids (17.4%) lasting under six weeks; erythema over four weeks in 2 patients; one product migration above the inner corner of the eye; one overcorrection | follow-up to one month; photographs graded by the authors themselves; no control |
The 2014 paper drew four published letters of comment and reply in the same journal that year. What neither series can show is how long the result lasts under the eye, how often late complications appear after a year or more, or how it compares with hyaluronic acid in the same patients.
Complications on record
A 2022 systematic review collected 52 published cases of delayed complications after tear-trough filler from 28 articles. Hyaluronic acid accounted for 37 cases, poly-L-lactic acid for 4 and calcium hydroxylapatite for 4. Across all fillers, the delayed problems were swelling (42.3%), lumps or nodules (25.0%), xanthelasma-like reactions (17.3%), migration (7.7%) and discoloration; they appeared on average 16.8 months after injection, and the authors note that synthetic particle fillers were more often linked to lumps and nodules (Trinh et al., Facial Plast Surg 2022, PMID 34666405). Case counts from published reports are not rates — most complications are never written up.
Individual reports since then include granuloma formation after calcium hydroxylapatite in the lower eyelid (Plast Reconstr Surg Glob Open 2025, PMID 40212090) and a 2017 multicentre report of xanthelasma-like reactions to filler (PMID 27218809). A 2026 systematic review of vision loss after biostimulator injections, calcium hydroxylapatite among them, is in the same search (Aesthetic Plast Surg 2026, PMID 41263987); our Sculptra under the eyes page reports its poly-L-lactic acid cases, and the wider Radiesse harm record is on Radiesse side effects.
How it compares with the usual under-eye filler
A 2021 systematic review of 23 tear-trough filler studies found Restylane, a hyaluronic-acid gel, was the product most commonly used, with reported duration of 8 to 12 months and mostly mild side effects such as bruising, swelling, blue-grey discoloration and contour irregularities (Trinh et al., Facial Plast Surg 2022, PMID 34192769). The practical difference is reversibility: hyaluronic acid can be broken down with hyaluronidase, an off-label use, and calcium hydroxylapatite cannot. Polynucleotide injections are another option sold for the area; our polynucleotides for under eyes page covers what has been tested.
What is not established
- Safety and effectiveness of Radiesse in the periorbital area — the label's own words.
- Any randomized or controlled comparison of calcium hydroxylapatite with hyaluronic acid or with no treatment under the eye. On 3 November 2026 ClinicalTrials.gov listed none; the search returned a lipoatrophy study (NCT05776836) and a GLP-1 facial-volume study (NCT07419854).
- How long an under-eye result lasts, measured beyond one month in a published series.
- The rate of late lumps, migration or granuloma after calcium hydroxylapatite under the eye.
Whether any filler is right for an under-eye hollow, and which one, is a decision for a licensed clinician, ideally one who can say what they would do if the result needed correcting.
Sources
Opened 3 November 2026: US FDA labeling for Radiesse injectable implant filed with PMA P050052/S129 and P050052/S162 (accessdata.fda.gov/cdrh_docs/pdf5/P050052S129D.pdf and P050052S162D.pdf; precautions and warnings). PubMed search ("calcium hydroxylapatite"[tiab] OR "calcium hydroxyapatite"[tiab] OR radiesse[tiab]) AND (periorbital[tiab] OR "tear trough"[tiab] OR infraorbital[tiab] OR "under-eye"[tiab] OR "lower eyelid"[tiab] OR "under eye"[tiab]) (43 records, every title read). Abstracts: Hevia O, Dermatol Surg 2009, PMID 19614938; Bernardini FP et al., Ophthalmic Plast Reconstr Surg 2014, PMID 24398484; Trinh LN et al., Facial Plast Surg 2022, PMIDs 34666405 and 34192769; records 40212090, 22731869 and 27218809. ClinicalTrials.gov API v2 searches "calcium hydroxylapatite AND (tear trough OR infraorbital OR periorbital)" and "Radiesse AND (tear trough OR infraorbital OR periorbital OR under eye)" (2 records each, the same two). Approved uses as recorded, with sources, on our Radiesse page. Corrections go to the contact page.