Porous calcium hydroxylapatite has been used in otolaryngology, dentistry and radiology for many years. Currently, calcium hydroxylapatite is gaining popularity for facial esthetics in the form of the product Radiesse (San Mateo, CA). Although Radiesse is not yet approved in the United States for cosmetic use, it is being used off-label by an increasing number of dermatologists and plastic surgeons for facial soft-tissue augmentation. Preliminary clinical and histologic studies have shown safety, efficacy and durability in various esthetic applications including the nasolabial folds and HIV lipoatrophy.