A Systematic Review and Meta-analysis of Single-group Studies Assessing the Role of Calcium Hydroxylapatite in Aesthetic Enhancements and Satisfaction

Abstract

Background: Many studies assess aesthetic effectiveness of calcium hydroxylapatite (CaHA), with single-group designs as the most frequently applied designs in practice. This study systematically reviewed CaHA’s effectiveness for aesthetic purposes among these studies. Methods: A comprehensive search was conducted across 5 bibliographic databases. Single-group studies with at least 10 human adults were included. Summary measures of patients satisfaction and global aesthetic improvement scores were combined using the generalized linear mixed model. This systematic review adhered to the PRISMA reporting standards. Results: Of 3131 records, 46 single-group studies, majority focused on facial areas (n = 32), were included for final qualitative analysis. A total number of 27 studies were included in the meta-analysis. Findings of the meta-analysis showed that 98% (95% confidence interval [CI], 91%–99%; I 2, 0.0%) of patients were satisfied with the injection results in the facial area and 90% (95% CI, 67%–97%, I 2, 35%) in other treated body areas. Also, patients reported 89% (95% CI, 76%–96%; I 2, 65%) improvement on the global aesthetic improvement scale in facial areas and 94% (95% CI, 75%–99%; I 2, 0.0%) in other treated regions. Similarly, investigators reported global aesthetic improvement in 92% of patients (95% CI, 33%–100%; I 2, 92%) in facial areas and 95% (95% CI, 1%–100%; I 2, 89%) in other treated areas. Conclusions: Our findings showed aesthetic improvements and satisfaction following CaHA injections in both facial and nonfacial areas. However, studies focusing on nonfacial regions are limited. We recommend more rigorously designed trials to better understand CaHA’s clinical effects.