Blending Hyaluronic Acid and Calcium Hydroxylapatite for Injectable Facial Dermal Fillers: A Clinical and Ultrasonography Assessment

Abstract

Both hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) fillers have well-established indications in cosmetic medicine. Nevertheless, limited data are available on the effectiveness of combining CaHA and HA. The purpose of this report was to demonstrate the safety, tolerability, and clinical and ultrasonographic improvement of facial skin laxity using a blending technique that admixes HA and CaHA. Fifteen regular patients, including three men, between 25 and 71 years of age were reported. The participants were subjects who came regularly to the dermatologic office seeking a lifting effect without surgery. They were submitted to injection of an admixture of HA and CaHA and followed for 180 days. The clinical assessment consisted of photographic evaluation by two blind investigators, and a consensual subjective evaluation was performed by the physicians (PGAIS) using the five-point Global Aesthetic Improvement Scale. Dermal thickness was analyzed in jaw areas using high-frequency ultrasound. Subjects completed a satisfaction questionnaire with responses scored according to the five-point Global Aesthetic Improvement Scale (GAIS) to evaluate patient satisfaction. After 180 days of follow-up, clinical assessments by blinded physicians found that all patients improved. All the participants were highly satisfied with the results and reported exceptional improvement. Dermal thickness increased by 9.4% (8.2–10.8%), 14.0% (12.2–15.9%), and 18.8% (16.2–21.9%) at D90, D120, and D180, respectively, by ultrasonography. In conclusion, an injection technique using an admixture of CaHA and HA fillers was well tolerated, offering high satisfaction and long-lasting progressive benefits. The authors believe that this procedure optimizes the treatment time and results because HA promotes early volume restoration and CaHA stimulates long-term dermal remodeling through the synthesis of collagen and elastin.