Letter to the Editor: Post hoc analysis of “Clinical and histological comparative outcomes after injections of poly‐L‐lactic acid and calcium hydroxyapatite in arms: A split side study”

For decades, a wide variety of natural and synthetic materials have been used to augment human tissue to improve aesthetic outcomes. Dermal fillers are some of the most widely used aesthetic treatments throughout the body. Initially, the primary function of dermal fillers was to restore depleted volume. As biomaterial research has advanced, however, a variety of biostimulatory fillers have become staples in aesthetic medicine. Such fillers often contain a carrying vehicle and a biostimulatory material that induces de novo synthesis of major structural components of the extracellular matrix. One such filler, Radiesse (Merz Aesthetics, Raleigh, NC), is composed of calcium hydroxylapatite microspheres suspended in a carboxymethylcellulose gel. In addition to immediate volumization, Radiesse treatment results in increases of collagen, elastin, vasculature, proteoglycans, and fibroblast populations via a cell-biomaterial–mediated interaction. When injected, Radiesse acts as a cell scaffold and clinically manifests as immediate restoration of depleted volume, improvements in skin quality and appearance, and regeneration of endogenous extracellular matrices. This narrative review contextualizes Radiesse as a regenerative aesthetic treatment, summarizes its unique use cases, reviews its rheological, material, and regenerative properties, and hypothesizes future combination treatments in the age of regenerative aesthetics. Level of Evidence: 5

Section: Caha-r Is a Regenerative Aesthetic Treatmentmentioning

confidence: 99%

Section: Immune Responsementioning

confidence: 99%

The Role of Calcium Hydroxylapatite (Radiesse) as a Regenerative Aesthetic Treatment: A Narrative Review

Aguilera,

McCarthy,

Khalifian

et al. 2023

A Structured Approach for Treating Calcium Hydroxylapatite Focal Accumulations

McCarthy,

van Loghem,

Martinez

et al. 2024

Background Radiesse, a widely used calcium hydroxylapatite (CaHA) dermal filler, has shown effectiveness in soft tissue augmentation and regeneration. As with all dermal fillers, the potential for nodules may arise. Understanding the pathogenesis of these nodules and exploring effective treatment methodologies are crucial for optimizing patient outcomes. Objectives A literature search was carried out to identify published literature documenting reversal of CaHA nodules. After identification, a consensus panel developed a structured approach, denoted by levels, for applying such reversal methods. Methods This concise review presents an algorithmic approach to addressing CaHA focal accumulations (non-inflammatory nodules) based on invasiveness, cost, and potential risks based on published literature. Results Level 0 involves no intervention, relying on natural degradation for asymptomatic nodules. Level 1 interventions utilize mechanical dispersion techniques, including massage and in situ dispersion, which have demonstrated high success rates, cost-effectiveness, and minimal invasiveness. Level 2 introduces alternative modalities such as pharmacological treatments with 5-fluorouracil and corticosteroids, lasers, and experimental approaches. Level 3 represents last-resort options, including calcium chelating agents, manual removal, and surgical excision. Conclusions The article offers a structured approach to manage CaHA focal accumulations.

Microfocused Ultrasound With Visualization (MFU-V) and Hyperdilute Calcium Hydroxylapatite (CaHA-CMC) of the Lower Face and Submentum to Treat Skin Laxity: A Pilot Study Demonstrating Superiority of MFU-V First Followed by Hyperdilute CaHA-CMC

Doyle,

Looi,

Chu

2024

Background Microfocused ultrasound with visualization (MFU-V) and hyperdilute calcium hydroxylapatite-carboxymethylcellulose (CaHA-CMC) dermal injections are effective for improving skin laxity in the lower face and submentum by stimulating neocollagenesis and neoelastogenesis. Objectives Combining these treatments in an optimal order may inform best practices in aesthetic dermatology. Despite their frequent concurrent use, no study has evaluated the impact of treatment order. This study aimed to determine the optimal sequence for administering MFU-V and hyperdilute CaHA-CMC. Methods Twelve healthy women aged 35-65 were randomized into two groups. Group A received MFU-V followed by hyperdilute CaHA-CMC six weeks later, while Group B received the treatments in the opposite order. Evaluations included histological assessments, aesthetic outcomes, and safety measures. Results Group A showed greater improvements in subjective global aesthetic improvement scale (sGAIS), investigator global aesthetic improvement scale (iGAIS), and FACE-Q patient-perceived age visual analog scale (VAS) scores. Both groups exhibited similar improvements in FACE-Q Satisfaction with Lower Face and Jawline scores. Histologically, both groups demonstrated significant elastin production at the 120-day follow-up. Group A showed a 143% relative increase in elastin coverage, compared to a 63% increase in Group B. Consequently, Group A exhibited superior qualitative and histologic improvements. Conclusions Administering MFU-V first, followed by hyperdilute CaHA-CMC six weeks later, is the optimal sequence for this combination therapy. Although both groups experienced increased elastin synthesis and aesthetic improvements, the order of treatments significantly impacted the outcomes, favoring the sequence used in Group A. This finding provides valuable insight for optimizing combination therapies in aesthetic dermatology.