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. 2022 Feb;46(1):373-381.
doi: 10.1007/s00266-021-02479-x. Epub 2021 Aug 2.

Combining Calcium Hydroxylapatite and Hyaluronic Acid Fillers for Aesthetic Indications: Efficacy of an Innovative Hybrid Filler

Nabil Fakih-Gomez #  1 , Jonathan Kadouch #  2
Affiliations

Combining Calcium Hydroxylapatite and Hyaluronic Acid Fillers for Aesthetic Indications: Efficacy of an Innovative Hybrid Filler

Nabil Fakih-Gomez et al. Aesthetic Plast Surg. 2022 Feb.

Abstract

Background: Limited data are available describing effectiveness of combining the use of calcium hydroxylapatite (CaHA) and hyaluronic acid (HA).

Methods: The authors performed a retrospective chart review of patients injected with a premixed combination of CaHA and a cohesive polydensified matrix (CPM®) HA (CaHA:CPM-HA ) in the authors' aesthetic practices. The midface and lower face were injected. Patients' records were evaluated, and treatment results were scored using the Merz Aesthetics Scale for the jawline® (clinician rated, CR-MASJ). Adverse events were recorded.

Results: A total of 41 patients were included, all females with a mean age of 47.5 years (range 21-63 years). The mean CR-MASJ score improved from 2.12 at baseline to 0.68 at t = 3 months (SD = 0.69, 95% CI 1.28-1.60) and 1.27 at t = 12 months (SD = 0.74, 95% CI 0.43-0.74). 100% of the subjects had experienced a ≥1-point improvement in CR-MASJ score at t = 3 months, versus 85% at t = 12 months. No adverse events were reported.

Conclusion: The results of this study support the volumizing and lifting potential of the hybrid mix CaHA:CPM-HA for treatment of cheeks and jawline.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Calcium hydroxylapatite; Effectiveness; Fillers; Hyaluronic acid; Hybrid; Premixing; Radiesse.

PubMed Disclaimer

Conflict of interest statement

Both authors are consultants for Merz Pharma.

Figures

Fig. 1
Fig. 1
Many physicians are taking advantage of the complementary mechanisms of action of HA and CaHA fillers by combining
Fig. 2
Fig. 2
Merz Aesthetics Scale® for jawline: a validated, objective, quantitative rating scale for evaluating the esthetic signs of aging
Fig. 3
Fig. 3
a 37-year-old female seeking full facial rejuvenation. b Premixed hybrid filler injection (3 cc of CaHA, 6 cc of CPM-HA V and 1 cc of lidocaine 2%) (black) is injected subcutaneously with threading technique. Also 0.5 cc of CPM-HA V (purple) was injected to the temples in each side and 0.5 cc of CPM-HA B (orange) in lateral orbital rim and tear valley on each side. c Result at 1 month after premixed hybrid filler injection. d Before and after 1 month after premixed hybrid filler injection. e Result at 6 months after premixed hybrid filler injection. f Result at 12 months after premixed hybrid filler injection. g Before and after 12 months after premixed hybrid filler injection
Fig. 4
Fig. 4
a 46-year-old female seeking full facial rejuvenation. b Premixed hybrid filler injection (3 cc of CaHA, 3 cc of CPM-HA V and 1 cc of lidocaine 2%) (black) is injected subcutaneously with threading technique. c Result at 1 month after premixed hybrid filler (3 cc of CaHA, 3 cc of CPM-HA V and 1 cc of lidocaine 2%). d Revision at 1 month after previous premixed hybrid filler injection 3 cc of CaHA, 3 cc of CPM-HA V and 1 cc of lidocaine 2%. Patient desired more improvement. Re-injection of premixed hybrid filler (3 cc of CaHA, 4 cc of CPM-HA V and 1 cc of lidocaine 2%) (black) and 0.5 cc of CPM-HA Balance (orange) in tear valley per side. e Result at 6 months after premixed hybrid filler injection (6 cc of CaHA, 7 cc of CPM-HA V and 2 cc of lidocaine 2%) and 0.5 cc of CPM-HA balance in tear valley per side. f Result at 12 months after premixed hybrid filler injection. g Result at 14 months after premixed hybrid filler injection
Fig. 5
Fig. 5
Mean CR-MASJ scores (with 95% confidence intervals) across baseline and post-treatment (t = 3 months and t = 12 months) measurements
Fig. 6
Fig. 6
Improvement in jawline contour quantified by the validated photo-numeric 5-point Merz Aesthetics Scale for jawline® (clinician rated, CR-MASJ). The mean CR-MASJ scores improved from 2.12 at baseline to 0.68 (SD = 0.69) at t = 3 months and 1.27 (SD = 0.74) at t = 12 months
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