Pan-Asian Consensus on Calcium Hydroxyapatite for Skin Biostimulation, Contouring, and Combination Treatments

Abstract

Background: Several usage guidelines for calcium hydroxylapatite (CaHA), a dermal filler material, exist for non-Asian patients, making it necessary to determine whether their findings and consensuses are applicable to Asian patients who have distinct anatomies, cultural preferences, and aesthetic requests.

Objective: We sought to develop a Pan-Asian consensus on CaHA use in skin biostimulation, contouring, and combination treatments for face and body indications.

Methods: A survey on CaHA usage for contouring and biostimulation indications in Asian patients was conducted, followed by discussions to establish consensus statements and topics for examination.

Results: Several aspects of facial shaping and contouring or skin biostimulation with CaHA were agreed on, including that dilution is not a key consideration, that microfocused ultrasound with visualisation precedes CaHA in same day or session treatments, and that cannulas should be used. Among the many agreements on interventions in specific facial and body areas, there were also disagreements due to the diverse Asian patient presentations, requests, and access to tools or products; for example, CaHA should be placed in the interfascial layer for temple contouring, CaHA should not be injected directly into the infraorbital area for safety, and diluted CaHA should be injected subdermally for nonfacial or whole-face biostimulation and contouring.

Conclusion: Our disagreements highlight the diversity of Asian facial morphotypes and desired aesthetic outcomes and underscore the need for customized aesthetic strategies to accommodate the heterogeneity of Asian anatomies, cultural preferences, and aesthetic ideals. Establishing consensus statements on critical aspects of Asian patient considerations, efficacy and safety, is crucial. This document provides strategic guidance on the use of classic, diluted CaHA for biostimulation or undiluted Radiesse^®(+) (Merz Pharma GmbH & Co. KGaA, Frankfurt, Germany) for lifting and contouring to ensure consistent CaHA delivery for successful patient outcomes.

Keywords: Asian; calcium hydroxylapatite; consensus statement; dermal fillers.

FIGURE 1.

CaHA Injection into temples. Patient before (left) and after (right) temple volumization with 3.0 mL of CaHA. Photos courtesy of Dr. Jeng Feng Chen.

FIGURE 1b.

Physician demographics. Clinical background and usage of aesthetic procedures and tools discussed in the consensus meeting.

FIGURE 2.

Chin augmentation. Patient before (left column) and after (right column) receiving 1.5 mL of CaHA. Photos courtesy of Dr. Jeng Feng Chen.

FIGURE 2b.

CaHA Injection into the forehead. Before (left) and two weeks postinjection (right) with 0.3 mL of diluted CaHA (1.5 mL CaHA with 1 mL of lidocaine) in the forehead, facilitated through saline hydrodissection, with 0.5 mL of moderately diluted CaHA (0.5 mL of lidocaine for 1.5 mL of CaHA) per side along the brow ridge. Temples are filled with CPM-HA to balance the gap between the new forehead and cheek prominence. Figures courtesy of Dr. Yates Chao.

FIGURE 3.

Illustration of cheek areas under consideration. Reproduced with permission from Few J, Cox SE, Paradkar-Mitragotri D, Murphy DK. A multicenter, single-blind randomized, controlled study of a volumizing hyaluronic acid filler for midface volume deficit: patient-reported outcomes at 2 years. Aesthet Surg J. 2015;35(5):589–599. Copyright May 11, 2015, Oxford University Press.

FIGURE 4.

Facial biostimulation. Patient before (left vertical panel) and after (right vertical panel) receiving 1.5 mL of CaHA diluted 1:1 with 2% lidocaine. Photo courtesy of Dr. Siew Tuck Wah.