An Innovative Treatment Using Calcium Hydroxyapatite for Non-Surgical Facial Rejuvenation: The Vectorial-Lift Technique

Abstract

Background: The facial aging process entails alterations in the volume, shape, and texture of all skin layers over time. Calcium hydroxyapatite (CaHA) is a well-established safe skin filler with unique properties to resolve some skin alterations by stimulating neocollagenesis. The vectoral-lift (V-lift) technique targets the global repositioning of facial structures by addressing distinct anatomical injection planes. It includes deep facial augmentation with Radiesse Plus^TM to retain ligament restructuring and superficial subcutaneous enhancement with diluted Radiesse Duo^TM. Herein, we present cases that illustrate the use of this approach.

Methods: This pilot study enrolled 36 participants (33 women and three men; ages 37-68 years) in a Brazilian clinical setting, and all patients underwent a single treatment. Photographs were taken at rest, in frontal and oblique views, before injection, and 90 days after treatment.

Results: Treatment resulted in elevation of the upper and middle face, notable improvements in the infraorbital hollow, and adjustment of the mean facial volume.

Conclusions: The V-lift technique is a three-dimensional pan-facial treatment that relies on ligament support and face vectoring to obtain a lifting effect and facial contour restoration. It encompasses deep facial augmentation involving the use of Radiesse Plus^TM for restructuring and retaining ligaments and Radiesse Duo^TM for superficial subcutaneous enhancement. This approach targets a global repositioning of the facial structures by addressing distinct anatomical injection planes. It achieves a repositioning of the overall facial anatomy without requiring a substantial volumetric expansion.

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: Aesthetics; Biostimulation; Calcium hydroxyapatite; Collagen; Dermatology; Plastic surgery; Skin aging.

Fig. 1

Injection areas in the subcutaneous and supraperiosteal facial planes. 1: Radiesse Duo injection areas in the subcutaneous plane aim to create a vector to lift the face. 2: Radiesse Lidocaine injection areas in the supraperiosteal plane. 3: Radiesse Lidocaine injection areas in the subcutaneous plane

Fig. 2

Facial mapping for a series of injections. Top line: Markings and delimitations of the regions for treatment. Bottom line: The injection sequence comprising Radiesse Duo (first syringe), Radiesse Lidocaine (second syringe), Radiesse Duo (third syringe), and Radiesse Lidocaine (fourth syringe)

Fig. 3

Timeline of treatment comprising Day 0 (D0; day of treatment) and Day 90 (D90; 90 days after treatment) time-points for a patient who underwent the V-lift technique. A generalized improvement of the shadows of the face, restoration of the zygomatic arch and malar region, attenuation of nasolabial lines, and elevation of the angle of the mouth can be observed 90 days after completion of the V-lift technique

Fig. 4

Timeline of treatment comprising Day 0 (D0; day of treatment) and Day 90 (D90; 90 days after treatment) time-points for a patient who underwent the V-lift technique. A generalized improvement of face shadows, restoration of the zygomatic arch, attenuation of the malar mound with restoration of the malar region, attenuation of nasolabial lines, and elevation of the pre-jowl area can be observed 90 days after completion of the V-lift technique

Fig. 5

Timeline of treatment comprising Day 0 (D0; day of treatment) and Day 90 (D90; 90 days after treatment) time-points for a patient who underwent a V-lift technique. Note the global repositioning of tissues with the resulting softer facial expression

Fig. 6

A comparison of a young and aging face showing the three-dimensional aging process. Left: A schematic representation of the face of a young woman with well positioned anatomical layers. Right: A schematic representation of an aging face with changes in the positioning of ligaments due to the gravitational weight of anatomical compartments determined by aging

Fig. 7

A schematic representation of the repositioning of the cutaneous ligaments leading to a suspension effect

Fig. 8

Biomechanical subMAS layer redensification mechanisms and vectorization of the facial ligaments implement the global repositioning of the face as a mechanism of pulleys interconnected by the superficial musculoaponeurotic system (SMAS) and superficial temporal fascia

Fig. 9

A schematic representation of the planes of injection, vectors and direction of injection of different types of CaHA, according to study objectives and definition of facial planes

Fig. 10

Face CT scan showing CaHa injection in the zygomatic arch in the subSMAS plane (justaperiosteal) and in the temporal region in the subcutaneous plane