A Novel Hybrid Injectable for Soft-tissue Augmentation: Analysis of Data and Practical Experience

Abstract

Background: HA/CaHa (HArmonyCa, Allergan Aesthetics, an AbbVie Company) is a hybrid injectable filler developed for aesthetic purposes that contains calcium hydroxyapatite microspheres suspended in a hyaluronic acid gel. This review describes preclinical and clinical data, recommendations for use based on the primary author's clinical experience, and case studies that illustrate implementation of product use recommendations and patient outcomes.

Methods: Preclinical data on the lift capacity and tissue integration of the HA/CaHa hybrid injectable and clinical data on its safety, efficacy, and real-world use were extracted from poster presentations, published literature, manufacturer instructions for use, and proprietary data files. Case studies were presented based on clinical experience.

Results: The HA component of HA/CaHa provides an immediate and noticeable filling and lifting effect, whereas CaHa microspheres result in neocollagenesis. In preclinical studies, HA/CaHa demonstrated higher lift capacity (P < 0.05) and faster tissue integration than a CaHa filler and led to collagen I gene and protein expression. Clinical studies showed clinical safety and effectiveness with high patient satisfaction. The most common adverse event was injection-site response. Clinician recommendations for achieving desired aesthetic results while minimizing or preventing adverse events are reviewed, including patient selection and assessment, treatment approaches based on face shape, injection technique, and postprocedure care.

Conclusion: The novel hybrid injectable consisting of HA with incorporated CaHa microspheres in a single marketed product may help achieve aesthetic goals by immediately restoring volume and potentially improving skin architecture and soft-tissue quality over time.

Fig. 1.

HA/CaHa hybrid injectable filler consisting of crosslinked sodium hyaluronate gel with embedded synthetic calcium hydroxyapatite microspheres, as viewed on electron microscopy, showing a smooth consistency of the microspheres.

Fig. 2.

Preclinical study results. A, Lift capacity and (B) tissue integration of facial fillers and (C) collagen deposition (collagen I fibers) in a preclinical model of HA/CaHa, a CaHa filler, and a polycaprolactone filler. *P < 0.05 vs polycaprolactone. **P < 0.05 vs CaHa and polycaprolactone. Panels B and C are copyright Allergan Aesthetics. Collagen I fibers (second-harmonic generation imaging) were observed at 8 weeks in all products.

Fig. 3.

Treatment considerations when injecting HA/CaHa. A, Illustration showing the potential treatment areas for HA/CaHa using the C-Plus Approach. B, Anatomical presentation of the subcutaneous plane for HA/CaHa deposition along the mandible line and mandibular ramus. Image courtesy of Andre Braz, MD.

Fig. 4.

HA/CaHa treatment of a 53-year-old woman concerned with facial contour loss, skin thinning, and skin laxity. Treatment received: 2.5 mL of HA/CaHa; 1.25 mL per side of face. Individual results may vary. Images courtesy of Andre Braz, MD.

Fig. 5.

HA/CaHa treatment of a 50-year-old woman with concerns about facial contour loss, skin thinning, and skin laxity. Patient is shown with her face at rest before treatment and 1 year after the second treatment session; improvements in the jawline are evident. Individual results may vary. Images courtesy of André Braz, MD.

Fig. 6.

HA/CaHa treatment of a 50-year-old woman with concerns about facial contour loss, skin thinning, and skin laxity. When the patient is smiling, improvements are seen in the accordion lines, jawline, and midface. Treatment received: 6.1 mL of HA/CaHa in two separate sessions; results shown from second session. Individual results may vary. Images courtesy of André Braz, MD.