Dual Benefits of Calcium Hydroxyapatite Filler: A Prospective Study on Midface Volume Restoration and Skin Quality Enhancement

Abstract

Background: Calcium hydroxyapatite (CaHA) fillers are widely used for soft-tissue augmentation due to their volumizing properties and biostimulatory effects. However, clinical evidence supporting the dual role of CaHA as both a volumizer and a skin booster remains limited.

Objectives: To evaluate the efficacy of CaHA filler (VoLassom) in midface volume restoration and assess its effects on skin barrier function, hydration, and elasticity over 24 weeks.

Methods: Fifteen participants aged 19-70 years with moderate midface volume deficiency (Midface Volume Deficiency Scale [MFVDS] grade ≥ 3) received CaHA filler injections. Clinical assessments included MFVDS scoring, the Global Aesthetic Improvement Scale (GAIS), and patient satisfaction ratings at baseline and at weeks 2, 4, and 24. Instrumental evaluations of transepidermal water loss (TEWL), corneometer-based hydration, and cutometer-measured elasticity (R2, R5, and R7) were conducted at all timepoints.

Results: MFVDS scores significantly decreased from baseline to weeks 2, 4, and 24, demonstrating sustained volume restoration. GAIS scores remained high, with all participants rated as significantly improved (5.0) at weeks 2 and 4, though slightly reduced at week 24 (4.53 ± 0.52). Patient satisfaction remained consistently high. TEWL significantly decreased at weeks 4 and 24 (p < 0.01), indicating improved skin barrier function. Corneometer measurements showed significant hydration improvements at all timepoints (p < 0.05 and p < 0.001, respectively). Skin elasticity, measured by R2, R5, and R7, significantly increased at weeks 4 and 24 (p < 0.01), suggesting enhanced skin firmness.

Conclusions: CaHA filler demonstrated effective and sustained volume restoration while significantly improving skin hydration, barrier function, and elasticity. These findings suggest that CaHA functions not only as a volumizer but also as a skin booster, offering a comprehensive approach to facial rejuvenation. Nevertheless, further studies with larger cohorts are warranted to validate these results.

Keywords: calcium hydroxyapatite; dermal filler; facial rejuvenation; skin booster; volumization.

FIGURE 1

Changes in Midface Volume Deficiency Scale (MFVDS) scores over time. The mean MFVDS score decreased significantly from baseline (3.33 ± 0.49) to week 2 (1.07 ± 0.70, p < 0.001) and week 4 (1.13 ± 0.64, p < 0.001), demonstrating substantial volume improvement. At week 24, the MFVDS score increased to 2.00 ± 0.63 but remained significantly lower than baseline (p < 0.001), indicating partial volume retention. y‐axis: MFVDS score (scale 1–5); x‐axis: Time point.

FIGURE 2

Representative Cases Demonstrating Midface Volume Enhancement After Treatment. Representative cases showing the effects of treatment on midface volume. Case A: (A1) Baseline image before treatment. (A2) Follow‐up image taken 4 weeks post‐treatment, illustrating a noticeable increase in midface volume. Case B: (B1) Baseline image before treatment. (B2) Follow‐up image taken 4 weeks post‐treatment, demonstrating similar volume enhancement in a different patient.

FIGURE 3

Changes in transepidermal water loss (TEWL) over time. TEWL values showed a decreasing trend from baseline (12.22 ± 2.21 g/h/m²) to week 4 (10.80 ± 2.30, p < 0.01) and week 24 (9.91 ± 3.37, p < 0.01), indicating improved skin barrier function following treatment. y‐axis: TEWL (g/m²/h); x‐axis: Time point.

FIGURE 4

Changes in skin hydration measured by corneometry. Skin hydration improved significantly from baseline (66.53 ± 9.75) to week 2 (71.77 ± 9.74, p < 0.05), week 4 (75.71 ± 8.52, p < 0.001), and week 24 (75.34 ± 7.67, p < 0.05), reflecting increased moisture retention after filler treatment. y‐axis: Corneometer units; x‐axis: Time point.

FIGURE 5

Cutometer measurements of skin elasticity parameters (R2, R5, and R7) at baseline, week 2, week 4, and week 24. Skin elasticity, as represented by R2, R5, and R7, improved over time, with significant increases in R2 at weeks 4 and 24 (p < 0.0002 and p < 0.00004, respectively), along with significant improvements in R5 and R7, suggesting enhanced skin firmness and resilience following treatment. y‐axis: Cutometer units; xaxis: Time point.