Hidroxiapatita de cálcio: uma revisão quanto à eficacia, segurança e imaginologia quando usado como preenchedor e como bioestimulador

Este artigo teve como objetivo apresentar por meio de uma revisão de literatura a eficácia, segurança e satisfação dos pacientes com o uso de hidroxiapatita de cálcio como preenchedor e como bioestimulador de colágeno. Trata-se de uma revisão de literatura realizada por meio de busca ativa dos artigos cientificos na base de dados: U.S. National Library of Medicine (PubMed), utilizando como termo de busca: calcium hydroxylapatite cosmetic. Foram selecionados 69 publicações, no periodo de 2016 à 2021, entretanto à partir dos critérios de inclusão e exclusão foram selecionados 20 artigos. Baseado na revisão de literatura feita neste estudo, a hidroxiapatita de cálcio mostrou-se eficaz como bioestimulador de colágeno e elastina ; como preenchedor apresentou um melhor efeito lift (exceto no caso do lift de sobrancelha) por causa do seu alto módulo de elasticidade, podendo ser usado como suporte para outros preenchedores e fios de sustentação; teve um elevado nivel de satisfação dos pacientes; é considerado um material com um bom perfil de segurança, desde que respeitada a técnica e as indicações ; e pode ser visualizado em radiografias, tomografias e ultrassonografias de alta resolução.

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

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.

A Hybrid Filler: Combining Calcium Hydroxylapatite and Hyaluronic Acid Fillers for Aesthetic Indications

Limited data are available describing the use of calcium hydroxylapatite (CaHA) and hyaluronic acid (HA) in combination. The aim of this study is to investigate the safety of premixing CaHA and HA fillers before injection. The authors performed a retrospective chart review of patients injected with a premixed combination of CaHA and a cohesive polydensified matrix (CPM®) HA in the authors’ aesthetic practices. Patients records were evaluated for adverse events at 1-3 month, 5-7 month and >12-month posttreatment follow-up visits. The retrospective chart review identified 134 patients who had been treated with premixed CaHA: HA, most of whom were female (95%). Most patients were treated for multiple facial areas. Injections were subcutaneous and performed with 25G 38- or 50-mm cannulas, using a fanning injection technique. Injection volumes and product ratios depended on the number of areas being treated and severity of the aesthetic defect. Only 2 adverse events were reported which comprised slight cases of overcorrection at 1-3 months, both of which resolved with hyaluronidase. No other adverse events were reported. This combined evaluation of the published literature and retrospective examination of case reports raised no concerns about the use of premixed CaHA and CPM-HA (Hybrid) fillers for the treatment of a range of facial aesthetic indications.

Cosmetic Syndrome Correction with Calcium Hydroxylapatite-Based Filler in Patients with Connective Tissue Dysplasia

Undifferentiated connective tissue dysplasia is one of the most common diseases of nowadays, which does not fit into the group of hereditary syndromes. This condition is diagnosed in 20–50% of the population at any age. The study aimed to correct the facial soft tissues of patients with undifferentiated connective tissue dysplasia through the cosmetic procedure of calcium hydroxylapatite injection. In 2018, a 36-year-old patient addressed the beauty salon with signs of undifferentiated connective tissue dysplasia, such as severe asymmetry of the face, infraorbital and nasolabial sulci, and thin and easily folding skin. Signs were observed from the age of 22, i.e., for 14 years. The therapy was performed using special features of the correction of facial soft tissue changes in patients with connective tissue dysplasia (CTD) using calcium hydroxylapatite-based products (Radiesse®, Merz North America, Inc., USA). Particular attention is given to the need for early correction to prevent premature skin aging related to this condition. After 14 days, a significant improvement of the patient’s skin condition was noted after the passing of two procedures. Her condition was estimated as consistent with T1-2P0G0A1Zh1 P1M1K1 and corresponded to grade I age-related changes in the superficial soft tissues. The performed treatment showed high efficacy in case of mild connective tissue dysplasia diagnosis. The results showed that when collecting information from anamnesis, the diagnostic criteria for dysplasia should be considered. If the criteria are met, the cosmetological correction with collagen stimulators becomes possible.