Ultrasonographic Patterns of Calcium Hydroxyapatite According to Dilution and Mix With Hyaluronic Acid

Abstract

ObjectivesTo assess the ultrasonographic patterns of different calcium hydroxyapatite (CaHA) formulations, including the undiluted, diluted, and mixed with hyaluronic acid (HA) compounds.MethodsTo review the ultrasonographic images of patients ≥18 years with confirmed injections of CaHA clinically and ultrasonographically, and without different concomitant types of fillers in the same region or other systemic or localized cutaneous diseases.ResultsTwenty‐one patients met the criteria (90% female; 10% male; mean age: 52 years ± 12.8). Of these, 33.3% have been injected with an undiluted formulation, 33.3% with diluted, and 33.3% with a mixed formulation. All cases were studied with devices presenting frequencies that ranged from 18 to 24 MHz. Twelve cases (57%) were also studied with the 70 MHz.The ultrasonographic patterns of CaHA presented differences in the presence and intensity of PAS and the degree of inflammation according to the dilution and mix with HA. Diluted formulations show a milder intensity posterior acoustic shadowing (PAS) artifact than undiluted at 18–24 MHz. In mixed formulations, 57% showed mild PAS, and 43% demonstrated no PAS artifact at 18–24 MHz, besides fewer inflammatory changes in the periphery of the deposits.ConclusionsThe ultrasonographic patterns of CaHA show differences in the presence and intensity of PAS and the degree of inflammation according to the dilution and mix with HA. Awareness of these ultrasonographic variations can support better discrimination of CaHA.

Ultrasound for fillers: a preprocedural and postprocedural tool

“…7,12,[14][15][16] Calcium hydroxyapatite-based fillers show as brightly hyperechoic small deposits with posterior acoustic shadowing that can vary in intensity according to the dilution. 7,12,17 Poly-l-lactic acid-based fillers appear as a diffuse hyperechoic agent that tends to generate prominent subcutaneous fibrosis at later stages. 7,12,13 Silicone oil presents as a poorly defined hyperechoic deposit with diffuse posterior acoustic reverberance, which is called a "snowstorm" artifact.…”