Use of calcium hydroxylapatite in the upper third of the face: Retrospective analysis of techniques, dilutions and adverse events

Abstract

Calcium hydroxylapatite (CaHA) is a commonly used soft tissue filler for aesthetic facial improvement, in particular for the lower and mid-face. The golden standard for upper facial filler indications is hyaluronic acid (HA) injection. In this report we investigate the safety, efficacy and complication rates after injections of CaHA to the upper third of the face using a variety of different techniques. This was a retrospective analysis performed on patients who had received CaHA in 2016 and 2017 at various dilutions in the upper third of the face (frontal area, eyebrows and temporal hollows) using a number of injection techniques and both blunt-tipped cannulas as well as sharp needles. Records of adverse events and side effects were studied. Seventy patients had been injected with CaHA in the upper third of the face. There were 36 treatments to the frontal area, most with a cannula in the subgaleal space with standard dilution of CaHA (16.7% lidocaine containing epinephrine). There were 13 treatments to the brow, mostly with a cannula and multilevel technique, and 66 treatments to the temporal hollows, mostly with a cannula in the interfascial space with standard CaHA dilution. No serious complications were recorded. CaHA was effective and well-tolerated for a range of upper-face indications. More (prospective) research is required to further determine the value of CaHA treatments in these areas.

Managing intravascular complications following treatment with calcium hydroxylapatite: An expert consensus

“…To minimize risk, injections should always be performed slowly, with low volume and attention paid to the pain feedback received from the patient. Close to the supratrochlear and supraorbital foramina, no injection should be performed in the supraperiosteal and subgaleal planes, respectively 42,43…”

“…A recent cadaver study, which compared the forces required to penetrate the facial arterial vasculature, found that all sizes of cannula with the exception of 27G required greater forces for intra‐arterial penetration compared with correspondingly sized needles; 27G cannulas required a similar force to a 27G needle 34. Van Loghem et al47 suggest the use of a cannula when treating the frontal area and have published techniques for injections in this zone 43…”

The use of periocular fillers in aesthetic medicine

“…8,[10][11][12][13][14][15][16][17] The second most popular periocular filler was Calcium Hydroxylapatite (CaHA). [18][19][20][21] Literature pertaining to the periocular use of Autologous Fat (AF) 22,23 Polymethylmethacrylate (PMMA), 9 Poly-L-Lactic Acid (PLLA), 24 Collagen 25 and polyalkylimide 26 was also identified. Research in to newer dermal fillers such as polynucleotides (PN) 7 and fibroblasts 5,28 was also identified.…”

“…5-9, 11-13, 15, 17,18, 20, 22,23, 25-34 The superior sulcus was the second most commonly treated area. 10,14,[35][36][37] The glabella, 21,33 crow's feet, 27,33 and brow 19 were other areas also treated with periocular dermal filler injection. Articles related to glabella enhancement for nasal augmentation were excluded.…”

“…The author does not mention how many patients developed oedema in total. 19 Therefore we can assume the rate is actually higher if we include those that resolved within 3 days. Sires et al reported a case of Radiesseinduced Herpes Zoster.…”