Global Recommendations for Facial Rejuvenation Using a Hyaluronic Acid and Calcium Hydroxyapatite Hybrid Injectable.

BACKGROUND: The hybrid injectable HA-CaHA contains a formulated matrix of crosslinked hyaluronic acid (HA) gel with embedded calcium hydroxyapatite (CaHA) microspheres to increase skin elasticity and hydration as well as promote neocollagenesis, respectively. Clinical practice recommendations for use of HA-CaHA are limited. AIMS: The objective of this article was to provide global recommendations on safe and effective practices for injecting HA-CaHA. PATIENT/METHODS: An expert panel consisting of eight international consultants was invited to discuss and provide best-practice recommendations on HA-CaHA patient selection, skin laxity assessment, injection techniques, touch-up/retreatment practices, combination treatment protocols, and safety considerations. RESULTS: The expert panel recommended using HA-CaHA for structural support and soft tissue repositioning in patients with skin laxity, sagginess, and mild to moderate loss of volume and contour. They also recommended defining injection entry points by referring to the line of ligaments and the zygomatic arch and keeping injections in the lateral and thus less mobile areas of the face. Experts advised using a cannula instead of a needle, retreating only if mild to moderate skin laxity recurs, and injecting in small volumes. Measures to minimize potential side effects, including injection site responses, were discussed. CONCLUSIONS: Expert clinical recommendations affirm the safe and effective use of HA-CaHA to improve soft tissue quality over time.