Hyperdilution of CaHA fillers for the improvement of age and hereditary volume deficits in East Asian patients

Abstract

With their high elasticity and viscosity, calcium hydroxylapatite (CaHA) fillers are now widely used to treat age-related or hereditary facial soft tissue volume deficits. CaHA filler volume augmentation is further enhanced by its ability to stimulate neocollagenesis and improve skin quality. However, its high viscosity and cohesivity may hinder its spread and distribution, while its injection by cannula or needle may require moderate extrusion force and lead to uneven distribution or focal accumulation in tissues. Thus, new or modified delivery techniques and tools have emerged, particularly from East Asian physicians. One such technique is hyperdilution with diluents such as lidocaine or normal saline. CaHA hyperdilution appears to be more frequently used by experienced injectors who have varying methodologies. Here, we demonstrate the precise delivery of diluted filler to treat indications related to hereditary volume deficits, volume loss, or aging in the periorbital, nasolabial and submalar regions, marionette lines, and hollowed mid-facial areas. Regardless of age or indication, dilution eases filler delivery for the injector, while using lidocaine as the diluent decreases patient discomfort and minimizes pain. Increasing injection diluent volumes reduces filler thickness (viscosity) and facilitates its even spread, encouraging skin stimulation through more direct contact with tissues and minimizing unevenness. Our results effectively demonstrate that hyperdilution is an innovative and positive evolution in CaHA filler delivery.

Keywords: CaHA; facial sculpting; facial volumization; hyperdilution; skin regeneration.

Conflict of interest statement

Disclosure All authors have received an honorarium from Merz to attend a meeting. The authors report no other conflicts of interest in this work.

Figures

Figure 1

Treatment of periorbital, nasolabial, and submalar regions with CaHA filler results in volume augmentation and skin texture improvement. Notes: Patient is shown at initial visit (A) prior to treatment and at follow-up visits at 8 weeks (B), 7 months (C), and 14 months (D) after the first procedure in which RAD CaHA filler was diluted with 2% lidocaine in a 5:1 ratio. (Photos courtesy of Dr Jong Woo Kim.) Abbreviations: CaHA, calcium hydroxylapatite; RAD, Radiesse®.

Figure 2

Treatment of marionette lines with diluted RAD using 27G cannula. Notes: Patient is shown at initial consultation (A) before treatment, 1 month after treatment (B), and 1 year (C) after treatment. Improvements to fine wrinkles were observed even after 1 month, due to the volumizing and neocollagenesis effect of RAD. (Photos courtesy of Dr Jongseo Kim.) Abbreviation: RAD, Radiesse®.

Figure 3

Low-resolution derma-scope images of marionette line area. Notes: The left and right sides of the patient’s face are shown at initial consultation before injection (A and B) and 1 month after treatment (C and D). Improvements to deep and fine lines are visible and persist even after 1 year (E and F) due to neocollagenesis. (Photos courtesy of Dr Jongseo Kim.)

Figure 4

Treatment of mid-face volume loss with hyperdiluted RAD. Notes: Patient is shown before treatment at initial visit (A and C), at 3.5 months (B), and 4.5 months (D) following RAD injection. (Photos courtesy of Dr Hyungseok Ko.) Abbreviation: RAD, Radiesse®.

Figure 5

Treatment of the whole-face by RAD hyperdilution. Notes: Patient is shown before (A and C) and 3 months after treatment (B and D). (Photos courtesy of Dr Kate Goldie.) Abbreviation: RAD, Radiesse®.