Calcium Hydroxylapatite Research Articles

Human Histology and Persistence of Various Injectable Filler Substances for Soft Tissue Augmentation.

An increasing number of soft tissue filler substances have been introduced to the beauty market outside the U.S. which lackexperimental and clinical data in support of their claim. Ten commercially available filler substances were examined for biocompatibility and durability: 0.1 cc of each substance was injected deep intradermally into the volar forearm of one of the authors and observed for clinical reaction and permanence. At 1, 3, 6, and 9 months the test sites were excised, histologically examined, and graded according to foreign body reactions classification. Collagen (Zyplast) was phagocytosed at 6 months and hyaluronic acid (Restylane) at 9 months. PMMA microspheres (Artecoll) had encapsulated with connective tissue, macrophages, and sporadic giant cells. Silicone oil (PMS 350) was clinically inconspicuous but dissipated into the tissue, causing a chronic foreign body reaction. Polylactic acid microspheres (New-Fill) induced a mild inflammatory response and had disappeared clinically at 4 months. Dextran microspheres (Reviderm intra) induced a pronounced foreign body reaction and had disappeared at 6 months. Polymethylacrylate particles (Dermalive) induced the lowest cellular reaction but had disappeared clinically at 6 months. Polyacrylamide (Aquamid) was well tolerated and remained palpable to a lessening degree over the entire testing period. Histologically, it dissipated more slowly and was kept in place through fine fibrous capsules. Polyvinylhydroxide microspheres suspended in acrylamide (Evolution) were well tolerated, slowly diminishing over 9 months. Calcium hydroxylapatite microspheres (Radiance FN) induced almost no foreign body reaction but were absorbed by the skin at 12 months.Host defense mechanisms react differently to the various filler materials, but all substances- resorbable or nonresorbable-appeared to be clinically and histologically safe, although all exhibit undesirable side effects. Since the mechanism of late inflammation or granuloma formation is still unknown, early histological findings are not useful in predicting possible late reactions to filler substances.

Enhancing the Lateral Orbital "C-Angle" With Calcium Hydroxylapatite: An Anatomic and Clinical Study.

Deliberate injection of specific facial subunits may improve aesthetic outcomes in facial rejuvenation. We contend that the lateral orbital area (LOA) is a key anatomic subunit in the perception of eye attractiveness, with a C-shaped distribution of fat contributing to the formation of a distinct angle in the lateral orbit. The aim of this study was to describe the anatomy of the LOA that constitutes the C-shaped angle and to investigate the safety and cosmetic outcomes of nonsurgical enhancement of that area with calcium hydroxylapatite (CaHA). Four injected fresh-frozen cadaver heads were dissected. Twenty patients were enrolled in a prospective clinical study. Participants were seen on the day of injection, and at 2 weeks and 3 months postinjection. Two-dimensional and 3D photographs were analyzed to quantify the volumetric changes between pretreatment and postinjection time points. Secondary outcomes included Global Aesthetic Improvement Scale score and subject satisfaction at 3 months. Cadaver dissections revealed distinct fat compartments and a zone of adhesion forming the C-shaped area around the lateral orbit. In the clinical study, a mean of 1.88 mL of CaHA was injected into each lateral periorbital region. There was 97% and 76% volume retention at 2 weeks and 3 months, respectively, with 70% of patients being "very satisfied" at 3 months. The average Global Aesthetic Improvement Scale rating at 3 months was 3.95. There were no complications. The LOA is a distinct facial subunit that can be enhanced safely by CaHA injection with good cosmetic outcomes. Focusing on the C-angle can improve periorbital aesthetics.

Correction of temporal wasting using calcium hydroxylapatite with integral lidocaine: An underused procedure for enhancing overall facial appearance.

Hollowing of the temple area is an early sign of aging that is often overlooked, but when corrected, can lead to significant subject and physician satisfaction. To assess physician and subject awareness of the impact of temporal hollowing on appearance and to evaluate treatment satisfaction following injection of calcium hydroxylapatite with integral lidocaine (CaHA(+)). Subjects with temporal depression grade ≥2 on a validated Temple Hollowing Scale were recruited. CaHA(+) was injected supraperiosteally using a bolus technique. Photographs were taken prior to treatment and 30 days, and graded by three evaluating physicians using the Global Aesthetic Improvement Scale (GAIS) and Temple Hollowing Scale. The same physicians estimated subjects' age before and after treatment. Photographs were graded by patients as part of a satisfaction questionnaire. The study enrolled 10 subjects aged 32-68years old. Physician GAIS scores of subject appearance at 1month were rated as "very much improved" in 80% and "much improved" in 20% of subjects. Temple hollows were graded as 1 after treatment in 90% of subjects. Following blinded review of patients' true ages, estimates for subjects' perceived age were on average 4years younger than their actual age. Most subjects had not been aware of temple hollowing prior to treatment, but nine out of 10 were very to extremely satisfied with results, and all were willing to repeat treatment. No treatment complications were observed. Treatment of the temple area can have a dramatic aesthetic effect and should not be neglected when addressing facial rejuvenation. CaHA(+) is an effective and well-tolerated product for use in the temple area and is associated with a high degree of subject and physician satisfaction.

Management of periorbital hyperpigmentation: An overview of nature-based agents and alternative approaches.

Periorbital hyperpigmentation (POH) is a common dermatological condition that presents as dark periorbital area beneath the lower eyelids, and it is commonly found in females belonging to the age group of 16 to 45 years. The data presented in this review include studies conducted on patients with a clinical/histological diagnosis of POH or melasma. Many diverse topical depigmenting agents comprising an array of naturally obtained actives such as arabinoxylans, α-arbutin, asiaticoside, azelaic acid, beta-carotene, boswellic acid, caffeine, chrysin, curcumin, cyanidin-3-glucoside, d-glucoronic acid, dihydrochalcone, dipalmitoyl-hydroxyprolene, fucoxanthin, genistein, glabridin, b-glucogallin, hyaluronic acid, lactic acid, lycopene, niacinamide, pycnogenol, retinol, salidroside, and xymenynic acid demonstrated significant benefits in the management of POH. An exhaustive literature search revealed that other techniques such as blepharoplasty, carboxytherapy, calcium hydroxylapatite fillers, tear trough implant, Q-switched ruby laser, medicated tattoo, fat transfer, micro-needling, chemical peels, nitrogen plasma skin regeneration, intense pulsed light, and radiofrequency have been evaluated and reported to be beneficial in the treatment of POH. The use of topical depigmenting agents is the most widely reported method in the clinical management of POH. Of these, α-arbutin, caffeine, cyanidin-3-glucoside, and dihydrochalcone are reported to exhibit significant benefits. Combination products containing a blend of actives are reported to be better than single active containing products. This review aims to provide a comprehensive perspective on the role of several topical actives in the modulation of melanin and tyrosinase biosynthesis pathway involved in the complex pathophysiology of POH. It also presents the advantages of combination products and other alternative therapies used in the management of POH.

Anatomy of the Dorsum of the Foot and Its Relevance for Nonsurgical Cosmetic Procedures.

Operative procedures to enhance the aesthetic appearance of the feet are associated with risks. Minimally invasive procedures to volumize the dorsum of the foot are to this point not described. The present study investigates the safety and efficacy of such procedures in a retrospective clinical, anatomical, and ultrasound-based study. A total of 106 feet from 53 female patients (mean age, 64.1 ± 8.3 years) were investigated retrospectively after the injection of a commercially available calcium hydroxylapatite product using a single-entry proximal-to-distal fanning injection technique. Anatomical dissections in 20 fresh, nonembalmed feet from 10 human body donors (mean age, 83.1 ± 8.8 years) were dissected, and 20 feet from 10 healthy volunteers (mean age, 26.5 ± 6.2 years) were examined by ultrasound imaging to help guide conclusions. Aesthetic outcome after 3 months was graded by the patients as 4, connoting good improvement (range, 3 to 5). No allergic reactions or other types of adverse events were documented. The layered anatomy of the dorsum of the foot was confirmed by anatomical dissections and ultrasound imaging as follows: skin, dorsal superficial fatty layer, dorsal superficial fascia, dorsal intermediate fatty layer, superficial lamina of the dorsal deep fascia, dorsal deep fatty layer, and deep lamina of the dorsal deep fascia. Minimally invasive injections of soft-tissue filler in the dorsum of the foot can provide an alternate solution to enhance the aesthetic appearance of feet. The present study provides support for the safety and efficacy of volumizing procedures using a 22-gauge, 50-mm, blunt-tip cannula. Therapeutic, IV.

Complications of non‐hyaluronic fillers

AbstractBackgroundThere are three non‐hyaluronic acid fillers available in the United States: Poly‐L‐lactic acid, calcium hydroxylapatite, and polymethylmethacrylate. Potential complications vary amongst the products.AimsTo identify the most common and most concerning complications for the three FDA‐approved non‐hyaluronic acid fillers.Materials & MethodsA comprehensive review of the literature was performed with key search words "complications," "non‐hyaluronic acid fillers," "poly‐l‐lactic acid," "calcium hydroxyapatite," and "polymethylmethacrylate."ResultsSimilar to hyaluronic acid fillers, the most common adverse effects of non‐HA fillers are injection site reactions, and the most concerning events are cutaneous necrosis and blindness. Non‐HA fillers also have increased risk of papule, nodule, and granuloma formation.DiscussionPapules and nodules arising early are likely to be technique‐dependent, while those arising later can be due to an immunologic foreign‐body response or infectious process. Histopathologic examination is required to diagnose a granuloma. Management of these complications requires intralesional and/or systemic corticosteroids, intralesional 5‐fluorouracil, surgical excision, and systemic antibiotics.ConclusionIt is vital that injectors are experienced in proper injection technique. Even more importantly, injectors must have the knowledge to recognize and manage complications when they arise.

Prospective and randomized comparative study of calcium hydroxylapatite vs calcium hydroxylapatite plus HIFU in treatment of moderate-to-severe acne scars.

Acne scars are the most common sequelae of the severe inflammatory process of acne, and its managing is a challenge. Objective of this study was to assess safety and effectiveness of calcium hydroxylapatite monotherapy and its association with high-intensity microfocused ultrasound for treating moderate-to-severe atrophic acne scars. Women with moderate-to-severe atrophic scars of the face were enrolled on the study. Assessments were made by digital macrophotographs, Vectra H2, and Antera 3D. From October to December 2019, twenty women which fitted the inclusion criteria signed a consent form and received 3.0mL of calcium hydroxylapatite and after 4weeks, 400 lines of HIFU. No major side effects were reported during the study, and all patients completed the follow-up after 6months. At 1month, patients treated with calcium hydroxylapatite (group 1) improved wrinkles and skin texture compared to placebo (group 2). At 3 and 6months, all patients improved acne scars. Our study showed that that both calcium hydroxylapatite and HIFU in monotherapy were safe and effective treatments for atrophic scar acne. Calcium hydroxylapatite was clinically effective when compared with placebo, though the combination of calcium hydroxylapatite and HIFU did not enhance the clinical efficacy compared to monotherapy.

Update on vocal fold augmentation

Unilateral vocal fold palsy is afrequent cause of hoarseness. In the presence of glottis closure insufficiency, the effectiveness of conservative voice therapy is often limited and phonosurgery may be indicated. Injection laryngoplasty is effective for correction of insufficiency. Early intervention during the first 6months after diagnosis is desired to avoid subsequent insufficient endogenous compensation. Particularly patients with glottic closure insufficiency ≤2 mm in stroboscopy may benefit from this procedure. With appropriate patient selection, duration of the effect exceeding 12months has been described for hyaluronic acid, calcium hydroxylapatite, and autologous fat. Due to rare complications such as allergic swelling at the injection site, regular laryngoscopic monitoring and observation for two nights after injection are recommended. The voice must only be rested for afew hours.

Use of injectables in rhinoplasty retouching: Towards an evolution of surgical strategy? Literature review

BackgroundSurgical revision rate of rhinoplasty is from 5% to 15% in literature. Objective of reviewIn the context of post-rhinoplasty deformities, we aim to investigate the modalities of using injectables, their impacts on revision rate of rhinoplasty as well as their influences on the surgical strategy. Type of reviewWe realized an international literature review to collect informations on main studies reporting series of exclusive secondary medical rhinoplasties or mixed primary/secondary medical rhinoplasties, as well as per-operative injection. Search strategyThe databases of the National Library of Medicine, Cochrane Library, Embase and Web of science were explored using the following Boolean string: (rhinoplasty OR nose) AND (injectable OR fillers OR hyaluronic acid OR calcium hydroxylapatite). The search was limited to the English language literature for studies published from 2007 up to December 2019. ResultsFifteen cohort studies were included. Hyaluronic acid was the most commonly used injectable for rhinoplasty revision. Patient satisfaction rates varied between 80% and 100%. Reinjections were necessary in about 20 to 50% of cases whatever the used injectables. Minor complications (swelling, bruising, erythema) were frequent after filler injections (4%). Severe complications such granulomas or vascular embolism causing skin necrosis/visual impairment were rare (0.4%). Their physiopathology, management and prevention are detailed. ConclusionsThe use of injectables seems to reduce the need of secondary surgical rhinoplasties. It can be expected that an evolution in surgical practices will result from injectables using, but it will be possible only if the technique is perfectly understood to avoid potentially serious vascular complications.

Hyperdiluted Calcium Hydroxylapatite 1: 2 for Mid and Lower Facial Skin Rejuvenation: Efficacy and Safety.

Diluted/hyperdiluted calcium hydroxylapatite (CaHA) represents an emerging biostimulatory treatment. However, limited data concerning the effects of this agent on the face have been provided so far. To investigate the efficacy and safety of hyperdiluted CaHA 1:2 treatment for mid and lower face rejuvenation. A retrospective study of 40 patients seeking skin rejuvenation for mid and lower face, treated with hyperdiluted CaHA 1:2 technique at baseline (T0), was performed. Patients were classified according to validated scales of aging in the mid to lower face at T0 and efficacy was established with scales calculated again at 4-month post-treatment (T1). In addition, efficacy was assessed by blinded evaluation of T0/T1 clinical pictures, non-invasive skin imaging and patient satisfaction. Safety was assessed through pain scale and minor/major adverse events. Hyperdiluted CaHA 1:2 successfully decreased aging severity scores of the mid and lower face. Variations of collagen morphology and increased vessel density at T1 were observed with noninvasive skin imaging. Most patients were very satisfied. Mean pain score was low and only minor adverse events were reported. Hyperdiluted CaHA 1:2 technique seems to be effective and safe for mid and lower face skin rejuvenation.

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

BackgroundInadvertent intra‐arterial injection of dermal fillers including calcium hydroxylapatite (CaHA) can result in serious adverse events including soft tissue necrosis, permanent scarring, visual impairment, and blindness. When intra‐arterial injection occurs, immediate action is required for optimal outcomes, but the infrequency of this event means that many physicians may never have experienced this scenario. The aim of this document is to provide evidence‐based and expert opinion recommendations for the recognition and management of vascular compromise following inadvertent injection of CaHA.MethodsAn international group of experts with experience in injection of CaHA and management of vascular complications was convened to develop a consensus on the optimal management of vascular compromise following intra‐arterial CaHA injection. The consensus members were asked to provide preventative advice for the avoidance of intravascular injection and to produce a treatment protocol for acute and delayed presentation. To ensure all relevant treatment options were included, the recommendations were supplemented with a PubMed search of the literature.ResultsFor prevention of intra‐arterial CaHA injection, consensus members outlined the importance of a thorough knowledge of facial vascular anatomy and patient history, as well as highlighting potential risk zones and optimal injection techniques. Individual sections document how to recognize the symptoms of vascular occlusion leading to vision loss and tissue necrosis as well as detailed treatment protocols for the management of these events. For impending tissue necrosis, recommendations are provided for early and delayed presentations with treatment protocols for acute and follow‐up treatment. A separate section details the treatment options for open and closed wounds.ConclusionsAll physicians should be prepared for the eventuality of intra‐arterial injection of a dermal filler, despite its rarity. These consensus recommendations combine advice from aesthetic experts with the latest reports from the published literature to provide an up‐to‐date office‐based protocol for the prevention and treatment of complications arising from intra‐arterial CaHA injection.

Commentary on the Use of Intralesional Sodium Thiosulfate to Dissolve Facial Nodules From Calcium Hydroxylapatite.

Commentary on the Use of Intralesional Sodium Thiosulfate to Dissolve Facial Nodules From Calcium Hydroxylapatite.

Cotransplantation of mesenchymal stromal cells and endothelial cells on calcium carbonate and hydroxylapatite scaffolds in vivo

This study investigated the cotransplantation of bone marrow mesenchymal stromal cells (BMSC) and human umbilical cord endothelial cells (HUVEC), and evaluated their contribution to vascular and bone tissue engineering in vivo.To evaluate the success of osteogenic differentiation and timely vascularization of different osteoconductive scaffolds in vivo, we transferred BMSC and HUVEC pre-cultivated calcium carbonate (CaCO3) and hydroxylapatite (HA) matrices into immunocompromised RNU-rats, and analyzed mineralization, expression of osteopontin, and vascular integration via new vessel formation.After in vivo transplantation, pre-cultivated scaffolds demonstrated overall improved mineralization of 44% for CaCO3 (p = 0.01, SD ± 14.3) and 34% for HA (p = 0.001, SD ± 17.8), as well as improved vascularization of 5.6 vessels/0.1 mm2 on CaCO3 (p < 0.0001, SD ± 2.0) and 5.3 vessels/0.1 mm2 on HA (p < 0.0001, SD ± 2.4) compared with non-pre-cultivated controls. However, no significant differences between the implantation of BMSC-only, HUVEC-only, or BMSC + HUVEC cocultures could be observed.There is an increasing demand for improved bone regeneration in tissue engineering. Cotransplantation of mesenchymal stromal cells and endothelial cells often demonstrates synergistic improvements in vitro. However, the benefits or superiority of cotransplantation was not evident in vivo and so will require further investigation.

Combination of Calcium Hydroxylapatite Diluted With Normal Saline and Microfocused Ultrasound With Visualization for Skin Tightening.

Background/Objectives: Treatment options for the correction of age-related changes in skin include the use of energy-based devices and dermal fillers. In this study, we evaluate the clinical efficacy and tolerability of microfocused ultrasound with visualization (MFU-V) and injectable calcium hydroxylapatite (CaHA) filler diluted with normal saline, for the correction of age-related changes and to assess patients' satisfaction with this combination therapy. Methods: This was a randomized, split-face, comparative clinical study and immunohistochemical analysis in 20 subjects with indications for lower face, neck and décolleté lifting. Over five visits, CaHA diluted with normal saline (1:2) was injected subdermally in the lower third of the face, neck and décolleté, and lower abdominal quadrant. MFU-V was performed on the lower third of the face, neck, and décolleté, and the right lower abdominal quadrant. Results: Upon baseline examination, the age-related changes were quantified as follows: marionette lines score 2.47 ± 0.8, jawline contour score 2.2 ± 0.7 and neck score 2.1 ± 0.7 points; and after 15 months, they changed to 1.8 ± 0.7 (P≤0.00003), 1.89 ± 0.56 (P≤0.005), and 1.7 ± 0.6 (P≤0.005) points, respectively. The procedures were well tolerated, and subject satisfaction was high. Conclusions: The injections of CaHA in combination with MFU-V treatment stimulated neoangiogenesis, led to the increased synthetic activity of cells, a marked increase in collagen and elastin fibers, and remodeling of both the superficial and deep layers of the dermis. An improvement in the severity of age-related changes was observed in all areas studied. J Drugs Dermatol. 2020;19(4):405-411. doi:10.36849/JDD.2020.4625.

Chin Augmentation and Reshaping: Using Calcium Hydroxylapatite With Lidocaine (CaHA+) Filler

Adequate chin projection is associated with strength in the male jawline, youth in a female face, and a harmonious balance with the nose. Calcium hydroxylapatite plus integral lidocaine (CaHA+; Merz North America, Inc.) is a filler that has demonstrated immediate volume improvement for midface augmentation and for filling facial folds. There is a paucity of reports of the use of CaHA+ in the chin. The objective of this study was to assess the use of moldable CaHA+ injections to improve the chin profile. Twelve patients with microgenia were treated with CaHA+ chin injections for improvement of the chin profile. Deep, pre-periosteal, serial injections of CaHA+ were performed on the chin. Efficacy was assessed by the treating physician using sagittal profile views at 1-week, 1-month and 6-month follow-ups. Patients were monitored for complications. In total, 5 male and 7 female patients were treated to optimal enhancement of their chin profile. Average age was 47 years (range of 22-64 years). Patients received a mean total volume of 4.8 mL CaHA+. All patients were satisfied, and results persisted at the 6-month assessment. No complications were noted. CaHA+ can be used to augment the chin to enhance a recessed chin profile. This procedure is quick and effective, providing immediate results. Patients seeking a less-invasive alternative to surgery without the associated downtime may be ideal candidates for CaHA+ injections into the chin.

Near Complete Recovery of Visual Acuity After Calcium Hydroxylapatite Injection–Related Vision Loss

Injection of fillers has gained popularity over the past decades in aesthetic treatments. Calcium hydroxylapatite (CaHA; Radiesse) was introduced in the year 2003 and received approval from the Food and Drug Administration in 2006 for the treatment of moderate-to-severe wrinkles. The properties of CaHA include biostimulation, neocollagenesis, and stability over a long period. However, similar to other fillers, CaHA is associated with the risk of complications such as ecchymosis, inflammation, local infection, skin necrosis, and vascular occlusion. Iatrogenic vision loss remains the most devastating complication related to vascular occlusion. Development of vision impairment is associated with a relatively high risk of permanent damage to vision acuity and poor prognosis. The current report presents a case of a patient who suffered from skin necrosis, vision impairment, and ophthalmoplegia after the injection of CaHA into the nasal dorsum. Significant improvement in visual acuity was observed during hospitalization after the treatment. The patient recovered to near-normal visual acuity and completely recovered from ophthalmoplegia. We aimed to discuss the current treatment employed and review the literature on CaHA-related vision loss.

Facial Rejuvenation Using a Mixture of Calcium Hydroxylapatite Filler and Hyaluronic Acid Filler.

Calcium hydroxylapatite filler is a popular dermal filler, as it provides long-lasting results. However, it sometimes undergoes unexpected early volume loss, due to rapid gel absorption before neocollagenesis. To compensate for this phenomenon, hyaluronic acid filler was added to calcium hydroxylapatite filler for injection as a mixture. Twenty-five patients who scored 1 or 2 on the Merz 5-point scale for the nasolabial fold and jawline were injected with 3.0 mL of the mixture. The mixture was prepared with 1.0 mL of hyaluronic acid filler, 0.5 mL of lidocaine, and 1.5 mL of calcium hydroxylapatite filler. A visual analog scale (VAS) and the 5-point global satisfaction scale (GSS) were used for objective and subjective assessments. In a subset of patients, for histologic analysis, 0.1 mL of the mixture and 0.1 mL of only calcium hydroxylapatite filler were injected into the right and left postauricular areas, respectively. The histologic analysis was performed 6 months after implantation. The mean VAS and GSS scores for both sets of wrinkles were above "fair" at every follow-up, including at short-term and long-term periods. The skin biopsies from both postauricular areas from selected patients showed increased dermal collagen bundles without inflammation. The mixture of calcium hydroxylapatite filler and hyaluronic acid filler maintained constant volume with high satisfaction, as hyaluronic acid filler compensated for the unexpected early volume loss of calcium hydroxylapatite filler. This procedure can be applied safely, and it is also convenient, because no retouching procedure is needed.

Calcium hydroxylapatite for collagen biostimulation in the neck

Calcium hydroxylapatite for collagen biostimulation in the neck

Using the BODY-Q to Evaluate Appearance and Quality of Life Following Treatment of Skin Laxity of the Outer Thigh with Microfocused Ultrasound and Calcium Hydroxylapatite.

Two procedures that have demonstrated collagen-stimulating properties and improvements in skin laxity in a variety of aesthetic indications are microfocused ultrasound with visualization (MFU-V) and injection with calcium hydroxylapatite (CaHA). By treating skin laxity with a combination of these therapies, it was hypothesized that our patients would experience improved appearance and quality of life as measured by the BODY-Q. A total of 60 consecutive female patients aged 30 to 60 years with body mass index less than 28 kg/m2 who expressed interest in treatment for skin laxity affecting the outer thighs completed selected scales (Body Image, Appraisal of Excess Skin, Satisfaction with Hips and Outer Thighs, and Appearance-Related Psychosocial Distress) from the BODY-Q within 1 week of treatment. At the time of treatment, MFU-V was directed to the outer thighs (150 lines at focal depths of 3.0 and 4.5 mm per outer thigh). Immediately following MFU-V, patients received treatment with CaHA injected into the subdermis (1.5 mL diluted 1:1 with 1.5 mL of 2% lidocaine solution per outer thigh). At 90 days posttreatment, these patients repeated the BODY-Q. At 90 days posttreatment, with 100% follow-up among the 60 consecutive female patients treated, scores from the BODY-Q scales showed statistically significant improvement (P < 0.01). Following treatment of skin laxity on the outer thighs with a combination of MFU-V and CaHA, our patients reported a statistically significant improvement in appearance and quality of life at 90 days posttreatment. This protocol may be applicable to other areas of the body.

Voice Restoration after Radiation and Supracricoid Partial Laryngectomy by Injection Augmentation of the Arytenoid

Supracricoid partial laryngectomy (SCPL) is an organ-preserving surgical technique intended to achieve oncologic control of laryngeal cancer while maintaining laryngeal functions. Most patients who undergo SCPL achieve a serviceable voice. However, several factors can affect the function of the neoglottis after SCPL. We report the case of a 53-year-old male referred for near aphonia after undergoing SCPL for recurrent laryngeal carcinoma initially treated with radiation. Calcium hydroxylapatite injection augmentation of the right arytenoid was performed to assist neoglottic closure. Flexible laryngoscopy demonstrated greatly improved neoglottic closure postoperatively, and the patient's voice was successfully restored. This case demonstrates a novel technique for voice restoration in patients who have undergone partial laryngectomy.