Calcium Hydroxylapatite Injection Research Articles

Calcium Hydroxylapatite (CaHA) and Aesthetic Outcomes: A Systematic Review of Controlled Clinical Trials.

Background: This study aimed to systematically review and summarize the available controlled clinical trials on the effectiveness of calcium hydroxylapatite (CaHA) in terms of aesthetic outcomes, skin-aging-related outcomes, and patient/investigator satisfaction. Methods: We included controlled clinical trials involving at least 10 human adults that examined the effects of CaHA on aesthetic and skin-aging-related outcomes and satisfaction. Due to the high heterogeneity among the included studies, only a qualitative analysis is provided. Results: Out of 2935 relevant references, 13 studies were included, of which 8 studies focused on facial areas and 5 on dorsum of hand. CaHA injection was associated with enhancements in global aesthetic improvement scale, whether applied in facial regions or on the dorsum of hands. The findings suggested high patients' satisfaction following CaHA when applied to facial areas. Studies highlighted improvements in hand grading scales and a reduction in facial wrinkles. Conclusions: Current evidence suggests that CaHA injections improve aesthetic results, including facial areas, such as nasolabial folds and jawline, and hands, with high levels of satisfaction. Considering the methodological limitations and heterogeneous comparisons groups, additional controlled clinical trials would contribute to a better understanding of the applications and advantages offered by CaHA.

The Comparative Dermal Stimulation Potential of Constant-Volume and Constant-Amount Diluted Calcium Hydroxylapatite Injections Versus the Concentrated Form.

Biostimulation properties of diluted and hyperdiluted calcium hydroxylapatite (CaHA) injections have become increasingly popular. However, the existing data are insufficient to certify a particular dose-response pattern. To assess and compare the dermal stimulation potentials of different concentrations of CaHA injections. Two independent experiments (Experiment-1: constant injection volume vs Experiment-2: constant CaHA amount) included 4 study groups each, and these experimental groups were placed consecutively on the abdominal skin of a juvenile Yorkshire pig. Histopathological and immunohistochemical stainings were performed on punch biopsy materials collected 4 months after the injection day. The fibroblast count significantly decreased upon dilution from 1:3 to 1:19 in experiment 1 ( p = .000) but still higher than the control group. In experiment 1, the collagen density of the concentrated form was more elevated than the 1:19 dilution and the negative control groups ( p = .034 and .000, respectively) but similar to the 1:3 dilution ( p = .123). No significant difference was observed between the groups regarding collagen density with a standard amount of CaHA (0.2 mL, 30%) ( p > .05). Despite the efficacy being more pronounced till 1:3 dilution, hyperdiluted CaHA at any dilution ratio up to 1:19 can provide a higher fibroblast count than the negative control group.

Characterization of Adipose-Derived Mesenchymal Stem Cells from tissue harvested with the guided SEFFI technique and co-cultured with calcium hydroxyapatite

Increased interest in regenerative medicine in the last few years was registered. In parallel, a progressive increase in injectable calcium hydroxylapatite (CaHA) applications has been observed due to its applications in skin rejuvenation. This study combined micro fragmented fatty tissue (FAT) grafting with the CAHA filler procedure to observe the biological effect on FAT. Each sample of micro fragmented adipose tissue harvested using the guided Superficial Enhanced Fluid Fat Injection (guided SEFFI) technique were collected from 5 patients. The 5 samples were divided into aliquots to create two different experimental conditions: FAT and FAT combined with CaHA (FAT + R). Afterwards, the cellularity of mesenchymal phenotype and the in vitro differentiation capacity in mesenchymal lineages were assessed in both experimental conditions, FAT and FAT+R. Despite low cellularity observed for FAT+R compared to FAT, isolated cells could grow and expand in culture in both experimental conditions, thus proving their proliferative ability. Cells were proved to differentiate towards mesenchymal lineages, expressing mesenchymal markers by flow cytometry analysis. Combining emulsified harvested tissue prepared with guided SEFFI technique with CaHA products can be exploited to counteract the loss of volume and skin ageing of the human face and body. This approach to regenerative aesthetic treatment is a promising treatment for facial antiaging therapy.

Combining topical dermal infused exosomes with injected calcium hydroxylapatite for enhanced tissue biostimulation.

Exosome research continues to flourish. Subsequent knowledge surrounding indications, dose-response, safety, efficacy, and the ability to combine exosome treatment as a "skin primer"-for biostimulation modalities such as calcium hydroxylapatite (CaHA), platelet-rich plasma (PRP), and platelet-rich fibrin matrix (PRFM) is growing rapidly. The objective of this study was to develop safe, reproducible methods of improving topical exosome absorption to enhance the quality of skin either by themselves, or in combination with injectable CaHA. Under IRB Approval (International Cell Surgical Society: ICSS-2022-007), 40 patients were enrolled in this study. Twenty patients underwent facial biostimulatory dermal infusion alone, to determine if this method allowed adequate exosome absorption. Five patients underwent facial biostimulatory infusion followed immediately by Dilute CaHA injection (1:1 dilution) to the face. Five patients underwent exosome biostimulatory dermal infusion followed immediately by hyperdilute CaHA (dilution 1:4) injection to the neck. Five patients underwent Facial Dilute CaHA injection (1:1 dilution) alone, without dermal infusion. Five patients underwent neck hyperdilute CaHA injection (1:4 dilution) alone, without dermal infusion. All patients had pretreatment Quantificare 3-D photo-documentation and skin analysis (Quantificare, France). In all patients, the skin was first cleansed with a gentle glycolic acid facial wash (Gregory MD). To induce a "homing inflammatory environment" for the exosomes, sea salt exfoliation was performed (SaltFacial®, SaltMed, Cardiff, CA). A nitric oxide-generating serum (N101 Pneuma Nitric Oxide, Austin, TX) was then applied to act as an enhanced vehicle for absorption. A 3MHz ultrasound (SaltFacial®, SaltMed, Cardiff, CA) was then utilized to further deepen the absorption of the nitric oxide serum. A topical emulsion containing equal volumes (1.0cc containing 1 million) of exosomes (Kimera Labs, Miramar, FL), 25 units of botulinum toxin (Xeomin, Merz Aesthetics, Raleigh, NC) and hyaluronic acid (Belatero, Merz Aesthetics, Raleigh, NC) was mixed via back-and-forth propulsion in a 3-cc syringe. When adequately mixed, the emulsion was then applied to the treatment areas. The cavitating ultrasound was then used to aid in the absorption of the emulsion. The patients were then treated with high-intensity LED therapy (SaltFacial®, SaltMed, Cardiff, CA), utilizing the collagen restoration preset program of combination red (660 nm) near-infrared (930 nm) wavelength for 20 min. Post-treatment Quantificare analysis was performed at 15 and 30 days after treatment. Without exception, all dermal infusion alone and CaHA injection alone patients showed an improvement in the tone, quality, and texture of their skin. Quantificare results showed consistent improvement in wrinkles, pores, skin evenness, improved vascularity, and a reduction in oiliness and unwanted pigment. When employed as a skin primer prior to injections (CaHA), enhanced and more rapid results were seen. Biostimulatory dermal infusion can be achieved utilizing topical placental mesenchymal stem cell-derived exosomes. These exosomes can be used alone, or mixed with ancillary ingredients such as botulinum toxin, hyaluronic acid dermal filler, and CaHA to customize and personalize treatments based upon individual patient needs. Topical absorption is enhanced with sea salt exfoliation, a topical nitric oxide-generating serum, and 3MHz cavitating ultrasound. Post-absorption activity is enhanced with high-intensity LED treatment. The addition of CaHA injections after the topical exosome "priming of the skin" yielded enhanced skin quality faster than exosomes or CaHA alone.

Multidimensional assessment of voice quality after injection augmentation of the vocal fold with autologous adipose tissue or calcium hydroxylapatite.

The purpose of this study was to evaluate short- and long-term outcome of injection augmentation with autologous adipose tissue (AAT) and calcium hydroxylapatite injection (CAHA) in patients with a unilateral vocal fold paralysis (UVFP). A retrospective cohort study was performed in patients diagnosed with UVFP, who had received injection augmentation with AAT or CAHA. Multidimensional voice analysis was performed before, 3 and 12months after injection. This analysis included patient self-assessment (Voice Handicap Index-30), perceptual (overall dysphonia grade according to the GRBAS scale), aerodynamic (MPT, s/z ratio) and acoustic (fundamental frequency, dynamic range) parameters. Effects were assessed using a linear mixed model analysis. Forty-six patients were available for evaluation, with a total of 53 injection augmentations (AAT n = 39; CAHA n = 14). We found significant improvement of patient self-assessment and perceptive voice outcome at 3months, which were maintained at 12months. In the CAHA group, s/z ratio and dynamic range of extreme frequencies also improved significantly over time. No statistically significant differences were found between the two treatments (AAT vs. CAHA). No major complications were reported. This study, using a guide-line recommended panel of outcome parameters, shows a high success rate of injection augmentation with AAT or CAHA for patients with UVFP at 12months with significant improvement in most voice outcome parameters, although voices do not completely normalize. There is no significant difference in outcome between the two materials.

Cosmetic Syndrome Correction with Calcium Hydroxylapatite-Based Filler in Patients with Connective Tissue Dysplasia.

Undifferentiated connective tissue dysplasia is one of the most common diseases of nowadays, which does not fit into the group of hereditary syndromes. This condition is diagnosed in 20–50% of the population at any age. The study aimed to correct the facial soft tissues of patients with undifferentiated connective tissue dysplasia through the cosmetic procedure of calcium hydroxylapatite injection. In 2018, a 36-year-old patient addressed the beauty salon with signs of undifferentiated connective tissue dysplasia, such as severe asymmetry of the face, infraorbital and nasolabial sulci, and thin and easily folding skin. Signs were observed from the age of 22, i.e., for 14 years. The therapy was performed using special features of the correction of facial soft tissue changes in patients with connective tissue dysplasia (CTD) using calcium hydroxylapatite-based products (Radiesse®, Merz North America, Inc., USA). Particular attention is given to the need for early correction to prevent premature skin aging related to this condition. After 14 days, a significant improvement of the patient's skin condition was noted after the passing of two procedures. Her condition was estimated as consistent with T1-2P0G0A1Zh1 P1M1K1 and corresponded to grade I age-related changes in the superficial soft tissues. The performed treatment showed high efficacy in case of mild connective tissue dysplasia diagnosis. The results showed that when collecting information from anamnesis, the diagnostic criteria for dysplasia should be considered. If the criteria are met, the cosmetological correction with collagen stimulators becomes possible.

Periorbital Hyperpigmentation—Dark Circles under the Eyes; Treatment Suggestions and Combining Procedures

Periorbital hyperpigmentation (POH) is a frequent concern among both young and adult patients. The etiology is multifactorial with a genetic background. Prevalence is higher in darker skin types. It has been estimated as high as 30% in a recent Indian study. Females are often more disappointed by POH than males. Treatment has to consider underlying pathologies and patients’ needs. We present our treatment algorithm for POH. In this study, 74 patients with POH, 64 females (86.5%) and 10 males (13.3%), were treated. Of these, 39 patients (53%) had a family history of POH. The age range of patients was 18−57 years (average: 36.1 years). In case of tear trough deformity, soft tissue augmentation was used by injection of hyaluronic acid gel, calcium hydroxylapatite, or autologous fat. Blepharoplasty with partial fat pad resection or repositioning via arcus marginalis release was used to correct severe orbital fat herniation and excess of the lower lid skin. Melanin hyperpigmentation of the skin was improved by sessions of Q-switched 1064 and 532 nm neodymium-doped yttrium aluminum garnet (Nd:YAG) laser. Small vessels (capillaries and veins) were targeted by a 1064 nm long-pulsed Nd-YAG laser. Sessions of intense pulsed light (IPL) or CO2 fractional laser were employed to improve skin texture and fine lines. Topical hyaluronic acid-based formulations may be used as adjuvant self-treatment by patients. For pigmented and mixed-type POH, ultraviolet light protection is recommended as a maintenance treatment. By the use of various technologies, treatment can be individually tailored.

Five-year results of vocal fold augmentation using autologous fat or calcium hydroxylapatite.

To evaluate 5-year voice outcomes of vocal fold augmentation (VFA) using autologous fat (AF) injection via direct microlaryngoscopy versus office-based calcium hydroxylapatite (CaHA) injection. Retrospective study of patients who underwent VFA between 2012 and 2015, with a 5-year follow-up. Patients with a glottic gap of ≤ 3mm caused by unilateral vocal fold paralysis or vocal fold atrophy were included in the study. VFA was performed using AF injection via direct microlaryngoscopy in 17 patients, and using office-based CaHA injection in 19 patients. Subjective satisfaction with voice, voice handicap index (VHI), and maximal phonation time (MPT) were analyzed pre-injection, and at 12 and 60months post-VFA. Altogether 36 patients underwent VFA between 2012 and 2015, of whom 5 were excluded within 1year post-VFA, and 2 were excluded between 1 and 5years post-VFA. Of the remaining 29 patients, 3 (10.3%) underwent re-intervention at between 1 and 3years post-VFA. Thus, the 5-year follow-up included 26 patients (72.2%; 11 males and 15 females). At 5years after surgery, 73.1% of the patients were satisfied with their voice, with no significant between-group difference (P=0.307). The mean improvement of VHI was 28.8±17.82 in the autologous fat group versus 33±26.24 in the CaHA group (P=0.458). MPT improvement was also similar between the two groups: 6.2±4.26 for the autologous fat group versus 6.3±4.34 for the CaHA group (P=0.667). Both AF injection via direct microlaryngoscopy and office-based CaHA injection yielded good and comparable 5-year results.

Long lasting facial rejuvenation by repeated placement of calcium hydroxylapatite in elderly women.

Calcium hydroxylapatite (CaHA) is a biostimulatory filler with long lasting efficacy after a single injection. Data con the effect of repeated injections, however, are sparse. This is a single-center observational study. Forty Caucasian females of Fitzpatrick skin type I to III, aged between 50 and 95 years (mean age 63 ± 13.4 years), and seeking nonsurgical improvement of facial aging were included. Patients with previous face lifts, threads or other surgical treatments were excluded. Only women ≥50 years of age were included. Midface and lower face were treated, that is, cheeks, tear troughs, jawline, and Marionette lines. The usual time for a repetition of filler injection was 12 to 14 months. Mean follow-up was 36 ± 10.8 months after first injection of Radiesse. Outcome was measured using the Global Aesthetic Improvement Scale (GAIS). Mean patient's GAIS was 2.7 ± 0.7, while physicians GAIS was 2.6 ± 0.6 suggesting a remarkable improvement 12 months after the first procedure. Mean patient's GAIS at 3 and 5 years after first procedure was 2.4 ± 0.8, while physicians GAIS was 2.5 ± 0.7. Repeated injection of CaHA leads to a significant and long-lasting improvement of facial appearance.

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.

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.

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.

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.

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.

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.

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

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.

Paediatric injection medialisation laryngoplasty: Recent Great Ormond Street Hospital experience

IntroductionUnilateral vocal fold paresis may significantly impair the vocal quality and laryngeal competence of a child. Relatively little literature relates to injection medialisation laryngoplasty (IML) in children and previous reports have involved small numbers of heterogenous cases. MethodsA retrospective review was conducted of paediatric patients managed by our multidisciplinary specialist voice clinic undergoing IML for unilateral vocal fold paresis. Cases of bilateral paresis, those characterised by vocal fold fixation, and patients without formal pre and post-operative voice evaluation were excluded. ResultsEighteen IML procedures were performed in 12 children eligible for inclusion between 2005 and 2015. The average age at time of procedure was 12 years (range 9–15 years). Autologous fat was used in 5 procedures, succeeded by calcium hydroxylapatite (Radiesse® Voice) from 2011 (n = 13). A significant improvement in median GRBAS score components was observed after calcium hydroxylapatite injection in terms of grade (p = 0.008), breathiness (p = 0.002) and aesthenia (p = 0.016). A pre- and post-procedural Voice Handicap Index was self-completed by 6 patients receiving calcium hydroxylapatite injection; the median change in score was an improvement of 19 points (interquartile range 36.5). ConclusionWe describe the outcomes of a comparatively large paediatric series and have found IML using calcium hydroxylapatite to be a reliable technique associated with improved subjective outcome measures. Management of UVCP in the child is a challenge with particular investigative and interventional considerations. Further study supported by high quality subjective and, where possible, objective outcome measures, is required to better inform patient selection, timing of intervention and choice of injection material.

The use of injectable calcium hydroxylapatite in the surgically pretreated larynx with glottal insufficiency.

To evaluate the efficacy of vocal fold (VF) augmentation with calcium hydroxylapatite (CaHA) microspheres in the surgically pretreated larynx with glottal insufficiency. Prospective clinical pilot study. After several prior reconstructive attempts (following tumor resection, VF paralysis, in sulcus vocalis, and VF scarring), CaHA was injected under general anaesthesia using a transoral microlaryngoscopic approach in 10 patients with residual glottal insufficiency ≤1.5 mm. The postinterventional result was assessed after 1 day, and 1 and 3 months. Evaluation of augmentation comprised intraoperative video/photo documentation, pre-/postoperative videolaryngostroboscopy, as well as established subjective and objective voice function diagnostics (Grade, Roughness, Breathiness [GRB] Scale; Voice Handicap Index; voice range profile; and acoustic-aerodynamic analysis). In the pretreated VF with no or minimal lamina propria remaining, the exact placement of CaHA was not possible due to unpredictable propagation into the scarred tissue. The results showed an insufficient postoperative augmentation. Accordingly, the voice function did not improve. However, a significant increase of the vocal range from 6.2 ± 3.2 to 8.7 ± 3.9 semitones was observed in the speaking voice profile (P =.02). All other acoustic and aerodynamic parameters remained on the whole unchanged; the slight differences between pre- and postoperative findings were not significant. The application of CaHA in the surgically pretreated scarred larynx is not reliable to achieve a sufficient glottal closure and a satisfactory improvement of voice. Though CaHA is a welcome addition to our armamentarium against glottal insufficiency, the suitability for augmentation of scar tissue in the larynx must be considered carefully in each individual case. 4 Laryngoscope, 127:1125-1130, 2017.

Quality of life outcomes in peri-urethral calcium hydroxylapatite injection.

Peri-urethral calcium hydroxylapatite injection is an established treatment for patients with stress urinary incontinence. Information is limited regarding calcium hydroxylapatite treatment and quality of life (QOL) outcomes. We hypothesize that patients might improve QOL after peri-urethral calcium hydroxylapatite injection, which was reflected in validated questionnaires. The peri-urethral calcium hydroxylapatite injection billing code was used to identify patients who underwent injection from 2011-2013. Female patients who completed the American Urological Association Symptom Score (AUASS), the AUASS QOL and Michigan Incontinence Symptom Index (M-ISI), and the bother score (M-ISI bother), or pad count at baseline and follow-up were included. Change in questionnaire scores and pads were assessed using the paired t test. Sixty patients underwent 1 (30), 2 (63) or 3 (7%) peri-urethral calcium hydroxylapatite injections performed by a single surgeon. Thirty-seven patients provided questionnaires and 38 provided pad counts, all with a mean age of 75years. The overall AUASS, AUASS QOL, and overall M-ISI scores improved in 67.6, 54.8, and 61.3% respectively (4.5 ± 7.9, 1.3 ± 1.7 and 5.5 ± 8.6 respectively). The M-ISI bother score improved in 44.8% with a mean improvement of 0.5 ± 2.9, but did not reach significance. There was a 1.7 ± 3.7 decrease in the mean number of pads used daily after the procedure (p = 0.006) and 19% experienced transient urinary retention. Peri-urethral calcium hydroxylapatite injections can improve urinary QOL scores in patients with initial and recurrent stress urinary incontinence. This short-term retrospective analysis suggests that larger long-term studies focusing on QOL outcomes are needed to evaluate the effect of peri-urethral calcium hydroxylapatite has on incontinence-specific QOL.