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Global Consensus Guidelines for the Injection of Diluted and Hyperdiluted Calcium Hydroxylapatite for Skin Tightening

Goldie, Kate MBChB*; Peeters, Wouter MD; Alghoul, Mohammed MD, FACS; Butterwick, Kimberly MD§; Casabona, Gabriela MD; Chao, Yates Yen Yu MD; Costa, Joana MD#; Eviatar, Joseph MD, FACS**; Fabi, Sabrina Guillen MD, FAAD, FAACS††; Lupo, Mary MD‡‡; Sattler, Gerhard MD§§; Waldorf, Heidi MD║║,¶¶; Yutskovskaya, Yana MD##; Lorenc, Paul MD***


In the article that appeared on page S32 of the November 2018 Special Issue of Dermatologic Surgery , there was an omission in the conflict of interest statement. In addition to the listed conflicts, H. Waldorf is a consultant for Merz North America.

Dermatologic Surgery. 45(2):327, February 2019.

doi: 10.1097/DSS.0000000000001685
Original Article

BACKGROUND Calcium hydroxylapatite (CaHA) is approved to correct moderate-to-severe wrinkles and folds and soft-tissue volume loss in the face and hands. More recently, subdermal injection using diluted CaHA has been used to improve skin laxity.

OBJECTIVE To review evidence for the safe and effective use of diluted CaHA in the face and body and provide best practice recommendations.

METHODS A global panel of expert aesthetic physicians convened to develop consensus-based guidelines for treating laxity and superficial wrinkles using diluted (ratio of 1:1) and hyperdiluted (≥1:2) CaHA.

RESULTS Diluted and hyperdiluted CaHA stimulates targeted neocollagenesis in the injection area to improve laxity and skin quality in the mid- and lower face, neck, décolletage, upper arms, abdomen, upper legs, and buttocks. Treatment can be used as an adjunct to volume augmentation or combined with additional modalities for optimal results. Adverse events are related to the injection and include bruising, swelling, mild pain, and induration. In thinner and darker skin, too-superficial injections of less diluted CaHA can lead to more adverse events.

CONCLUSION This report provides preliminary guidelines for the novel off-label use of CaHA for biostimulation in the face and body. Further trials will provide additional clarity regarding treatment paradigms for optimal outcomes.

*European Medical Aesthetics Ltd, London, United Kingdom;

Plastic and Reconstructive Surgery, AZ KLINA, Brasschaat, Belgium;

Division of Plastic and Reconstructive Surgery, Northwestern Feinberg School of Medicine, Chicago, Illinois;

§Cosmetic Laser Dermatology, San Diego, California;

Scientific Department, Ocean Clinic, Marbella, Spain;

CHAO Institute of Aesthetic Medicine, Taipei, Taiwan;

#Brasília, Brazil;

**Oculo-facial Plastic Surgery, State University of New York College of Optometry, New York City, New York;

††Department of Dermatology, University of California, San Diego, California;

‡‡Department of Dermatology, Tulane Medical School, New Orleans, Louisiana;

§§Rosenparkklinik, Darmstadt, Germany;

║║Waldorf Dermatology Aesthetics, Nanuet, New York;

¶¶Department of Dermatology, Mount Sinai Hospital, New York, New York;

##Dermatovenerology and Cosmetology Department, Pacific State Medical University of Health, Moscow, Russia;

***Department of Plastic Surgery, Lenox Hill Hospital, New York, New York

Address correspondence and reprint requests to: Kate Goldie, European Medical Aesthetics Ltd., MBChB, 77 Harley Street, London W1G8QN, United Kingdom, or e-mail:

K. Butterwick is a speaker, research grant, and/or advisor for Allergan, Colorscience, Galderma, Merz, Sinclair Pharmaceuticals, and Thermi Aesthetics. G. Casabona is a speaker and consultant for Allergan and Merz Aesthetics. J. Costa is a speaker and/or advisor and investigator for Bayer and Merz Aesthetics. J. Eviatar is a speaker and/or advisor and investigator for Alastin, Allergan, Galderma, Kythera, Merz, and Revance, and advisor, trainer, and investigator for Thermi Aesthetics. S. Fabi is a speaker and/or advisor and/or investigator for Alastin, Allergan, Almirall, Galderma, Kythera, Merz, and Revance. K. Goldie is a global key opinion leader for Merz Aesthetics. M. Lupo is a speaker, trainer, researcher, and/or consultant for Allergan, Galderma, and Merz Aesthetics. W. Peeters is a speaker and advisor for Bloomedical NV, Integra Life, and Merz Aesthetics. G. Sattler is a speaker and/or advisor for Allergan, Alma, Galderma, and Merz. The remaining authors have indicated no significant interest with commercial supporters.

© 2018 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.
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