Diluted Calcium Hydroxylapatite for Skin Tightening of the Upper Arms and Abdomen

September 2017 | Volume 16 | Issue 9 | Original Article | 900 | Copyright © September 2017

Natalia G. Lapatina MD PhDa and Tatiana Pavlenko MD PhDb

aClinic of Aesthetic Medicine and Plastic Surgery, Moscow, Russia bExpert Beauty Clinic, Rostov-on-Don, Russia

BACKGROUND: The collagen-stimulating properties of Radiesse® (calcium hydroxylapatite, CaHA) can be used for skin-tightening procedures by hyper-diluting the product with lidocaine or saline. OBJECTIVE: To evaluate the effectiveness and safety of diluted CaHA for skin tightening in two case series of women with skin laxity in the upper arms or abdomen. METHODS: For each case series, 10 female subjects were enrolled. In the upper arms, CaHA diluted 1:2 with normal saline solution and 2% lidocaine was injected subdermally using a short, linear-threading technique. Skin elasticity was assessed at baseline and Months 1 and 3 using a cutometer. In the abdominal wall, CaHA diluted 1:4 with saline solution was injected subdermally using a linear-threading technique. Subjects underwent pre- and post-treatment (70 days) ultrasound scans to determine dermal thickness around the umbilicus and sides of the abdomen. Subjects and physicians assessed treatment outcomes using the 5-point Global Aesthetic Improvement Scale (GAIS). Adverse events and tolerability were recorded. RESULTS: Cutometry results for upper arm skin showed an increase in skin elasticity from 72 U at baseline to 82 U at Month 3 (P≤0.05). Ultrasound measures of the abdominal wall demonstrated statistically significant increases in dermal thickness after injection of diluted CaHA of 0.7 mm (umbilicus) and 0.4 mm (sides of abdomen). Diluted CaHA resulted in an overall increase in dermal thickness of 26.7% (P≤0.05). In both case series, 90% of subjects and physicians rated treatment outcomes on GAIS as much or very much improved. Treatment was well tolerated. CONCLUSIONS: Diluted CaHA improved skin elasticity and increased dermal thickness in the upper arms and abdomen after only a single treatment. The procedures were well tolerated, and subject and investigator satisfaction with treatment results was very high. Injection of diluted CaHA is an effective procedure for skin tightening in the upper arms and abdomen.

J Drugs Dermatol. 2017;16(9):900-906.


Radiesse® (calcium hydroxylapatite, CaHA; Merz North America, Inc., Raleigh, NC, USA) is a highly effective filler for facial soft-tissue augmentation and is associated with a high and well-established safety profile.1 Since the EU approval of CaHA in 2003, it has gained wide acceptance for a range of facial aesthetic procedures and is CE-marked with a broad indication, including deep and subdermal soft-tissue augmentation of the facial area, and restoration and correction of facial volume loss. At the time of writing, CaHA is the only FDA-approved dermal filler for both the face and the hands. In 2009, the FDA approved a protocol for mixing CaHA with lidocaine to enhance patient comfort during treatment. In 2015, Radiesse® (+) Lidocaine with integral 0.3% lidocaine received FDA approval. The product also received a CE mark in 2016 and is now available to physicians in Europe.An important characteristic of CaHA is that it achieves aesthetic results by a combination of an immediate volumizing effect and long-term collagen stimulation. Recent research has discovered that the collagen-stimulating properties of CaHA can be harnessed for skin-tightening procedures by hyper-diluting the product with either lidocaine or saline. In a pilot study, 24 subjects received supraperiosteal injection of CaHA into the postauricular area.2 Punch biopsies were taken 4 and 9 months later and analysed for collagen type I and type III, elastin and markers of angiogenesis. Peak concentrations of newly-formed collagen type III were observed at 4 months, while collagen type I predominated at 9 months, suggesting that a process of natural neocollagenesis was taking place in which newly formed collagen type III is gradually replaced by mature type I. Elastin expression increased in parallel with collagen type I and there was also increased angiogenesis, suggesting that the dermal remodelling was accompanied by outgrowth of new blood vessels and therefore improved nutrient supply to the skin.This property of CaHA has utility for a number of off-label applications that are frequently used in clinical practice. The ability of diluted CaHA to stimulate new collagen synthesis offers the potential for a minimally invasive treatment option in areas of tissue laxity and flaccidity. The aim of the current study was to