Multilayer Technique Using Calcium Hydroxylapatite Biostimulation With Different Dilutions in the Lateral Face.

Background: There seems to be an interdependency of superficial structures on deeper layers, so that aging-related changes in 1 layer may lead to changes to the adjacent layers. Following the same rationale, treatment of 1 area may influence other neighboring aesthetic units. A more holistic approach would encompass soft-tissue repositioning and regenerative biostimulation, aiming for improvement of skin quality by increasing skin's collagen content. Objectives: To describe the use of calcium hydroxylapatite (CaHA) in different presentations for soft-tissue repositioning and improvement of skin quality in the same session. Methods: Males or females between 40 and 60 years of age, with normal BMI, mild facial laxity, underwent supraperiosteal injection of undiluted CaHA for focal biostimulation along the zygomatic arch, in the mandible angle and in the prejowl area, followed by treatment of diluted CaHA in the posterior temporal area, and the remainder in the premasseteric area in the same session, with follow-up pf at least 90 days. Investigator assessment was evaluated using the Global Aesthetic Improvement Scale. Results: Out of 6 treated patients (median age of 44.5 years), 66% were deemed as improved (Grade 3) for the treatment of upper third of the face, whereas 83% of the patients were assessed as having at least improved for the mid and lower thirds of the face. Only mild adverse events were reported. Conclusions: The technique described in this pilot study provides a full-face approach with CaHA based on the current concepts of the line of ligaments and facial biomechanics. Further studies are needed to validate the results. Level of Evidence 4: