Complete biodegradable nature of calcium hydroxylapatite after injection for malar enhancement: an MRI study

Abstract

Background

Radiesse^® (Calcium hydroxylapatite [CaHA]) is a biocompatible, injectable gel for facial soft tissue augmentation. It is a completely biodegradable filler and this is well documented, but objective imaging methods to confirm this property are scarce.

Methods

We present a case report in which CaHA was injected into the midface of a 50-year-old woman for volume restoration and shaping of the cheek region. On the right side of the face, 1.6 mL CaHA was injected as several (5−7) small depots (0.1−0.2 mL) using a 28G 3/4 inch needle and the vertical supraperiosteal depot technique. On the contralateral side of the face, the subject received 1.6 mL CaHA over three entry points using a 27G 1 1/2 inch blunt cannula and the fanning technique. CaHA location and degradation were assessed using magnetic resonance imaging (MRI).

Results

CaHA appears as low-to-intermediate signal intensity on MRI images taken immediately after injection for malar enhancement with a symmetrical distribution. On MRI images taken 2.5 years after injection, no CaHA was visible but tissue volume remained increased, indicating a collagen-stimulating effect. The treatment was well tolerated.

Conclusion

In addition to producing long-lasting aesthetic and collagen-stimulating effects, MRI images confirm that CaHA is completely biodegradable with no product remaining 2.5 years after injection.

Keywords:

• aesthetic
• biodegradable
• calcium hydroxylapatite
• MRI
• Radiesse

Acknowledgments

The author would like to acknowledge Dr Thomas Rappl, Senior Physician at the Department for Plastic, Aesthetic and Reconstructive Surgery, Medical University of Graz, Austria; and University Professor Dr Dieter Szolar, Diagnostikum Graz Süd West GmbH, Graz, Austria. This work was supported by Merz Pharmaceuticals. Jenny Grice provided help with medical writing.

Disclosure

Dr Pavicic is a speaker and consultant for Merz Pharmaceuticals and Galderma S.A., and reports no conflict of interest in this work.