Panfacial Approach to Rejuvenation Using Calcium Hydroxylapatite: A Case Series Illustrating Calcium Hydroxylapatite Versatility Through Dilution and a Multilayered Treatment Approach

Abstract Dermal fillers can be used in a wide range of applications. Although the versatility of hyaluronic acid fillers stems from the wide array of available products, for the biostimulatory filler calcium hydroxylapatite (CaHA), dilution can be used to control product volumizing capacity and flow properties, facilitating use for panfacial rejuvenation. Here, the authors share case studies illustrating how CaHA at various dilutions can be used to achieve global aesthetic improvement as part of a multilayered approach to rejuvenation. As part of a continuing medical education activity, the authors treated patients with 1 to 3 sessions of CaHA at various dilutions. Six months after the patients' initial treatments, the authors reconvened to share their experiences and discuss patient results. Select case studies are presented. Though each patient recieved a unique treatment tilored to their own needs, several themes emerged. Although undiluted product can be used to provide deeper volume and structural support in areas like the chin, jawline, and temples, more dilute product (1:1 and 1:2) can be used to provide some volume and/or smooth transitions in the face, whereas hyperdilute CaHA can be used over an even wider surface area in the face, neck, or décolletage to tighten skin and improve skin quality (1:3 and 1:4 dilutions). In the cases presented, patients achieved improvement in appearance through treatment with multiple dilutions of CaHA, providing several examples of how CaHA may be used as part of a multilayered approach to facial rejuvenation. Level of Evidence: 5 (Therapeutic)