Prevention and Management of Complications With a Hyaluronic Acid–Calcium Hydroxyapatite Hybrid Injectable

Wolfgang G Philipp-Dormston,1,2 Koenraad De Boulle,3,4 David B Eccleston,5 Rachna Murthy,6 Karim Sayed,7– 9 Philippe Snozzi,10,11 Fernando Urdiales-Galvez12 1Hautzentrum Köln, Cologne, Germany; 2Faculty of Health, University Witten/Herdecke, Witten, Germany; 3Aalst Dermatology Clinic, Aalst, Belgium; 4University College London, London, UK; 5MediZen, Birmingham, UK; 6FaceRestoration, Ltd, London, UK; 7Nomi Oslo Clinic, Oslo, Norway; 8Ouronyx Clinic, London, UK; 9University of South-Eastern Norway, Drammen, Norway; 10Smoothline, Zurich, Switzerland; 11University of Amsterdam, Amsterdam, Netherlands; 12Instituto Médico Miramar, Málaga, SpainCorrespondence: Wolfgang G Philipp-Dormston, Hautzentrum Köln, Schillingsrotter Str. 39-41, Köln, 50996, Germany, Tel +49 221 390 00 200, Fax +49 221 390 00 201, Email [email protected]: A ready-to-use hyaluronic acid–calcium hydroxyapatite (HA-CaHA) hybrid injectable has a dual mode of action for soft-tissue augmentation. Although previous studies have reported a favorable safety profile for HA-CaHA, there is a need for guidelines and recommendations based on real-world clinical experience for the management of complications associated with HA-CaHA.Purpose: This publication provides guidelines and recommendations for the prevention and management of HA-CaHA–related complications. A case study example, treatment algorithms, and injection techniques are included to illustrate the management of complications.Materials and Methods: On January 25, 2023, 13 European physicians were invited to an advisory board meeting to discuss strategies for optimizing patient care, minimizing adverse events (AEs), and identifying data gaps for the prevention and management of complications with HA-CaHA.Results: The management of a subset of AEs, including skin discoloration and edema, was discussed. Small group workshops also shared management algorithms for late noninflammatory adverse reactions, late inflammatory adverse reactions, localized vascular complications, and retinal vascular complications. Best practices for optimal injection techniques were discussed, and injection-technique protocols were developed for treatment sites. Treatment strategies for HA-CaHA–related complications are considered similar to treatment of those resulting from single-agent fillers, and knowledge of anatomy, aseptic technique, correct injection techniques, and appropriate posttreatment care is emphasized.Conclusion: These recommendations on the management of HA-CaHA–related complications may serve as a reference for the broad range of clinicians using HA-CaHA hybrid injectable for different indications and can help optimize patient outcomes and safety.Keywords: hyaluronic acid, calcium hydroxyapatite, prevention, complications