calcium hydroxylapatite

Action and Spectrum

Actions and Spectrum: 

Mechanism of Action: 

• Volumizing Effect: calcium hydroxylapatite provides immediate volume to the treated area. It is injected into the skin, adding volume and support to areas that have lost volume due to aging or other factors. 
• Collagen Stimulation: One of the unique properties of calcium hydroxylapatite is its ability to stimulate collagen production. Over time, the CaHA microspheres stimulate the body’s collagen production, further improving the treated area. This collagen stimulation helps to provide long-lasting results. 
• Biodegradation: calcium hydroxylapatite is gradually broken down and metabolized by the body. As the CaHA particles degrade, they are replaced by newly formed collagen, maintaining the volume and structure in the treated area. 

Spectrum of Activity: calcium hydroxylapatite is primarily used for facial rejuvenation and contouring. It can be used to address various aesthetic concerns, including: 

• Wrinkles and Fine Lines: CaHA can help reduce the appearance of facial wrinkles, such as nasolabial folds (smile lines), marionette lines, and vertical lip lines. 
• Facial Contouring: It can restore volume and improve facial contours, such as enhancing cheekbones, chin augmentation, and jawline definition. 
• Hand Rejuvenation: calcium hydroxylapatite can also be used to restore volume and improve the appearance of aging hands, adding a more youthful and plump look. 

Drug Interaction

Adverse Reaction

Frequency defined 

>10% 

Erythema (66.7%) 

Soreness, contour irregularity, irritation (29.9%) 

Pruritus (18%) 

Edema (69.2%) 

Ecchymosis (63.2%) 

Pain (28.2%)  

Hand augmentation 

Bruising (18.6%) 

Vagal response, Hypersensitivity, needle pricks (11%) 

Swelling (20.4%)  

1-10% (Hand Augmentation) 

Pain (6.2%) 

Itching (3.5%) 

Difficulty performing activities (1.8%) 

Redness (8%) 

Nodule, bumps/lumps (6.2%)  

<1% 

Nodule (0.9%) 

Black Box Warning

Black box warning: 

None

Contraindication / Caution

Contraindications/caution: 

Contraindications: 

• Hypersensitivity or Allergy: Individuals with known hypersensitivity or allergy to calcium hydroxylapatite or its components should not receive treatment with this substance. 
• Active Infection or Skin Disease: CaHA injections should not be performed in areas with active skin infections, such as cellulitis, or areas with inflammatory skin conditions like eczema or psoriasis.  
• Bleeding Disorders or Anticoagulant Use: Patients with bleeding disorders or those taking anticoagulant medications may have an increased risk of bleeding or bruising at the injection site.  

Caution: 

• Injection Technique: CaHA should be administered by a qualified and trained healthcare professional with experience with the product and its injection techniques. Improper injection technique can lead to complications, such as lumps, irregularities, or tissue damage. 
• Allergic Reactions: Although rare, allergic reactions to calcium hydroxylapatite can occur.  
• Inflammatory or Autoimmune Conditions: Caution should be exercised when using CaHA in individuals with active or chronic inflammatory skin conditions, autoimmune diseases, or a history of immunosuppression. These conditions may increase the risk of adverse reactions or complications. 
• Infection Prevention: Following proper aseptic techniques during the procedure is essential to reduce the risk of infection. Avoid treatment in areas with active skin infections or individuals with recurrent infections. 
• Delayed Onset Nodules: In rare cases, delayed onset nodules or granulomas may form at the injection site. These can occur several weeks or months after treatment. 

Pregnancy / Lactation

Pregnancy consideration: It is generally recommended to avoid cosmetic procedures during pregnancy. 

Pregnancy category: C 

Lactation: Excretion of the drug in human breast milk is unknown 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester. 

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

• Volumizing Effect: When injected into the skin, calcium hydroxylapatite provides immediate volume and structural support. It acts as a filler, helping to restore volume to areas that have lost density due to aging or other factors. 
• Collagen Stimulation: One of the unique properties of CaHA is its ability to stimulate collagen production. Over time, the CaHA microspheres act as a scaffold, promoting the growth of new collagen fibers. This collagen stimulation helps enhance the treatment’s long-term effects and improve the skin’s elasticity and firmness. 

Pharmacodynamics: 

The pharmacodynamics of calcium hydroxylapatite (CaHA) as a dermal filler involves several vital aspects: 

• Volume Restoration: CaHA provides immediate volume and structural support when injected into the skin. It acts as a filler, replenishing areas of the face or body that have lost volume due to aging or other factors.  
• Collagen Stimulation:  The stimulation of collagen production contributes to the long-term effects of CaHA, enhancing skin quality and improving its overall texture and tone. 
• Tissue Integration: CaHA particles are biocompatible, allowing them to integrate with the surrounding tissues. They create a scaffold-like structure, which helps to support and maintain the volume and shape in the treated area. The integration of CaHA with the surrounding tissues provides natural-looking and long-lasting results. 
• Gradual Biodegradation: While CaHA provides immediate volume, the body gradually breaks down and resorbs it over time. As the CaHA particles biodegrade, they are replaced by newly formed collagen fibers, ensuring the longevity of the results. The gradual biodegradation and replacement with collagen maintain the volume and structural support in the treated area. 

Pharmacokinetics: 

Absorption 

CaHA is typically injected directly into the dermis or subcutaneous tissue. As such, it bypasses the process of absorption from the gastrointestinal tract. CaHA particles remain localized at the injection site upon injection, providing immediate volume and structural support. 

Distribution 

It does not distribute widely throughout the body. It remains predominantly at the injection site, integrating with the surrounding tissues and providing the desired volumizing effect. The distribution beyond the injection site is limited. 

Metabolism 

The body does not metabolize CaHA. It gradually undergoes biodegradation over time. As the CaHA particles break down, they are slowly resorbed and replaced by newly formed collagen fibers. The exact metabolic pathways and processes involved in the biodegradation of CaHA need to be better defined. 

Elimination and Excretion 

Since CaHA is not metabolized, it is not excreted in its original form. Any remnants of CaHA that are not biodegraded or resorbed may eventually be cleared through the body’s natural elimination processes.

Adminstartion

Administration: 

Subcutaneous injection using a needle having an exterior diameter of 25 ga and an inner diameter of 27 ga (Luer lock fittings). 

Apply a correction factor of 1:1; do not overcorrect 

Patient Information Leaflet

Patient information leaflet 

Generic Name: calcium hydroxylapatite 

Why do we use calcium hydroxylapatite? 

calcium hydroxylapatite (CaHA) has various uses in medicine and healthcare. Here are some typical applications: 

• Dermal Filler: One of the primary uses of CaHA is as a dermal filler for aesthetic purposes. It is injected into the skin to restore volume, smoothen wrinkles and fine lines, and improve facial contours. CaHA-based dermal fillers often rejuvenate the face, including the cheeks, nasolabial folds (smile lines), marionette, and chin. 
• Facial Augmentation: CaHA can be used for non-surgical facial augmentation procedures. It enhances and shapes facial features such as the chin, jawline, and temples. By adding volume and structure, CaHA can help create more balanced facial proportions and improve overall facial aesthetics. 
• Hand Rejuvenation: CaHA-based fillers can also be used to rejuvenate the hands. As the hands age, they may lose volume and develop prominent veins and wrinkles. Injecting CaHA into the hands can restore volume, reduce the appearance of veins, and improve the texture and smoothness of the skin. 
• Scar Correction: CaHA fillers can improve the appearance of certain scars, such as atrophic or depressed scars. By filling in the depressed areas, CaHA can help elevate the scar and make it less noticeable.