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Hand Rejuvenation with Customizable Hybrid Fillers: Premixed Calcium Hydroxyapatite and Hyaluronic Acid

  • Original Articles
  • Fat Grafting/Regenerative Surgery
  • Published:
Aesthetic Plastic Surgery Aims and scope Submit manuscript

Abstract

Introduction

Hand aging is a prevalent concern characterized by the atrophy of local soft tissues and increased visibility of vessels and tendons. Hyaluronic acid (HA) and calcium hydroxyapatite (CaHA) are well-established treatments for addressing this issue. While hybrid filler containing HA and CaHA has been proposed for facial rejuvenation, studies investigating its efficacy for hand rejuvenation are lacking.

Objective

This study aims to assess the safety and efficacy of a premixed hybrid filler containing calcium hydroxyapatite (CaHA) and hyaluronic acid (HA) for hand rejuvenation.

Methods

A prospective, double-blind, controlled trial was conducted. The control arm (CA) received conventional subdermal treatment with CaHA at a 1:1 dilution. The intervention arm (IA) underwent hybrid treatment, consisting of CaHA at a 1:1 dilution combined with 1 ml of low-density HA. Evaluation was performed subjectively using the Global Aesthetic Improvement Scale (GAIS) and the Manchester Hand Grading System (MHGS), and objectively using cutometry, corneometry, and ultrasound.

Results

Both the CA and the IA exhibited high rates of patient satisfaction and satisfaction as assessed by blinded evaluators. Although numerical superiority was observed in the IA, no statistical difference was found between the two groups. Significant improvements in hydration, elasticity, and skin thickness were observed in both arms, with no discernible difference between them. Greater ultrasound echogenicity was noted in the IA, which, as indicated by existing literature, may suggest enhanced biostimulation. No adverse effects were reported in either arm.

Conclusion

Premixed filler containing HA and CaHA for hand rejuvenation appears to be a safe and effective approach.

Level of Evidence I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.

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Funding

None of the authors received any funding or financial support for the content of this article.

Author information

Authors and Affiliations

  1. Instituto Boggio—Medicina, Ensino e Pesquisa, São Paulo, Brazil

    Gladstone Eustaquio de Lima Faria, Adriane Tartare, Luciana Zattar, Ana Carolina Henriques Ribeiro Machado & Ricardo Frota Boggio

  2. Department of Facial Plastic and Cranio-Maxillo-Facial Surgery, Fakih Hospital, Khaizaran, Lebanon

    Nabil Fakih-Gomez & Cristina Muñoz-Gonzalez

  3. Private Clinic, Buenos Aires, Argentina

    Fernando Felice

  4. ReSculpt Clinic, Amsterdam, The Netherlands

    Jonathan Kadouch

Authors
  1. Gladstone Eustaquio de Lima Faria
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  2. Nabil Fakih-Gomez
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  3. Adriane Tartare
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  4. Luciana Zattar
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  5. Ana Carolina Henriques Ribeiro Machado
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  6. Fernando Felice
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  7. Jonathan Kadouch
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  8. Cristina Muñoz-Gonzalez
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  9. Ricardo Frota Boggio
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Contributions

G.E.L.F., N.F.G. and R.F.B: performed and designed the research, data analysis and wrote the article. A.T., L.Z., A.C.H.R.M performed the research. F.F., J.K., C.M.G, final review.

Corresponding authors

Correspondence to Gladstone Eustaquio de Lima Faria or Luciana Zattar.

Ethics declarations

Conflict of interest

The authors G.E.L.F, A.T., F.F, J.K., and N.F-G. are consultants for Merz Aesthetics. R.F.B. is consultant for Allergan Aesthetics.

Ethics statement

This study was performed in line with the principles of the Declaration of Helsinki. The study was duly submitted to the Research Ethics Committee under number 76774723.0.0000.8054 and favorable opinion to conduct the study under number 6,666,307.

Consent to publish

All participants have provided consent for the publication of their photographs.

Data policy

For this type of study, we don’t have data to deposit in a public repository.

Appendices

  • R0: This parameter represents the skin's passive response to force.

  • R1: The skin's ability to return to its original state.

  • R2: Gross elasticity, with a value closer to 1 (100%) indicating higher elasticity.

  • R3: Maximum amplitude of the last and first curves compared to indicate skin fatigue effects.

  • R4: Minimum amplitude of the last and first curves compared to indicate skin fatigue effects.

  • R5: Net elasticity, with a value closer to 1 (100%) indicating higher skin elasticity.

  • R6: Portion of viscoelasticity in the elastic part of the curve, with smaller values indicating higher elasticity.

  • R7: Portion of elasticity compared to the complete curve, with a value closer to 1 (100%) indicating higher elasticity.

  • R8: The skin's ability to return to its normal state.

  • R9: Effects of skin fatigue after repeated suction, with smaller R9 values indicating lesser effects.

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Faria, G.E.d.L., Fakih-Gomez, N., Tartare, A. et al. Hand Rejuvenation with Customizable Hybrid Fillers: Premixed Calcium Hydroxyapatite and Hyaluronic Acid. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-024-04145-4

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