Abstract
Background
Treating signs of aging requires skeletal restructuring, facial contour redefinition, and sagging skin treatment. Hence, HarmonyCa® was recently introduced in the market, combining hyaluronic acid and hydroxyapatite. However, there are no studies evaluating the physicochemical properties of this material.
Purpose
To analyze the morphology, rheology, and clinical applicability of HarmonyCa® over a 180-day follow-up.
Methods
A morphological analysis with scanning electron microscopy (SEM) and energy-dispersive X-ray spectroscopy (EDS) and rheology measurement with a rheometer. The clinical applicability analysis included a tissue ptosis patient who received the product and was reassessed 30 and 180 days after applying HarmonyCa®.
Results
SEM and EDS analyses showed two distinct morphologies related to hydroxyapatite and hyaluronic acid. The rheological measurements of HarmonyCa® showed G′ and G″ of 51.56 and 44.01 Pa, respectively. The tan δ value was 0.8503, and G* was 108.1 Pa. The clinical outcomes were satisfactory.
Conclusion
HarmonyCa® presents a good synergy between hyaluronic acid and hydroxyapatite. Also, the rheological analysis showed moderate viscosity for the product, with a clinical indication for subcutaneous application.
Level of Evidence IV
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.
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00266-024-04173-0/MediaObjects/266_2024_4173_Fig1_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00266-024-04173-0/MediaObjects/266_2024_4173_Fig2_HTML.png)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00266-024-04173-0/MediaObjects/266_2024_4173_Fig3_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00266-024-04173-0/MediaObjects/266_2024_4173_Fig4_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00266-024-04173-0/MediaObjects/266_2024_4173_Fig5_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00266-024-04173-0/MediaObjects/266_2024_4173_Fig6_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00266-024-04173-0/MediaObjects/266_2024_4173_Fig7_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00266-024-04173-0/MediaObjects/266_2024_4173_Fig8_HTML.jpg)
![](http://media.springernature.com/m312/springer-static/image/art%3A10.1007%2Fs00266-024-04173-0/MediaObjects/266_2024_4173_Fig9_HTML.jpg)
Similar content being viewed by others
References
Diaz L, Santos VBP, Cavalcante A, Huffenbaecher PSR, Queiroz TP, Santos PL, Rocha T (2022) Harmonyca®: uma nova geração de injetores híbridos. AOS 03:55–62
Bravo BSF, de Almeida TSC, Carvalho RM, Machado CJ, Bravo LG, Elias MC (2023) Dermal thickness increase and aesthetic improvement with hybrid product combining hyaluronic acid and calcium hydroxyapatite: a clinical and sonographic analysis. Plast Reconstr Surg Glob Open 11(6):e5055
Barone M, Salzillo R, Persichetti P (2023) Minimally invasive facial rejuvenation with the hybrid Filler HArmonyCa™. Aesthet Plast Surg. https://doi.org/10.1007/s00266-023-03649-9
Urdiales-Gálvez F, Braz A, Cavallini M (2023) Facial rejuvenation with the new hybrid filler HArmonyCa™: clinical and aesthetic outcomes assessed by 2D and 3D photographs, ultrasound, and elastography. J Cosmet Dermatol 22(8):2186–2197
Fagien S, Bertucci V, von Grote E, Mashburn JH (2019) Rheologic and physicochemical properties used to differentiate injectable hyaluronic acid filler products. Plast Reconstr Surg 143(4):707e–720e
Cotofana S, Lachman N (2019) Anatomy of the facial fat compartments and their relevance in aesthetic surgery. J Dtsch Dermatol Ges 17(4):399–413
Tzikas TL (2008) A 52-month summary of results using calcium hydroxylapatite for facial soft tissue augmentation. Dermatol Surg 34(Suppl 1):S9-15
Jansen DA, Graivier MH (2006) Evaluation of a calcium hydroxylapatite-based implant (Radiesse) for facial soft-tissue augmentation. Plast Reconstr Surg 118(3 Suppl):22S-30S
Moers-Carpi M, Storck R, Howell DJ, Ogilvie P, Ogilvie A (2012) Physician and patient satisfaction after use of calcium hydroxylapatite for cheek augmentation. Dermatol Surg 38(7 Pt 2):1217–1222
Baspeyras M, Dallara JM, Cartier H, Charavel MH, Dumas L (2017) Restoring jawline contour with calcium hydroxylapatite: a prospective, observational study. J Cosmet Dermatol 16(3):342–347
Simunovic F, Schlager S, Montanari M, Iblher N (2017) Prospective 3D analysis of facial soft tissue augmentation with calcium hydroxylapatite. J Cosmet Laser Ther 19(5):283–289
Rovatti PP, Pellacani G, Guida S (2020) Hyperdiluted calcium hydroxylapatite 1: 2 for mid and lower facial skin rejuvenation: efficacy and safety. Dermatol Surg 46(12):e112–e117
Chang JW, Koo WY, Kim EK, Lee SW, Lee JH (2020) Facial rejuvenation using a mixture of calcium hydroxylapatite filler and hyaluronic acid filler. J Craniofac Surg 31(1):e18–e21
Fakih-Gomez N, Kadouch J (2022) Combining calcium hydroxylapatite and hyaluronic acid fillers for aesthetic indications: efficacy of an innovative hybrid filler. Aesthet Plast Surg 46(1):373–381
Edsman K, Nord LI, Ohrlund A, Lärkner H, Kenne AH (2012) Gel properties of hyaluronic acid dermal fillers. Dermatol Surg 38:1170–1179
Ferrairo BM, Mosquim V, de Azevedo-Silva LJ, Pires LA, Souza Padovini DS, Magdalena AG (2023) Production of bovine hydroxyapatite nanoparticles as a promising biomaterial via mechanochemical and sonochemical methods. Mater Chem Phys 295(127046):127046
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflicts of interest to disclose.
Human or Animal Rights
The patient selected for this study agreed to the treatment and publication of the material generated, signing the free and informed consent form.
Informed Consent
The patient selected for this study agreed to the treatment and publication of the material generated, signing the free and informed consent form.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Santos, P.L., Magdalena, A.G., Ficho, A.C. et al. Analysis of the Morphology, Rheology, and Clinical Applicability of a Hybrid Injectable with Hyaluronic Acid and Hydroxyapatite. Aesth Plast Surg (2024). https://doi.org/10.1007/s00266-024-04173-0
Received:
Accepted:
Published:
DOI: https://doi.org/10.1007/s00266-024-04173-0