Dispersion of Calcium Hydroxylapatite Accumulations in the Skin: Animal Studies and Clinical Practices

OBJECTIVES To describe a method whereby accumulated calcium hydroxylapatite (CaHA) can be dispersed into surrounding dermal or subcutaneous tissues by local injection of an aqueous solution followed by vigorous massage. DESIGN Researchers examined three possible antidotes to correct CaHA nodularity: massage alone, injection of saline into the site followed by massage, and injection of sterile water into the site followed by massage. During the 21-day study period of CaHA alone and CaHA mixed with adjuvant, researchers observed inflammatory reactions on Day 0 and Day 21. Antidote efficacy was observed immediately after injection on Day 0 and again on Day 21. RESULTS The sterile water and CaHA+adjuvant saline solutions combined with massage demonstrated significantly less nodularity. In addition, CaHA+adjuvant blebs (nodules) were flattened out more upon massage than were CaHA-only blebs, a finding consistent with deliberate decrease in elasticity of CaHA alone. Clinical experience results also demonstrated that use of lidocaine injection followed by massage resulted in dispersion of CaHA accumulation and restoration of even contours. CONCLUSIONS The protocol described here may represent a mechanism by which improper placement of CaHA in facial tissues may be effectively corrected without the need for excision or injection of steroids. Robert Voigts is a paid employee of Bioform Medical. Dr. DeVore is a consultant to Bioform Medical with stock options. Dr. Grazer is a paid consultant for Bioform. David J. Howell, PhD, RRT (San Francisco, CA) contributed to the writing of this manuscript.