Hyaluron, hydroxyapatite or both?

Radiesse or hyaluron for wrinkle injections?

Welcher Filler für welchen zweck?

Durch Faltenunterspritzung nicht nur die Haut glätten, sondern das Gewebe auch noch von innen verjüngen – geht das? Ja. Genau dafür wurden Filler aus Kalziumhydroxylapatit wie Radiesse oder Crystalys konzipiert. Sie füllen nicht nur mechanisch verlorenes Volumen auf oder unterfüttern Falten, sondern regen auch die Kollagensynthese an. Vor kurzem erschien mit HArmonyCa auch ein neuartiger Hybridfiller auf dem Markt, der die Vorteile von Hyaluron mit denen von Kalziumhydroxylapatit verbindet. Was die Frage aufwirft: Radiesse oder Hyaluron oder beides – wann empfiehlt sich welcher Filler? Im folgenden Beitrag schildere ich meine Ansicht.

These are the topics:

Wrinkle treatment with Radiesse filler or new hybrid products?

Hyaluron: Standard in aesthetic medicine

Dermafiller, die in der ästhetischen Faltenbehandlung eingesetzt werden, basieren heute in der Regel auf Hyaluron. Hyaluron ist als Füllstoff vielfältig einsetzbar, vom Glätten kleiner Fältchen bis zum Volumenaufbau ganzer Gesichtspartien. Es hat sich deshalb als Standard in der ästhetischen Faltenbehandlung fest etabliert.

Hyaluron is also a substance that occurs naturally in the body. It is therefore predominantly well tolerated. As a filler gel, it fills wrinkles and compensates for volume loss in an excellent way, but otherwise remains passive. On the one hand, this has the advantage of limiting the side effect profile. On the other hand, apart from its mechanical lifting effect, it does not stimulate any physical processes that could support the smoothing effect.

New collagen through calcium hydroxylapatite

The formation of new collagen fibers would be desirable as a priority. If this could be additionally stimulated by means of filler injections, then the filling effect of hyaluronic acid could be increased to a real tissue rejuvenation. The skin would be infused with additional fibers that, in addition to the effect of the filler, have a tightening and stabilizing effect and prolong the durability of the result.

Filler with calcium hydoxylapatite

Radish and Crystalis

Such fillers have been available for several years. They usually contain calcium hydroxylapatite. Well-known products are, for example, Radiesse (Merz Aesthetics) or Crystalys (Luminera). Fillers such as Radiesse and Crystalys do not contain hyaluron, but consist of an aqueous gel containing small spheres of calcium hydroxylapatite. Calcium hydroxyapatite (also calcium hydroxyapatite or just hydroxyapatite) is an inorganic compound of calcium and phosphorus and, like hyaluron, occurs naturally in the human body.

Hydroxyapatite in teeth, bone and cartilage

Behandlung mit Radiesse Filler

Calcium hydroxylapatite is one of the main building blocks of teeth and bones. As a substance produced naturally in the body, it is, like hyaluron, completely degradable. Calcium hydroxyapatite fillers such as Radiesse and Crystalys, like those made of hyaluron, are therefore of limited durability. After a few months, they are completely metabolized by the body. Aesthetic treatment with Radiesse or Crystalys must therefore be repeated at regular intervals. As is also known from hyaluron fillers.

Radiesse also lasts limited, but longer

As a rule, however, fillers such as Radiesse or Crystalys work longer than hyaluronic fillers. Radiesse, for example, advertises a shelf life of one year and longer. This is made possible by the biostimulation provided by the calcium hydroxylapatite in Radiesse in addition to mechanical smoothing. Radiesse activates the so-called fibroblasts in the tissue, which produce new collagen and elastin fibers. These fibers lead not only to a filling effect, but also to a long-lasting tightening. The tissue structure is strengthened in depth, the skin appears firmer and more elastic.

However, it takes a while for this effect to take full effect, up to 3 months. Collagen synthesis starts relatively quickly after the treatment, but it takes time. This is not the case with newer hyaluronic fillers; they usually achieve an immediate, clearly visible effect.

Calcium hydroxylapatite and hyaluron in one filler

New: HarmonyCa

The new product HArmonyCa (Allergan) is now heading in this direction. HArmonyCa is a derma filler for restoring facial volume and correcting deep wrinkles. HArmonyCa stems from Allergan’s collaboration with Luminera, whose filler program they acquired in 2020. Luminera produced fillers from both hyaluronic acid and hydroxyapatite, the latter of which includes the Crystalys product mentioned above.

As the name suggests, HArmonyCa combines the two techniques hyaluron (HA) and calcium hydroxyapatite (CA). Like a conventional filler, HArmonyCa consists of a matrix of cross-linked hyaluron, in which very fine spheres of calcium hydroxylapatite are embedded. HArmonyCa sterile, pyrogen-free, viscous implant intended for injection into subcutaneous tissue and deep layers of the skin. For pain relief, it contains 0.3% lidocaine. The concentration of hydroxyapatite microspheres is 55.7%.

HArmonyCA: hyaluron plus calcium hydroxylapatite

HArmonyCA thus combines the benefits of both techniques in one product: the filling effect of hyaluronic acid results in an immediate increase in volume. The face immediately looks fuller, the appearance more radiant. The beads of calcium hydroxyapatite also form a scaffold into which collagen-forming fibroblasts grow. It creates a formation similar to that of cartilage, which stabilizes the tissue and gives it a firm, elastic appearance. The result is a youthful-looking appearance with a long shelf life.

For which applications are fillers such as Radiesse or HArmonyCa suitable?

Treatment with Radiesse and Harmonyca

Treatment with HArmonyCa, Radiesse or Crystalys is indicated in all areas of the face characterized by deep wrinkles and significant volume loss. These include nasolabial folds, marionette lines, the cheek areas or the chin, jaw and bridge of the nose. Due to its firmer consistency, it is not suitable for smaller wrinkles, which can also be treated more cheaply with conventional hyaluron.

The injection immediately reduces wrinkles and volume defects. The collagen build-up stimulated by the calcium hydroxylapatite takes about 2-3 months and only then shows its full effect. Therefore, only then should it be decided whether the result is satisfactory or whether follow-up treatment is still desired. The result usually lasts 1-2 years, often longer.

Die Behandlung mit Radiesse, HArmonyCA oder Crystalys kann mit anderen Therapieoptionen problemlos kombiniert werden, insbesondere Botox und Fadenlifting.

When should fillers such as Radiesse or HArmonyCA not be used?

Fillers with hydroxyapatite such as Radiesse or HArmonyCa must not be used in patients:

mit einer bekannten Überempfindlichkeit gegen einen oder mehrere Inhaltsstoffe des Produkts, insbesondere auch das enthaltene Lidocain.

die an Hautkrankheiten oder anomaler Hautbeschaffenheit leiden.

die an einer Infektion oder Entzündung im Behandlungsareal leiden (akut oder chronisch).

die anfällig sind für Keloidbildung, hypertrophische Narbenbildung oder die Entstehung von Entzündungen der Haut.

mit gestörter Wundheilung aufgrund systemischer Störungen, Arzneimitteln oder Gewebestörungen.

With history of anaphylactic reactions and/or multiple severe allergies.

With known hypersensitivity to steroids or for whom treatment with steroids is contraindicated.

In addition, hydroxyapatite fillers are not suitable for injecting the glabella and periocular area or the lips and perioral area. Fillers containing calcium hydroxylapatite are also not suitable for superficial injections, as is the case with some hyaluronan products for skin hydration.

What should be observed after treatment with Radiesse or HArmonyCA?

Nach der Behandlung mit Radiesse oder HArmonyCA sollten die nachfolgenden Verhaltensempfehlungen befolgt werden:

For 24 hours after treatment, avoid strenuous activity, direct sunlight, solarium and extreme weather conditions.

Periodically apply an ice pack or cold compress to the treated area for 24 hours to reduce redness, swelling and irritation.

Gently massage any nodules that may appear on the treated area.

Since the hydroxyapatite can still be felt under the skin several weeks after treatment, remain calm if injected filler volume can be felt. It takes time for hyaluron and/or hydroxyapatite to be completely incorporated into the tissue. This is normal.

Side effects such as skin redness, edema (swelling), tenderness and itching may occur, but usually subside within 24-48 hours. If they persist longer, then be sure to contact the doctor.

With history of anaphylactic reactions and/or multiple severe allergies.

With known hypersensitivity to steroids or for whom treatment with steroids is contraindicated.

Cost of injections with hydoxylapatite at LIPS and SKIN

How much do Radiesse and HarmonyCa cost?

Due to the better effect and longer durability, fillers with hydroxyapatite are somewhat more expensive than fillers made of hyaluron. In addition, about 25% more filler volume is injected per injection than with conventional hyaluronic syringes with 1ml content.

Treatments with Radiesse or HArmonyCa cost in my practice from about €580. For a treatment of the complete face (4 injections) you have to estimate about €2.100. Please note that the prices quoted are indicative only. Individual billing is carried out according to the German Medical Fee Schedule (GOÄ).

Attractive at every age

LIPS and SKIN Aesthetic Medicine

Eva Maria Strobl, MD
Herzog-Heinrich-Strasse 34
80336 Munich