Hyaluron, hydroxyapatite or both?

Radiesse, Crystalys, HArmonyCA

Not only smoothing the skin through wrinkle injections, but also improving the tissue from the inside – is this possible? Yes. With calcium hydroxylapatite fillers such as Radiesse or Crystalys. Or, brand new, with a filler called HArmonyCA, which combines the benefits of hyaluron with those of calcium hydroxylapatite. I explain everything important about this in the following article.

These are the topics:

  • Hyaluron: Standard in aesthetic medicine
  • Radiesse and Crystalys
  • New on the market: HArmonyCA
  • Treatment with Radiesse and HArmonyCA
  • How much do Radiesse, Crystalys and HArmonyCA cost?

Hyaluron: standard in aesthetic medicine

Hyaluron fills excellently, but remains passive

Dermafillers used in aesthetic wrinkle treatment are usually based on hyaluron. Hyaluron can be used in a variety of ways, from smoothing small wrinkles to adding volume to entire facial areas. It has therefore become firmly established as the standard in aesthetic wrinkle treatment.Hyaluron is a substance that also occurs naturally in the body. It is therefore generally well tolerated. As a filler gel, it fills wrinkles and compensates for volume loss in an excellent way, but otherwise remains passive. Apart from the mechanical lifting effect from within, it does not stimulate any bodily processes that could support the smoothing effect of the filler.

New collagen through calcium hydroxylapatite

The formation of new collagen fibers would be particularly desirable. If this could be additionally stimulated by means of filler injections, then the effect could possibly be improved, since the additional tissue fibers have a tightening and stabilizing effect.

Radiesse and Crystalys

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

Hydroxyapatite in teeth, bones and cartilage.

Calcium hydroxyapatite is something like a main building block of teeth and bones. As an endogenous substance, it is completely degradable. Calcium hydroxylapatite fillers such as Radiesse and Crystalys, like those made of hyaluron, therefore have a limited shelf life. After a few months, they are completely metabolized by the body. Aesthetic treatment with Radiesse or Crystalys must therefore be repeated at regular intervals. Just as is known from hyaluron fillers.

Radiesse also lasts only for a limited time, but longer

As a rule, however, fillers such as Radiesse or Crystalys have a longer effect than hyaluronic fillers. Radiesse, for example, advertises a shelf life of one year and longer. This is made possible by the biostimulation that the calcium hydroxylapatite in Radiesse provides 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 lifting effect. As a result, the tissue structure improves in depth, and the skin appears firmer and more elastic.

New on the market: HArmonyCA

What is HArmonyCA?

HArmonyCa (Allergan), a new product, is now heading in this direction. HArmonyCa is a derma filler designed to restore facial volume and correct deep wrinkles. As the name suggests, it combines the two techniques of hyaluron (HA) and calcium hydroxyapatite (CA). Like a conventional filler, HArmonyCA consists of a matrix of cross-linked hyaluron in which fine spheres of calcium hydroxyapatite are embedded. HArmonyCa a sterile, pyrogen-free, viscous implant intended for injection into subcutaneous tissue and deep layers of the skin. It contains 0.3% lidocaine for pain relief. 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 appears fuller, the appearance more radiant. The beads of calcium hydroxyapatite also form a scaffold into which collagen-forming fibroblasts grow. A “cartilage-like” formation is created, stabilizing the tissue and giving it a firm, elastic appearance. The result is a youthful-looking appearance with long-lasting durability.

The treatment with Radiesse and HArmonyCA

For which regions are fillers like Radiesse or HArmonyCA suitable?

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.

Injection causes immediate alleviation of wrinkles and volume defects. The collagen build-up stimulated by the calcium hydroxylapatite requires 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.

Treatment with Radiesse, HArmonyCA or Crystalys can be easily combined with other therapy options, especially Botox and thread lifting.

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

Fillers with hydroxyapatite such as Radiesse, Crystalys or HArmonyCA must not be used in patients:

  • with a known hypersensitivity to one or more ingredients of the product, especially also the lidocaine it contains
  • Who suffer from skin diseases or abnormal skin condition.
  • Who suffer from infection or inflammation in the treatment area (acute or chronic).
  • Who are prone to keloid formation, hypertrophic scarring, or the development of inflammation of the skin
  • With impaired wound healing due to systemic disorders, drugs, or tissue disturbances
  • 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. Calcium hydroxylapatite fillers are also not suitable for superficial injections, as intended in some hyaluronan products for skin hydration.

What should be observed after treatment with Radiesse or HArmonyCA?

After treatment with Radiesse or HArmonyCA, the following behavioral recommendations should be followed:

  • Avoid strenuous activity, direct sunlight, solarium, and extreme weather conditions for 24 hours after treatment
  • For 24 hours, periodically apply an ice pack or cold compress to the treated area to reduce redness, swelling and irritation
  • Gently massage any nodules that may appear on the treated area
  • Since the hydroxyapatite may still be noticeable 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 your doctor.

How much do Radiesse, Crystalys and HArmonyCA cost?

Due to their superior efficacy and longer shelf life, fillers containing hydroxyapatite are slightly more expensive than fillers made of hyaluronic acid. In addition, about 25% more filler volume is injected per injection than with conventional hyaluronic injections with 1ml content. Treatments with Radiesse, Crystalys 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 these prices are only indicative. Individual billing is done according to the German Medical Fee Schedule (GOÄ).