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Background: Radiesse, or Calcium Hydroxylapatite (CaHA), is a semi-permanent, biodegradable injectable filler that provides immediate aesthetic improvement, while also stimulating neocollagenesis for biologic effects. The physical properties of CaHA make it difficult, if not impossible to remove. Unlike some of the hyaluronic acid (HA) based fillers, CaHA cannot be easily dissolved.Objectives: We present a simple and reliable technique for debulking and removing excess CaHA in the event of nodule formation, vascular compression, or overcorrection.Methods: An 18-gauge needle is used to make an incision near the filler excess. A 1 mm diameter grater-type mico-liposuction cannula (Lipocube, Inc., London UK) is attached to a 5-10 ml syringe under negative pressure. The cannula under syringe suction is used in a back-and-forth, reaming motion beginning in the base of the material and gradually moving toward the surface until the desired effect has been achieved. Identification of the CaHA can be established and removal confirmed with ultrasound (Clarius, Inc., Vancouver, BC, Canada) if available.Results: Although nodules, excess material and vascular compression secondary to CaHA are very rare occurrences, we have treated four patients with excess material and/or nodules. In one, the prominent cheek filler was reduced and a 1cm nodule that was palpable in the buccal region was eliminated. In the other three other patients, the palpable excess material was easily removed, in two at the time of injection and in the third, 6 months later. No patient required repeat treatment or replacement.Conclusions: CaHA is an important synthetic filler due to its ability to lift, augment and regenerate tissue without eliciting an immune response, but its use has likely been limited due to difficulty of removal. This removal technique is shown to adequately remove excess CaHA filler but is not applicable to inadvertent intravascular injection. [ABSTRACT FROM AUTHOR]

Background: A standardized technique for facial fat grafting, injectable tissue replacement and regeneration (ITR2), incorporating new regenerative approaches, was developed to address anatomic volume losses in superficial and deep fat compartments as well as skin aging.Objectives: The aim of this study was to track the short- and long-term effects of facial fat grafting by ITR2 in the midfacial zone over 19 months.Methods: Twenty-nine females were analyzed for midfacial volume changes after autologous fat transfer with ITR2 with varying fat parcel sizes. Volumes were evaluated with an imaging system to calculate differences between a predefined, 3-dimensional midfacial zone measured preoperatively and after fat grafting.Results: Patient data were analyzed collectively and by age (<55 and >55 years). Collective analysis revealed a trend of initial volume loss during Months 1 to 7 followed by an increase during Months 8 to 19, averaging 56.6% postoperative gain, and ending at an average of 52.3% gain in volume by 14 to 19 months. A similar trend was observed for patients <55 years of age, with a 54.1% average postoperative gain and a greater final average of 75.2%. Conversely, patients >55 years of age revealed a linear decay from 60.6% to 29.5%. Multiple regression analysis revealed no statistically significant influence of weight change throughout the study.Conclusions: A dynamic change in facial volume was observed, with an initial decrease in facial volume followed by a rebound effect, by 19 months after treatment, of improved facial volume regardless of the amount of fat injected. Volume improvement was greater in patients <55 years old, whereas in patients >55 years old, volume gradually decreased. This study represents the first time that progressive improvement in facial volume has been shown 19 months after treatment.Level Of Evidence:4: [ABSTRACT FROM AUTHOR]