PEER-REVIEW | CASE STUDY |
are embedded in a resorbable, viscoelastic sodium carboxymethylcellulose gel matrix (70%). An immediate corrective effect is noticeable on
implantation of the filler, as a result of augmentation by the gel matrix. An additional effect occurs in the dermis: the CaHA microspheres stimulate the formation of new collagen. This principle of neocollagenesis was confirmed in a canine model3
. In one study,
neocollagenesis was also histologically documented in a person following the injection of this filler4
. Over time, the
Figure 1 CT scan showing nasolabial folds before (A) and after (B) injection with CaHA
Firstly, a dominant fold develops in the fourth dorsal
interdigital space and is surrounded by multiple small parallel folds1
. The loss of elasticity and, more importantly,
the loss of volume in the tissue surrounding the veins, leads to the typical skeletonised appearance. As a result, transversal folds also develop in the third interdigital space, and dorsal ulnar-side wrist creases appear from the age of 40 years. In slim people, the extensor tendons are visible along the entire length of the retinaculum extensorum to each metacarpal head, which often concerns many patients who present for treatment. Histologically, disorganised collagen fibrils and elastotic degeneration are detectable. Reduced microcirculation and poorer lymphatic drainage have also been documented1
. As in the face, volume deficits in the hand can be
Figure 2 (A) Hands of a 77-year-old female patient before treatment with CaHA — the loss of volume is clear. (B) Hands immediately after treatment with CaHA. The immediate volumising effect is visible, and the veins less so
corrected using dermal fillers. The procedure is simple, safe, quick, and effective. Hyaluronic acid and calcium hydroxylapatite (CaHA)-based dermal fillers are used most often for this indication2
.
Properties of CaHA The volume filler Radiesse (Merz Aesthetics, San Mateo, CA) consists of synthetically produced CaHA microspheres between 25 and 45 m m in size (30%), which
CaHA microspheres are slowly broken down and metabolised into calcium and phosphate ions through normal metabolic processes. Reports on the duration of the filler effect in the literature range from 10 to 14 months, and often exceed that of hyaluronic acid fillers5
. CaHA has been used for over 20 years in dentistry and
Radiesse is more viscous and elastic than other
15
biodegradable dermal fillers . This makes CaHA particularly
suitable for volume correction in the hands.
surgery. Radiesse is approved by the US Food and Drug Administration (FDA) for the correction of moderate to severe facial wrinkles and folds, and the correction of lipoatrophy as a result of antiretroviral therapy in HIV patients. The efficacy and tolerability of the filler has been investigated in clinical studies in over 3000 patients. In fact, it is one of the best-documented dermal fillers5–13
. Note that the material is clearly distinguishable from
surrounding structures in a CT scan (Figure 1), while not always identifiable in X-rays14
.
CaHA for hand augmentation Radiesse is more viscous and elastic than other biodegradable dermal fillers15
. This makes CaHA
particularly suitable for volume correction in the hands. The opaque quality of Radiesse also means that it can be used to hide prominently protruding veins16
.
Homogeneous distribution with low injection pressure is advantageous in the hands. In addition, patients can easily help to ensure the success of treatment by keeping the fist clenched or sitting on their hands immediately after the treatment for a period of time (approximately 2 hours is usually advised).
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January/February 2013 |
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