Fakih-Gomez Nabil, Kadouch Jonathan, Aragón-Niño Íñigo, Faria Gladstone, Sanchez Gilberto, Hagedorn Nadine, Kaczuba Ewelina, Muñoz-Gonzalez Cristina
Department of Facial Plastic and Cranio-Maxillo-Facial Surgery, Fakih Hospital, Main Street, Khaizaran, 00000, Lebanon.
Practice for Aesthetic Dermatology, Resculpt Clinic, Amsterdam, The Netherlands.
Aesthetic Plast Surg. 2025 Jun 30. doi: 10.1007/s00266-025-05055-9.
Hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) are commonly used in nonsurgical aesthetic procedures. This study introduces a novel mixing technique, the foaming technique, aimed at enhancing the homogeneity and distribution of hybrid fillers containing CaHA and HA.
This retrospective study, conducted by five expert injectors between January 2022 and January 2024, evaluates the clinical outcomes and microscopic characteristics of the foaming technique. The technique involves premixing CaHA, HA, and lidocaine and subjecting the mixture to repeated negative pressure suctions to create foam, followed by additional mixing passes.
The study, conducted between January 2022 and January 2024, treated 1559 patients with hybrid fillers using the foaming technique and revealed no adverse events. Electron microscopy analysis highlighted distinct characteristics of the filler samples (1-CaHA; 2-CaHA, CPM-HA, and lidocaine without foaming; and 3-CaHA, CPM-HA, and lidocaine with foaming), showing a more homogeneous mixture when the foaming technique was applied. Sonography further elucidated unique imaging patterns influenced by the presence of foam, indicative of well-defined borders and the presence of a ring-down artifact. Conversely, in the absence of foam, the imaging typically revealed a band-like product with a less defined border.
The foaming technique demonstrates improved homogeneity and distribution of the premixed hybrid filler, along with the absence of adverse events and smoother particle surfaces observed in electron microscopy samples. Sonography further corroborated these findings, revealing a more uniform pattern with the foam, thereby influencing imaging characteristics. This technique signifies a significant advancement in optimizing hybrid filler applications.
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透明质酸（HA）和羟基磷灰石钙（CaHA）常用于非手术美容程序。本研究引入了一种新型混合技术——发泡技术，旨在提高含CaHA和HA的混合填充剂的均匀性和分布。
这项回顾性研究由五位专家注射医生在2022年1月至2024年1月期间进行，评估了发泡技术的临床结果和微观特征。该技术包括将CaHA、HA和利多卡因预混合，然后对混合物进行反复负压抽吸以产生泡沫，随后再进行额外的混合步骤。
在2022年1月至2024年1月期间进行的这项研究中，使用发泡技术用混合填充剂治疗了1559名患者，未发现不良事件。电子显微镜分析突出了填充剂样本（1 - CaHA；2 - CaHA、CPM - HA和未发泡的利多卡因；3 - CaHA、CPM - HA和发泡的利多卡因）的不同特征，显示应用发泡技术时混合物更均匀。超声检查进一步阐明了受泡沫存在影响的独特成像模式，表明边界清晰且存在振铃伪像。相反，在没有泡沫的情况下，成像通常显示边界不太清晰的带状产物。
发泡技术显示出预混合混合填充剂的均匀性和分布得到改善，同时在电子显微镜样本中未观察到不良事件且颗粒表面更光滑。超声检查进一步证实了这些发现，显示有泡沫时模式更均匀，从而影响成像特征。该技术标志着在优化混合填充剂应用方面取得了重大进展。
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