A 3-Tiered Approach for the Use of Calcium Hydroxylapatite Premixed with Lidocaine for Facial Applications

The adoption of calcium hydroxylapatite (CaHA) into clinical practice has been both rapid and wide-spread since it was approved for facial use in 2006. As practitioners have become comfortable using CaHA as one of their therapeutic options, different applications, some of which are off label and some of which are approved by the US Food and Drug Administration, have appeared in the literature, including ones for areas of the upper face, midface, and lower face, as well as the dorsal hands. Concomitant with the growth of extended applications has been a shift in the way the product is delivered. Originally, CaHA injections were preceded by administration of anesthesia; however, in 2009, the US Food and Drug Administration cleared premixing of lidocaine with CaHA for direct injection into the dermis. In this article, I describe a 3-tiered approach to premixing different volumes of lidocaine with CaHA depending on both the depth of injection and the anatomical area(s) to be treated.