Resumo

Objectives: This presentation will demonstrate, through two clinical cases, the sustained effect (over 17 months) in skin thickness and firmness when using a hybrid filler - 20 mg/mL of hyaluronic acid combined with calcium hydroxyapatite (HA/CaHA). The pinch test was utilized as a clinical tool to assess dermal thickness and firmness. The pinch test can also be used as a diagnostic indicator and a follow-up tool to provide evidence of dermal thickening for both injector and patient after the procedure. HA/CaHA offers a promising non-surgical option for enhancing dermal thickness and skin quality. Introduction: Everyone wants firm, resilient skin; however, nothing lasts forever. Skin firmness is influenced by genetics, shaped by our lifestyle habits, and naturally decreases with age. As we age, we experience bone resorption, fat pad repositioning, muscle atrophy, as well as tissue sagging and skin thinning. Over time, people struggle to maintain the firmness of their skin. Many people invest in skincare products or even consider surgical options. A hybrid filler (HA/CaHA) is an excellent choice to improve skin firmness in middle-aged women (as demonstrated in these two clinical cases). Materials / method: HA/CaHA was injected behind the functional ligament line on both sides of the patients` faces: 0.25 mL in the zygomatic arch, 0.5 mL in the parotid-masseteric region, and 0.5 mL along the mandibular line using a 22G cannula into the superficial subcutaneous layer with a fanning retrograde technique. Case 1: a 44-year-old female, monitored over 18 months. Pinch tests were performed at baseline, 1 month, 2 months, and 18 months post-procedure. Case 2: a 49-year-old female with a 17-month follow-up. The pinch test was conducted at baseline, 3 months and 17 months post-procedure. Results: Case 1: the patient’s smile revealed softening of the accordion lines. The pinch test at 30 days, 60 days, and 18 months post-procedure showed improvement in skin thickness with reduced stretch. Case 2: at 3 months post-procedure, the pinch test showed significant reduction in sagging. By 17 months post-procedure, improvement was still evident and maintained a perceptibly thicker and more resilient skin. In both cases, collagen production was evident, even up to 17 months post-procedure. These results align with existing literature supporting the biostimulatory effect of this hybrid filler. Conclusion: The long-term dermal thickening and lifting-effect observed in these clinical cases are consistent with findings in current literature. This presentation clinically demonstrates sustained biostimulation when using a hybrid filler, as confirmed by the pinch test (an effective and simple assessment tool for evaluating improvements in patient skin laxity). This study provides strong clinical evidence of the long-lasting skin-thickening and lifting effects of a hybrid filler and reinforces the role of HA/CaHa as a powerful biostimulator with results lasting up to 17–18 months.