The Injectable Midface Lift – Three Dimensional Changes in the Midface and Nasolabial Fold Following Calcium Hydroxyapatite Injection

Goals/Purpose:  

Three-dimensional volume changes in the midface and the Naso-Labial Fold (NLF) have not been systematically studied following malar injection of Calcium Hydroxyapatite(CaHa). 

Methods/Technique:  

A single surgeon performed 16 hemi-facial injections in 8 fresh cadavers(5M:3F).  CaHa malar injections were performed in the supraperiosteal plane with standard aliquots.  The VECTRA-Canfield 3D system was used to obtain sequential images pre- and post-1.5 and 3cc CaHa injections.  Measurements between the baseline and injection images were performed by a single examiner.  Anatomical verification of the product's location was performed immediately and at >24 hours post-injection.

Results/Complications:

Malar volume increased by 3.16cc and 4.94cc following injection of 1.5cc and 3cc of CaHa respectively (p=0.001).  There were consistently increased volumes in the region of the middle malar fat pad with areas of decreased volumes inferiorly and medially(Figure 1).  The change in volume per cubic-centimeter of CaHa injected was 2.11cc and 1.65cc for the 1.5cc and 3cc volumes respectively (p=0.036).  The average lateral movements of the NL crease at the level of the oral commissure, philtral columns, and nasal sill were 2.7, 2.5, and 1.9mm after injection of 1.5cc and 2.8, 2.9, and 2.4mm after 3cc.  There was a net decrease in the volume of the NLF of -0.3cc and -0.4cc following the 1.5cc and 3cc injections.  This corresponded to relative volume decrease of -0.2 and -0.27 cc per CaHa volume(Figure 2).  Anatomical dissection verified the location of the injected volumes in the middle malar fat pad immediately and >24hours post injection(Figure 3)

Conclusion:

Malar CaHa injection was associated with larger volume increases than that injected and relatively decreased volume inferiorly and medially.  Injection was also associated with lateral movement of the naso-labial crease and an associated decrease in the NLF volume.  This combination of findings indicates a lifting effect with recruitment of ptotic tissue volume post-injection.