A premixed calcium hydroxylapatite/ carboxymethylcellulose-hyaluronic acid hybrid filler for skin quality

Abstract

Background: Hybrid injectable approaches combining calcium hydroxylapatite/carboxymethylcellulose with hyaluronic acid gels may improve both facial contour and skin quality. Methods: We retrospectively reviewed 12 women treated with a premixed hybrid filler injected in the subdermal plane across the mid-and lower-face. Outcomes were assessed at baseline and 4 months using the Merz Aesthetic Scales for mid-and lower-face aging severity, the Lemperle Wrinkle Severity Scale (cheek wrinkles), and a 5-point Global Aesthetic Improvement Scale for patient-reported "skin glow." Results: All Merz domains and cheek wrinkle severity improved at 4 months (cheek wrinkles, p < 0.001). Seven of 12 participants rated their skin glow as "much improved" or "very much improved," and all 12 reported at least "improved." No serious adverse events occurred; bruising resolved spontaneously within 1-2 weeks. Conclusions: In this retrospective case series, the premixed hybrid filler was well tolerated and was associated with improvement in mid-and lower-face aging severity and patient-perceived skin glow at 4 months. Level of evidence: IV. (c) 2026 The Authors. Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/)