Minimally Invasive Facial Rejuvenation with the Hybrid Filler HArmonyCa™

There is an increasing request of minimally invasive procedures for facial rejuvenation, allowing a fast recovery while still offering satisfying outcomes. Hyaluronic Acid (HA) fillers are very useful to restore facial hollows and have a mild lifting effect, but are not effective in increasing dermal thickness and improving skin texture, which are amongst the main features of the aging face.Evidences in literature support the winning combination between HA and calcium hydroxyapatite (CaHa) in facial rejuvenation thanks to the hydrating and volumizing effect of HA and the neocollagenesis and lifting properties following CaHa injection Fakih-Gomez (Facial Plast Surg Clin North Am 13(3):371-80, 2005), Amiri (Front Med 10:1195934, 2023).HArmonyCa™ (Allergan Aesthetics an AbbVie Company) is a hybrid filler that combines HA (20 mg/mL) and CaHa 55.7% (microspheres 25-45 μm) with 0.3% lidocaine in a 1.25 ml syringe.Studies performed specifically with HArmonyCa™, showed very encouraging data on both safety and efficacy of this treatment Urdiales-Gálvez (J Cosmet Dermatol 22(8):2186-2197, 2023). In fact, besides its volumizing properties, HArmonyCa™ showed both a lifting and tightening effect on the skin visible throughout the 6-month follow-up period Urdiales-Gálvez (J Cosmet Dermatol 22(8):2186-2197, 2023).We hereby present the clinical case of a 56-year-old woman presenting moderate skin laxity, reduced skin thickness and turgor and negative eyelid vector with hollowness in the malar region bilaterally. She was treated with injection of 2.5 ml of HArmonyCa™ (Allergan Aesthetics an AbbVie Company) and 1 ml of Voluma™(Allergan Aesthetics an AbbVie Company) per side. The malar region regained its anatomical fullness, skin elasticity and turgor of both cheeks improved significantly and the patient was very satisfied with her outcome.The literature concerning patient satisfaction after treatments with HA and CaHA hybrid fillers is very poor as reported by Rivers (in: Rivers (ed) Forty-fourth Congress of the Italian Society of Aesthetic Medicine, Rome, Italy, 2023). This is one of the first contributes to the existing literature, but large and systematic studies are necessary in order to better assess a very important aspect of this very promising treatment for non-invasive facial rejuvenation.Level of Evidence V This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .