Mint & Needle Founder Brandi Gregge Co-Authors Clinical Commentary in the Journal of Cosmetic Dermatology on Reducing CaHA-CMC Accumulations

Reduction of Early-Onset Calcium Hydroxylapatite-Carboxymethylcellulose Accumulations Using Focused Mechanical Vibration: An Experimental Model and Case Report

1. Introduction

Particle-containing biostimulatory treatments, such as calcium hydroxylapatite-carboxymethylcellulose (CaHA-CMC; Radiesse, Merz North America Inc., Franksville, WI, USA), have become increasingly popular for their ability to restore soft tissue volume and promote extracellular matrix regeneration [1, 2]. Despite their clinical effectiveness, complications like noninflammatory nodules can occur, primarily attributed to localized focal accumulations (FAs) of particles rather than immune-mediated inflammatory responses [3]. These nodules typically result from superficial injections, accidental boluses, injection of large volumes of highly concentrated products, or poor dispersion of the material during injection [4]. FAs can arise minutes to days postinjection [3]. In contrast, delayed-onset nodules, which are generally driven by immune responses, often appear months after injection [5].

Previous strategies to manage these nodules have ranged from conservative measures, such as manual massage and warm compresses to more aggressive pharmacologic interventions, ablative technologies, and even negative pressure aspiration, with varying degrees of efficacy [6-9]. Recently, structured algorithms categorizing these interventions based on their invasiveness, effectiveness, and patient burden have been proposed [3]. Specifically, Level 1 interventions, which emphasize minimally invasive dispersion techniques, have shown promise in effectively resolving these accumulations by redistributing the filler particles over a broader tissue area."

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Journal of Cosmetic Dermatology, July 2025