Abstract
BACKGROUND: The use of dermal fillers has become increasingly popular in aesthetic medicine for facial rejuvenation and skin enhancement. Hyaluronic acid (HA) and calcium hydroxylapatite (CaHA) are particularly well-known for their unique benefits. This systematic review evaluates the combinations (e.g., using two separate treatments together) and hybrid treatments of HA and CaHA (e.g., direct syringe-to-syringe mixing), focusing on their mechanisms of action, aesthetic effectiveness, patient satisfaction, and safety. METHODS: Six bibliographic databases were searched for human and non-human studies that explored the mechanistic effects of combined and hybrid HA and CaHA treatments, and their aesthetic effectiveness, skin quality, satisfaction, and safety were included. Due to high heterogeneity among included studies, a qualitative synthesis of the evidence was performed. RESULTS: The combination of HA and CaHA stimulates collagen synthesis through different molecular pathways. The combined and hybrid treatments are associated with high aesthetic effectiveness in various facial areas, as reported by both investigators and subjects. Additionally, the combinations and hybrid treatments show high satisfaction rates and have a safe profile, with minor, self-resolving adverse effects. A trend of slight decline in both aesthetic improvement and treatment satisfaction was observed after six months. CONCLUSIONS: The combinations and hybrid treatments of HA and CaHA appear to be a promising, safe, and efficacious treatment for facial rejuvenation, offering both immediate volumizing effects and longer-term benefits through collagen synthesis. Future research should employ rigorous study designs aimed at refining treatment protocols and generating strong, long-term evidence for the safety and effectiveness of this combination or hybrid therapy in aesthetic medicine. LEVEL OF EVIDENCE II: 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 the Table of Contents or the online Instructions to Authors www.springer.com/00266 .