A combination of fillers and other modalities is often required to address all signs of periorbital aging. Patients are injected for volume loss, and for hyperpigmentation are treated with a combination treatments with chemical peels and lasers, but multiple visits can be burdensome. To streamline the current treatment approach for the periocular area, the current study investigated the benefit of the treatment with a blend of Hyaluronic Acid (HA) and Calcium Hydroxylapatite (CaHA). This dual-filler strategy is designed to utilize the rheological and volume replacement capabilities of HA alongside the bioregenerative effects of CaHA while avoiding excessive edema and/or delayed swelling that may occur when HA is injected alone.

One hundred and six adults were treated with a blend of crosslinked HA (22.5 mg/mL) and diluted/hyperdiluted CaHA. The filler ratio was chosen based on individual skin thickness and depth of palpebro-malar groove (PG) or supraorbital hollowness (SH). Assessments were performed at baseline (T0), 30, 60, 90, and 365 days. One patient underwent a comparative analysis of HA alone versus the HA-CaHA blend, evaluated through ultrasound, Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) scan post-injection.

All treated patients presented natural-looking results, less pronounced PG and SH with minimal edema on D30, and skin quality improvement with less laxity, wrinkling and pigmentation. No hyaluronidase injections for overcorrections were required. No severe complications were observed. For most patients, results varied according to the dilution of the blend; lower dilutions (1:1) lasted longer than higher dilution (1:4), even though results were still noticeable for patients treated with the latter (1:4) at the 1-year evaluation.

This study validates the use of a HA and CaHA blend (CaHA-CPM) for periocular rejuvenation, addressing various aging symptoms in this complex facial region.