The established safety and efficacy of HA fillers and CaHA and their availability in most aesthetic practices has led to many physicians exploring innovative ways of utilizing these products. The range of uses of CaHA was further expanded with the discovery that the collagen-stimulating properties of CaHA can be used for skin-tightening procedures by (hyper) diluting the product with lidocaine or saline.

Nowadays, some physicians are also taking advantage of the complementary mechanisms of action of CaHA and HA fillers by combining them so that subjects receive both CaHA and an HA filler in a single injection session.

This may involve layering products in the same facial area, or injection of a premixed combination of the two. Since the two publications by Jonathan Kadouch and Nabil Fakih on premixing CPM-HA and CaHA, called the hybrid filler, this approach has gained great popularity. Since then they have published many more papers and have demonstrated safety of the CaHA-CMC with CPM-HA products convincingly.

First and foremost, the safety of this procedure was well demonstrated by the authors first publication, but in their second publication also the efficacy of this hybrid filler was shown to be impactful. A couple of reasons have been put forward to explain this efficacy and support further exploring the combination/premixing of both products. Scientific data supports the idea that the products enhance and improve each other’s characteristics and effects, leading to a great aesthetic outcome.