Table Of ContentCalcium Hydroxylapatite
Soft Tissue Fillers
Expert Treatment Techniques
Calcium Hydroxylapatite
Soft Tissue Fillers
Expert Treatment Techniques
Edited by
Jani van Loghem
Aesthetic Physician
UMA Institute
Amsterdam, The Netherlands
First edition published 2021
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Contents
Preface vii
Contributors ix
Videos xiii
1 RADIESSE: The story of calcium hydroxylapatite 1
Oumama Draoui, Jani van Loghem, Wouter J. Peeters, and Pieter Siebenga
2 The upper third of the face: Forehead lift, cannula technique 13
Jani van Loghem
3 The upper third of the face: Frontal concavity 17
Yates Yen-Yu Chao and Jani van Loghem
4 The upper third of the face: Temporal hollows 23
Jani van Loghem
5 The upper third of the face: Lateral brow lift 29
Jani van Loghem
6 The upper third of the face: Frontal bossing, male 35
Jani van Loghem
7 The upper third of the face: Horizontal forehead lines 39
Jani van Loghem
8 The upper third of the face: Temporal crest smoothing 43
Jani van Loghem
9 The middle third of the face: Cheek augmentation 49
Shino Bay Aguilera, Luis Soro, and Jani van Loghem
10 The middle third of the face: Tear troughs 59
Jani van Loghem
11 The middle third of the face: Palpebromalar groove 63
Jani van Loghem
12 The middle third of the face: Nasolabial folds 69
Jani van Loghem
13 The middle third of the face: Nose augmentation 73
Steven Dayan, Thuy-Van Tina Ho, and Jani van Loghem
14 The middle third of the face: Preauricular wrinkles 79
Jani van Loghem
15 The middle third of the face: Accordion lines 81
Jani van Loghem
16 The lower third of the face: Prejowl sulcus and marionette lines 83
Nabila Azib
17 The lower third of the face: Oral commissures 89
Jani van Loghem
18 The lower third of the face: Radial lip lines 93
Jani van Loghem
v
vi Contents
19 The lower third of the face: Mentum augmentation 95
Jani van Loghem
20 Mentum crease 101
Jani van Loghem
21 The lower third of the face: The mandibular angle and jawline 103
Jani van Loghem, Shino Bay Aguilera, and Luis Soro
22 The lower third of the face: Masseter augmentation in men 109
Jani van Loghem
23 Neck and chest: Neck rejuvenation 113
Jani van Loghem
24 Neck and chest: Horizontal neck lines 115
Yates Yen-Yu Chao and Jani van Loghem
25 Neck and chest: Skin rejuvenation of the décolletage 119
Pieter Siebenga and Jani van Loghem
26 Neck and chest: Skin rejuvenation of the breast 123
Pieter Siebenga and Jani van Loghem
27 Neck and chest: Rejuvenation of abdominal skin 127
Pieter Siebenga and Jani van Loghem
28 Neck and chest: MesoCaHA for cheeks, neck, and décolletage 131
Yana A. Yutskovskaya and Anna Daniilovna Sergeeva
29 Extremities: Correction of skin laxity of the upper arms 135
Wouter J. Peeters and Jani van Loghem
30 Extremities: Hands 139
Tatjana Pavicic and Sebastian Cotofana
31 Extremities: Elbow skin quality improvement 145
Jani van Loghem
32 Extremities: Upper leg skin quality improvement 147
Jani van Loghem and Pieter Siebenga
33 Extremities: Calf augmentation 151
Jani van Loghem and Pieter Siebenga
34 Extremities: Foot rejuvenation 153
Jani van Loghem and Pieter Siebenga
35 Intimate areas: Labia majora and mons pubis 155
Jani van Loghem, Job Thuis, and Pieter Siebenga
36 Intimate areas: G-spot augmentation 157
Jani van Loghem
37 Intimate areas: Buttocks 161
Jani van Loghem and Pieter Siebenga
38 Penile augmentation 165
John Leonardo
39 Complication management and prevention 169
Pieter Siebenga and Jani van Loghem
Index 181
Preface
Calcium Hydroxylapatite Soft Tissue Fillers: Expert filler, biostimulators have taken up a very prominent place
Treatment Techniques is a hands-on reference book, in the arsenal of most aesthetic practitioners. There are a
created with the input of the world’s leading experts on the few commercially available biostimulatory products on the
use of the product. It can be used by doctors, nurses, and market such as calcium hydroxylapatite (CaHA), poly-L-
other professional injectors to study the relevant anatomy, lactic acid (PLLA), polycaprolacton (PCL), and tricalcium
aesthetic target sites, injection techniques, and to review the phosphate (TCP). CaHA is currently the most commonly
safest and most effective treatment protocols available for used biostimulatory product and is injected in many facial
this versatile product. As a training aid, the book contains and body indications. While the product is relatively safe,
multiple photo sequences as well as schematic diagrams there are complication risks involved. To achieve beautiful
to help in clarifying the proposed techniques. Links to results, the practitioner must have an aesthetic sense and
multiple videos for review have been included. We have knowledge of the ideal areas and depths to inject the
not only chosen to include the official on-label indications, product. International experts travel the world to present
but we also asked various internationally esteemed experts their techniques at congresses and seminars, and they
to share their ways of tweaking the standard protocols publish case reports when they find a new indication to
and to share their innovations. As a disclaimer, therefore, treat so that we can learn from them—and incorporate
many of the techniques discussed are off-label and at the the new techniques into our clinical practice. The demand
practitioner’s own risk. for aesthetic training is huge. Hundreds of congresses,
Injection of soft tissue fillers is the second most frequently workshops, masterclasses, and seminars are organized on a
requested aesthetic medical procedure in the United States weekly basis. Considering pharmaceutical companies often
and The Netherlands. Only botulinum toxin is injected have strong marketing incentives, some general injection
more than dermal fillers, partly because neuromodulators protocols they recommend are based more on their products,
have a shorter longevity than fillers. As the relatively young with perhaps less consideration for the anatomy. In this
medical field of aesthetic medicine is maturing, products book, we aim to share noncommercial expert information
and techniques are constantly changing to improve patient in a nonpolitical way. This is a multispecialty collaboration,
safety and satisfaction. While hyaluronic acid is the current and as such will be of interest to aesthetic physicians and
golden standard and most frequently injected soft tissue nurses in many disciplines and subspecialties.
vii
Contributors
SHINO BAY AGUILERA Albany Medical College, Albany, New York. He received his
Dr. Shino Bay Aguilera is a multi-award winning, world MD degree in 2008 from Ludwig Maximilians University,
renowned, cosmetic dermatologist, dermatologic surgeon, Munich, Germany. His first PhD degree in medical science
and cosmetic laser expert; he is also Dual Board certified is also from Ludwig Maximilians University. He obtained
with a fellowship in dermatology from the American his second PhD in anatomy from Paracelsus Medical
College of Osteopathic Dermatology. He has over 20 years University, Salzburg, Austria in 2015. After completing his
of advanced training in lasers and aesthetic medicine, and residency in trauma surgery, Dr. Cotofana transitioned to
is a clinical researcher published in medical literature. basic sciences and research, and moved to Ross University
He is a former chief medical director of the Dermatology School of Medicine as an associate professor of anatomy. In
Residency program at NOVA University, Florida, and 2017, he moved to Albany, New York, and joined the team
assistant professor of dermatology for Lake Erie College at Albany Medical College.
of Osteopathic Medicine, Suncoast University, and the In his scientific work, Dr. Cotofana specializes in
Universidad del Rosario in Bogota, Colombia. anatomy, facial embryology, and histology. He is an
A top requested international physician trainer and international speaker and live-dissector at many meetings,
keynote speaker for Cynosure, Allergan, Galderma, international conferences, and workshops. Dr. Cotofana
MERZ, Solta, and SkinCeuticals, Dr. Aguilera travels the also serves as a reviewer for more than ten scientific
world teaching physicians the proper use of the newest journals, and has published more than 50 peer-reviewed
laser advancements and cosmetic techniques. He has articles and books.
won the “Top Aesthetic Dermatologists Award” by the
STEVEN DAYAN
world’s leading physicians, “Best Non-Surgical Facial
Enhancment” from the Aesthetic Academy two years in a A facial plastic surgeon, professor, and researcher, Dr. Dayan
row, and “Hottest Aesthetic Doctor in the United States” has published over 120 articles in medical journals and five
and is constantly the “number one” in volume top injector books. He is a NY Times and USA TODAY best-selling
of Sculptra for face in the entire United States. He is on author. His accolades include the American Medical
the advisory board for Merz, Allergan, Galderma, and Association (AMA) Foundation’s Leadership Award
many other leading aesthetic product manufacturers. He and “Top Doc” recognition by numerous organizations
also participates in FDA clinical trial studies for a leading including Castle Connolly and U.S. News & World Report.
global laser manufacturer, and is called upon to determine As a founder of a medical research company, a medical
the best treatment protocols to maximize the safety and marketing company, a skin care training center, and a
efficacy of emerging energy and cosmetic technologies. Dr. medical education company, he remains on the cutting
Aguilera is also a speaker and trainer for Obagi and Solta. edge of aesthetic products, thinking, and education. He is
He is considered a key opinion leader in the industry by a member of ASAPS, AAPFRS, and ASDS while serving in
many of the world’s largest aesthetic companies. an elected position within the Facial Plastic Surgery society
as well as on the editorial boards of Archives of Facial Plastic
NABILA AZIB Surgery, Aesthetic Surgery Journal ASJ (the official journal for
Dr. Azib is a plastic surgeon in Rabat, Morocco. After receiving ASAPS), Facial Plastic Surgery, and Cosmetic Dermatology.
her diploma from the Collège de Médecine des Hôpitaux He is the current co-editor of Modern Aesthetic Magazine
de Paris in 2005, she became a member of Expert2Expert and medical editor of the Facial Plastic Surgery Times; but
group. For ten years she has been an international speaker it is his role as an adjunct professor—teaching a popular
and coauthor of different books. She has been scientific undergraduate course entitled “The science of beauty and its
director of the ICAAM Congress in Dubai for several years, impact on culture and business”—that serves as the basis of
scientific coordinator of Face2F@ce Congress in Cannes, his best-selling book, Subliminally Exposed.
and is now a senior faculty member of ECAMS (European An engaging educator, internationally recognized
College of Aesthetic Medicine and Surgery). keynote speaker, and a person who thinks “big” with an
As a plastic surgeon, she is able to give deep insights insatiable appetite for deeper knowledge and understanding
into anatomical science and the related importance of of human behavior, Dr. Dayan is known for his ability to
experience-oriented treatments. challenge the status quo and conventional wisdoms of
medicine.
SEBASTIAN COTOFANA
OUMAMA DRAOUI
Dr. Cotofana is an associate professor for anatomy in the
department of Medical Education as well as associate Dr. Draoui is a former intern of Rabat University
professor for surgery in the department of Surgery at Public Hospital, Morocco, and Paris APHP Public
ix
