{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,29]],"date-time":"2026-10-29T04:45:53Z","timestamp":1793249153565,"version":"4.5.0"},"reference-count":8,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T00:00:00Z","timestamp":1625011200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"Merz North America"},{"name":"xMedica, LLC"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,1,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Over the past several years, hyperdilute calcium hydroxylapatite (CaHA) has emerged as an effective modality for improving skin quality and managing laxity in the face, arms, hands, neck, d\u00e9colletage, upper arms, abdomen, buttocks, and upper legs, as well as for treating cellulite and striae. Whereas undiluted CaHA is used to provide volume, hyperdilute CaHA is distributed across a much larger surface area in a more superficial plane to stimulate neocollagenesis and elastin formation over time. The absence of lymphocytic infiltrates and predominance of type 1 collagen in the tissue response to CaHA make hyperdilute CaHA a valuable tool for nonsurgical skin tightening.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The aim of this study was to provide practical step-by-step guidance on patient selection, dilution practices, and optimal injection technique to facilitate incorporation of the technique into clinical practice.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Over the course of 3 regional meetings in the United States, 12 expert physician injectors participated in live webinars as part of a continuing medical education program.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The practical guidance in this manuscript is based upon the most frequently requested information by audience members and the information considered critical for success by the authors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The minimally invasive nature of filler injection results in little downtime, making this treatment particularly appealing. The recommendations presented are consistent with previously published consensus guidelines on hyperdilute CaHA but are intended to serve as \u201chow-to\u201d guidance based on the experience of expert injectors who have successfully treated the face and body.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence: 4<\/jats:title>\n                    <jats:p\/>\n                  <\/jats:sec>","DOI":"10.1093\/asj\/sjab269","type":"journal-article","created":{"date-parts":[[2021,6,30]],"date-time":"2021-06-30T15:02:04Z","timestamp":1625065324000},"page":"NP29-NP37","source":"Crossref","is-referenced-by-count":45,"title":["Skin Tightening With Hyperdilute CaHA: Dilution Practices and Practical Guidance for Clinical Practice"],"prefix":"10.1093","volume":"42","author":[{"given":"Z Paul","family":"Lorenc","sequence":"first","affiliation":[{"name":"Department of Plastic Surgery, Lenox Hill Hospital , New York, NY , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeanette M","family":"Black","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessie S","family":"Cheung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie","family":"Chiu","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Cedars-Sinai Medical Center , Los Angeles, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberta","family":"Del Campo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan James","family":"Durkin","sequence":"additional","affiliation":[{"name":"Florida State University College of Medicine , Tallahassee, FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miles","family":"Graivier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeremy B","family":"Green","sequence":"additional","affiliation":[{"name":"University of Miami Frost Department of Dermatology and Cutaneous Surgery\/Jackson Memorial Hospital , Miami, FL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gideon P","family":"Kwok","sequence":"additional","affiliation":[{"name":"Kaiser Family Medicine Residency Program , Fontana, CA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Marcus","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charalambos \u201cBabis\u201d","family":"Rammos","sequence":"additional","affiliation":[{"name":"Department of Surgery, Division of Plastic Surgery, University of Illinois College of Medicine , Peoria, IL , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William Philip","family":"Werschler","sequence":"additional","affiliation":[{"name":"Department of Medicine\/Dermatology, University of Washington , Seattle, WA , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2021,6,30]]},"reference":[{"key":"2024083005210400500_CIT0001","volume-title":"Radiesse [instructions for use]","year":"2020"},{"issue":"9","key":"2024083005210400500_CIT0002","first-page":"1107","article-title":"Rheological properties of calcium hydroxylapatite with integral lidocaine","volume":"15","author":"Meland","year":"2016","journal-title":"J Drugs Dermatol."},{"key":"2024083005210400500_CIT0003","first-page":"S64","article-title":"Calcium hydroxylapatite filler for facial rejuvenation: a histologic and immunohistochemical analysis","volume":"34","author":"Berlin","year":"2008","journal-title":"Dermatol Surg."},{"issue":"4","key":"2024083005210400500_CIT0004","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1080\/147641704100003048","article-title":"Clinical, histologic and electron microscopic findings after injection of a calcium hydroxylapatite filler","volume":"6","author":"Marmur","year":"2004","journal-title":"J Cosmet Laser Ther."},{"issue":"1","key":"2024083005210400500_CIT0005","first-page":"68","article-title":"Improved neocollagenesis and skin mechanical properties after injection of diluted calcium hydroxylapatite in the neck and d\u00e9colletage: a pilot study","volume":"16","author":"Yutskovskaya","year":"2017","journal-title":"J Drugs Dermatol."},{"issue":"3","key":"2024083005210400500_CIT0006","doi-asserted-by":"crossref","first-page":"e2160","DOI":"10.1097\/GOX.0000000000002160","article-title":"Consensus recommendations for the use of hyperdiluted calcium hydroxyapatite (Radiesse) as a face and body biostimulatory agent","volume":"7","author":"de Almeida","year":"2019","journal-title":"Plast Reconstr Surg Glob Open."},{"key":"2024083005210400500_CIT0007","doi-asserted-by":"crossref","first-page":"S32","DOI":"10.1097\/DSS.0000000000001685","article-title":"Global consensus guidelines for the injection of diluted and hyperdiluted calcium hydroxylapatite for skin tightening","volume":"44","author":"Goldie","year":"2018","journal-title":"Dermatol Surg."},{"issue":"9","key":"2024083005210400500_CIT0008","first-page":"1136","article-title":"Composite volumization of the aging face: supra-periosteal space as the foundation for optimal facial rejuvenation","volume":"15","author":"Lorenc","year":"2016","journal-title":"J Drugs Dermatol"}],"container-title":["Aesthetic Surgery 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