{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T07:20:57Z","timestamp":1791876057336,"version":"4.3.4"},"reference-count":11,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T00:00:00Z","timestamp":1754697600000},"content-version":"vor","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J of Cosmetic Dermatology"],"published-print":{"date-parts":[[2025,8]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Calcium hydroxylapatite (CaHA) is a biostimulatory filler frequently used in a hyperdilute form to improve skin quality. While generally safe, nodule formation is the most common adverse event, particularly in dynamic areas.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>To describe a case of delayed\u2010onset CaHA nodules in the neck and review anatomical and procedural factors contributing to this complication, as well as prevention and management strategies.<\/jats:p><\/jats:sec><jats:sec><jats:title>Patient<\/jats:title><jats:p>A 72\u2010year\u2010old woman underwent three sessions of hyperdilute CaHA injections to the neck, with recent or concurrent onabotulinumtoxinA injections. After the third treatment, which followed a longer interval since her last botulinum toxin injection, she developed multiple firm, non\u2010tender nodules. A stepwise approach with intralesional saline injections\u2014initially using needles and later a cannula\u2014was implemented.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Initial saline injections with small\u2010gauge needles yielded minimal improvement. Transitioning to a 22G cannula enabled both saline delivery and mechanical disruption, resulting in complete resolution after five total treatments. The patient has remained recurrence\u2010free for over 2\u2009years.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Nodule formation following CaHA injection is most often due to product aggregation, and is particularly common in dynamic areas with thin overlying skin. Combining treatment with botulinum toxin may reduce this risk by limiting movement. Other preventive strategies include using higher dilutions of CaHA, avoiding high\u2010risk areas, and optimizing injection depth. When nodules do occur, mechanical disruption with a cannula combined with saline injection is a safe, effective, and minimally invasive first\u2010line treatment.<\/jats:p><\/jats:sec>","DOI":"10.1111\/jocd.70385","type":"journal-article","created":{"date-parts":[[2025,8,9]],"date-time":"2025-08-09T08:48:34Z","timestamp":1754729314000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Prevention of Calcium Hydroxyapatite Nodules in the Neck With Use of Botulinum Toxin: A Case Report and Review of Anatomy and Pathophysiology"],"prefix":"10.1111","volume":"24","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9373-2555","authenticated-orcid":false,"given":"Bianca Y.","family":"Kang","sequence":"first","affiliation":[{"name":"Department of Dermatology Mayo Clinic  Scottsdale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sabrina Guillen","family":"Fabi","sequence":"additional","affiliation":[{"name":"Cosmetic Laser Dermatology  San Diego California USA"},{"name":"Department of Dermatology University of California San Diego  San Diego California USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elika","family":"Hoss","sequence":"additional","affiliation":[{"name":"Department of Dermatology Mayo Clinic  Scottsdale Arizona USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,8,9]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000001685"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1093\/asj\/sjae031"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/GOX.0000000000002160"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/jocd.12326"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000000569"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.2165\/11530110-000000000-00000"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1524-4725.2010.01741.x"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1524-4725.2003.29212.x"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1097\/PRS.0000000000001877"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1529-8019.2006.00072.x"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1097\/DSS.0000000000001909"}],"container-title":["Journal of Cosmetic Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/jocd.70385","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T02:10:38Z","timestamp":1760062238000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/jocd.70385"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8]]},"references-count":11,"journal-issue":{"issue":"8","published-print":{"date-parts":[[2025,8]]}},"alternative-id":["10.1111\/jocd.70385"],"URL":"https:\/\/doi.org\/10.1111\/jocd.70385","archive":["Portico"],"relation":{},"ISSN":["1473-2130","1473-2165"],"issn-type":[{"value":"1473-2130","type":"print"},{"value":"1473-2165","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,8]]},"assertion":[{"value":"2025-02-06","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-28","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-08-09","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e70385"}}