title: Complications from Nasolabial Fold Injection of Calcium Hydroxylapatite for Facial Soft-Tissue Augmentation: A Systematic Review and Meta-Analysis.
abstract: BACKGROUND
  Despite its increasing usage of facial applications, there is a paucity of objective data regarding calcium hydroxylapatite (CaHA).
  
  
  OBJECTIVE
  To systematically evaluate the complications from CaHA injection for facial soft tissue augmentation.
  
  
  METHODS
  Published studies on CaHA injection for facial soft tissue enhancement were identified through searches of the PubMed, EMBASE, and Cochrane Controlled Trial databases. Only randomized, controlled trials comparing CaHA injection to either placebo or an active comparator for facial cosmetic use were included. The outcome measures were the count (n) and frequency (%) of each complication, including edema (swelling), erythema (redness), ecchymosis (bruising), pain, pruritus (itching), hematomas, nodules, and extrusions.
  
  
  RESULTS
  Four studies on nasolabial fold (NLF) injection of CaHA consisting of two subgroups were included: (i) a CaHA-lidocaine vs CaHA subgroup and (ii) a CaHA vs hyaluronic acid (HA) subgroup. The addition of lidocaine to CaHA therapy displayed no significant effect on edema (RR (95% CI): 1.07 (0.94-1.21), P = .311), erythema (RR (95% CI): 0.91 (0.66-1.24), P = .544), ecchymosis (RR (95% CI): 1.04 (0.71-1.52), P = .843), pain (RR (95% CI): 0.88 (0.58-1.33), P = .553), or pruritus (RR (95% CI): 0.82 (0.45-1.50), P = .515). There was no significant difference between CaHA vs HA for hematomas (RR (95% CI): 0.24 (0.01-4.31), P = .332) or nodules (RR (95% CI): 0.18 (0.01-6.62), P = .353). There was no significant publication bias detected in either subgroup (Begg's test P > 0.05).
  
  
  CONCLUSIONS
  These findings support the addition of lidocaine to NLF injection of CaHA and suggest an equivalence between CaHA and HA with respect to hematoma and nodule formation. LEVEL OF EVIDENCE 2: Risk.
authors.affiliation: From the Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Xiao-Hua
authors.initials: XH
authors.lastname: Shi
authors.affiliation: From the Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Xin
authors.initials: X
authors.lastname: Zhou
authors.affiliation: From the Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Zhang
authors.affiliation: From the Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Ze-Yuan
authors.initials: ZY
authors.lastname: Lei
authors.affiliation: From the Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Ting
authors.initials: T
authors.lastname: Liu
authors.affiliation: From the Department of Plastic and Cosmetic Surgery, Xinqiao Hospital, The Third Military Medical University, Chongqing, China.
authors.forename: Dong-Li
authors.initials: DL
authors.lastname: Fan
mesh_terms: D000779:Anesthetics, Local / Q000008:administration & dosage; D001672:Biocompatible Materials / Q000008:administration & dosage* / Q000009:adverse effects; D003357:Cosmetic Techniques / Q000009:adverse effects*; D017886:Durapatite / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007267:Injections; D008012:Lidocaine / Q000008:administration & dosage; D060052:Nasolabial Fold; D010146:Pain / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D015595:Skin Aging
chemical_list: D000779:Anesthetics, Local; D001672:Biocompatible Materials; D017886:Durapatite; D008012:Lidocaine