Risks and complications associated with the use of calcium hydroxyapatite – A literature review

Authors

DOI:

https://doi.org/10.33448/rsd-v15i3.50740

Keywords:

Calcium hydroxyapatite, Biostimulators, Collagen, Aging, Facial.

Abstract

Calcium hydroxyapatite (CaHA) is a widely used biostimulator in orofacial harmonization, especially for its ability to stimulate collagen production and promote skin rejuvenation. However, its use is not without risks and complications, making in-depth knowledge essential for professionals to avoid serious adverse effects. This study aims to review the main risks and complications related to the use of calcium hydroxyapatite in aesthetics, emphasizing its safety, indications, contraindications, and management methods. An integrative literature review was conducted using indexed databases available in English and Portuguese. The review revealed that, despite the proven efficacy of CaHA as a biostimulator, its application requires careful planning, anatomical knowledge, and technical expertise. Complications can range from mild events, such as erythema and edema, to serious occurrences, such as persistent nodules, tissue necrosis, and risk of blindness due to vascular occlusion. The use of facial ultrasound has been considered an important tool in the prevention and early diagnosis of complications. Furthermore, proper management — especially in cases of necrosis — requires rapid interventions, which may include the use of anti-inflammatory drugs, vasodilators, warm compresses, and, in some cases, antibiotics or surgical interventions. It is concluded that the safe use of calcium hydroxyapatite depends directly on the professional's training, knowledge of facial anatomy, and respect for technical contraindications. Understanding and preventing possible complications are essential to ensure satisfactory results and preserve the health and safety of patients.

References

Abboud, S. J., Pereira, P. A. & Figueiredo, M. I. (2021). Remodelação do mento com implante injetável de hidroxiapatita de cálcio (CaHA): relato de caso. Aesthetic Orofacial Sci. 2(1), 61-71.

Aksenenko, I. et al. (2022). A method for treating complications developed following contour correction with calcium hydroxylapatite-based filler. J Clin Aesthet Dermatol. 15(3), 38-43.

Almeida, A. B. et al. (2024). Bioestimulador de colágeno injetável para o retardamento do envelhecimento facial: uma revisão integrativa entre o poli-l-lático e hidroxiapatita de cálcio. Rev Estética em Movimento. 3(1).

Avelar, I. L., Reis, T. A. & Vana, H. C. (2022). Bioestimuladores de colágeno injetáveis utilizados na harmonização orofacial. Scientia Generalis. 3(2), 257-67.

Benedetto, M. R. S., Pozzi, F. S. & Silva, L. O. B. (2023). Substâncias consolidadas para bioestimuladores de colágeno: forma de ação, indicação e intercorrência – revisão literária. RECIMA21 Rev Cient Multidisciplinar. 4(1).

Cohen, S. R. et al. (2023). Radiesse Rescue: A preliminary study for a simple and effective technique for the removal of calcium hydroxyapatite–based fillers. Aesthetic Surg J. 43(3), 365–9.

Diaz, Z. N. et al. (2024). Foreign body reaction in the oral cavity after migration of injected calcium hydroxyapatite as structural support following an aesthetic procedure: a case report. Rev Otorrinolaringol Cir Cabeza Cuello, v. 84, 2024.

Dourado, T. (2016). Aplicabilidade da hidroxiapatita de cálcio na harmonização orofacial. Trabalho de Conclusão de Curso (Bacharelado em Odontologia). Centro Universitário Luterano de Palmas, Palmas, Tocantins, 2022. http://ulbra-to.br/bibliotecadigital/publico/home/documento/2174.

Driessen, R. R. M. et al. (2024). The role of calcium hydroxyapatite in stimulating collagen production and improving skin quality in aesthetic treatments: an integrative review. Seven Editora Acadêmica DOI: https://doi.org/10.56238/sevened2024.037-040. https://sevenpubl.com.br/editora/article/view/6173

Fenandes, J. M. B., Vieira, L. T. & Castelhano, M. V. C. (2023). Revisão narrativa enquanto metodologia científica significativa: reflexões técnico-formativas. REDES – Revista Educacional da Sucesso. 3(1), 1-7. ISSN: 2763-6704.

Garcia, F. F. S. & Silva, H. K. M. (2023). Utilização de bioestimuladores de colágeno na harmonização orofacial: revisão de literatura. J Multidiscip Dent. 13(3), 165-72.

Goldberg, D. J. et al. (2018). Expanding treatment options for injectable agents. Aesthetic Surg J. 38(supl. 1), S1-S7.

Goldie, K. et al. (2018). Global consensus guidelines for the injection of diluted and hyperdiluted calcium hydroxylapatite for skin tightening. Dermatol Surg. 44(supl. 10, S32-S41.

Guida, S. & Galadari, H. (2024). A systematic review of Radiesse/calcium hydroxylapatite and carboxymethylcellulose: evidence and recommendations for treatment of the face. Int J Dermatol. 63(2), 150-60. DOI: 10.1111/ijd.16888.

Ianhez, M. et al. (2024). Complications of collagen biostimulators in Brazil: Description of products, treatments, and evolution of 55 cases. J Cosmet Dermatol. 23(5), e1615-22.

Júnior, J. C. M., Suguihara, R. T. & Muknicka, D. P. (2023). Bioestimuladores de colágeno na harmonização orofacial. Res Soc Dev. 12(7), e19912742716. DOI: https://doi.org/10.33448/rsd-v12i7.42716

Lima, N. B. & Soares, M. L. (2020). Utilização dos bioestimuladores de colágeno na harmonização orofacial. Clinical and Laboratorial Research in Dentistry. 6(2), 165-72.

Marumo, Y. et al. (2017). Visual impairment by multiple vascular embolization with hydroxyapatite particles. Orbit. 37(3), 165-70.

Moura, M. L. F. G. et al. (2023). Utilização da hidroxiapatita de cálcio e ácido hialurônico (HArmonyCaTM) como preenchedor facial. Braz. J. Implantol. Health Sci. 5(5), 3707-25.

Neca, C. S. M. et al. (2022). O uso de bioestimuladores de colágeno à base de hidroxiapatita de cálcio. E-Acadêmica, 3(2), e7332237. DOI: https://doi.org/10.52076/eacad-v3i2.237

Oliveira, C. S. F. P. et al. (2021). Hidroxiapatita de cálcio: uma revisão quanto à eficácia, segurança e imaginologia quando usado como preenchedor e como bioestimulador. Res Soc Dev. 10(14), 12. DOI: https://doi.org/10.33448/rsd-v10i14.21689.

Parada, et al. (2016). Manejo de complicações de preenchedores dérmicos. Surgical & Cosmetic Dermatology. 8(4), 342-51.

Pereira, A. S. et al. (2018). Metodologia da pesquisa científica. [Free ebook]. Santa Maria. Editora da UFSM.

Risemberg, R. I. C. et al. (2026). A importância da metodologia científica no desenvolvimento de artigos científicos. E-Acadêmica. 7(1), e0171675. https://eacademica.org/eacademica/article/view/675.

Saragoça, A. B. O., Felix, G. S. & Castro, I. L. (2023). Bioestimuladores de colágeno (ácido polilático, hidroxiapatita de cálcio, policaprolactona e polidioxanona). RECIMA21 Rev Cient Multidisc. 4(1), e414460.

Shi, X. H. et al. (2016). Complications from nasolabial fold injection of calcium hydroxylapatite for facial soft-tissue augmentation: A systematic review and meta-analysis. Aesthet Surg J., 36(6), 712-717, 2016.

Silva, G. S.; Avelino, B. S. S. (2004). Rejuvenescimento facial: uma comparação entre os produtos mais utilizados e novos insights da cosmética brasileira. Rev Foco, 17(11), 106, 2024.

Snyder, H. (2019). Literature review as a research methodology: An overview and guidelines. Journal of Business Research, Elsevier. 104(C), 333-9. Doi: 10.1016/j.jbusres.2019.07.039.

Sousa, A. M. S. et al. (2023). Imaging features and complications of facial cosmetic procedures. Radiographics. 43(12), e230060.

Troczinski, A. P. et al. (2024). O uso da hidroxiapatita de cálcio bioestimulador de colágeno na biomedicina estética: uma revisão de literatura. Braz J Implantol Health Sci. 6(5), 1289-312.

Van Lghem, J. et al. (2020). Managing intravascular complications following treatment with calcium hydroxylapatite: An expert consensus. J Cosmet Dermatol. 19(11), 2845-58.

Wink, N. F. & Schneider, T. (2024). Bioestimuladores de colágeno e suas aplicações na estética: uma revisão bibliográfica. Rev Ciênc Saúde – REVIVA. 3(2), 1-37.

Zago Sá Fortes, R. et al. (2024). Adverse events and satisfaction outcomes with calcium hydroxylapatite and polycaprolactone fillers in facial aesthetics: A systematic review. Cosmetics. 11(5), 165.

Published

2026-03-10

Issue

Section

Health Sciences

How to Cite

Risks and complications associated with the use of calcium hydroxyapatite – A literature review. Research, Society and Development, [S. l.], v. 15, n. 3, p. e3315350740, 2026. DOI: 10.33448/rsd-v15i3.50740. Disponível em: https://rsdjournal.org/rsd/article/view/50740. Acesso em: 24 mar. 2026.