CaHA filler in Singapore is described by clinics as a filler, a collagen stimulator and a skin tightener, often on the same page. All three descriptions are correct, because the same product behaves differently according to how far it is diluted and how deep it is placed. This review sets out what each form of CaHA does, what the published studies measured, where it is not used, and how it compares with the other collagen biostimulators available in Singapore. I have practised aesthetic medicine since 2012, and I use CaHA undiluted for contour, diluted for skin tightening, and in sequence with HIFU.
CaHA filler in Singapore, the key takeaways
- CaHA filler is made of calcium hydroxylapatite microspheres suspended in a gel. The gel adds volume on the day, and the microspheres stimulate new collagen over the following months.
- Undiluted, CaHA lifts and contours the cheeks, chin and jawline. Diluted with saline, it firms lax skin without adding volume.
- Combined with HIFU, the order of treatment matters. HIFU first and diluted CaHA six weeks later produced more than twice the new elastin of the reverse order in a randomised study.
- Results last 12 to 18 months on average. CaHA cannot be dissolved in the way hyaluronic acid filler can, so placement and dilution must be correct at the first treatment.
What CaHA filler is and how calcium hydroxylapatite works
CaHA filler consists of calcium hydroxylapatite microspheres, 25 to 45 microns across, suspended in a carboxymethylcellulose gel. Calcium hydroxylapatite is the same mineral that forms bone and teeth, and it has more than 20 years of use in medicine. The gel gives immediate volume. Over the following two to three months the gel is absorbed, and the microspheres remain as a scaffold on which fibroblasts, the cells that produce collagen, lay down new collagen, mainly type I, around each particle. Part of the result is therefore the patient’s own tissue rather than the product. The microspheres are themselves broken down slowly into calcium and phosphate ions over 12 to 18 months, so CaHA is not permanent.
Undiluted CaHA for cheek, chin and jawline contour
Undiluted CaHA is firm and holds its shape, which suits areas that need structure rather than softness. I use it to restore cheek projection, to lengthen and project a retruded chin, and to sharpen the angle and line of the jaw. Because the gel resists deformation more than most hyaluronic acid fillers, a smaller volume gives a crisper edge and holds its projection. CaHA is not used in the lips, the area around the eyes or the frown lines between the brows, because the skin there is thin and mobile, and a firm product that cannot be dissolved carries a higher risk of visible lumps. CaHA for the nose is covered on my CaHA nose filler page.
Diluted and hyperdiluted CaHA for skin tightening
Diluted with one part saline to one part product, or hyperdiluted with two or more parts saline, CaHA no longer adds volume. The microspheres are instead spread as a thin sheet in the plane just beneath the skin, where each particle stimulates collagen and elastin in the tissue around it, so the whole treated area firms rather than one point lifting. Global consensus guidelines set out doses and injection planes for the mid and lower face, neck, décolletage, upper arms, abdomen and thighs. In a case series of 50 patients treated with hyperdiluted CaHA on the face, neck, décolletage and hands, skin thickness, laxity and wrinkles improved in 95% of patients aged 30 to 40, 80% of those aged 40 to 60 and 70% of those over 60. The decline with age likely reflects the slower collagen response of older fibroblasts. Diluted CaHA for the body is an off-label use, and I explain this before treatment.
CaHA with HIFU, why the order of treatment matters
HIFU tightens the deeper layers by heating focused points in the connective tissue beneath the skin, whereas diluted CaHA rebuilds collagen and elastin closer to the surface, so the two are often combined. In a randomised study of 12 women treated on the lower face and under the chin, those given HIFU first and diluted CaHA six weeks later had a 143% increase in elastin on biopsy, compared with 63% when the order was reversed, and they also scored better on aesthetic improvement. The likely explanation is that the heat injury from HIFU starts a repair response that is still active at six weeks, and CaHA placed into healing tissue recruits more fibroblasts than CaHA placed into resting tissue. In a split-face study of 20 patients followed for 15 months, the combination improved marionette lines, the jawline contour and the neck. A Singapore study of 12 women treated on the upper arms in a single session found firmer skin at 24 weeks on objective measurement. I plan combined treatment in the same order, with HIFU first.
CaHA for acne scars
CaHA can lift some atrophic acne scars, the depressed scars left where collagen was lost beneath a healed lesion. In a study of ten patients, it improved saucer-shaped scars for up to 12 months but did not improve ice pick scars, which are too narrow and deep for a filler to support from below. In a pilot study combining HIFU with diluted CaHA, moderate to severe atrophic acne scars improved significantly at 90 days, with the greatest change in the most severe scars. Ice pick and deep boxcar scars need other treatments, which are covered in my acne scar treatment review.
How long CaHA lasts
The gel gives the immediate effect and is absorbed over the first few months, and the collagen that forms around the microspheres carries the result after that. In facial studies the average result lasted 12 to 18 months. Skin tightening with diluted CaHA is usually planned as two or three sessions, four to eight weeks apart, followed by a maintenance session every 12 to 18 months. Sessions and prices are on my CaHA treatment page.
CaHA vs PLLA, PCL and hybrid hyaluronic acid
| CaHA | PLLA collagen stimulator | PCL filler | Hybrid hyaluronic acid | |
|---|---|---|---|---|
| Material | Calcium hydroxylapatite in gel | Poly-L-lactic acid powder | Polycaprolactone in gel | Hyaluronic acid of high and low molecular weight |
| Volume on the day | Yes, undiluted | No | Yes | No |
| Collagen stimulation | Yes | Yes | Yes | Hydration and skin quality |
| Can be dissolved | No | No | No | Yes, with hyaluronidase |
| Typical duration | 12 to 18 months | Up to 2 years | 1 to 4 years by version | About 6 months |
CaHA suits a face that needs both immediate shape and firmer skin over time. Poly-L-lactic acid (PLLA) builds volume gradually over two to three sessions, with no immediate effect, because the powder itself adds nothing and the result is entirely new collagen. Polycaprolactone (PCL) filler gives volume on the day and the longest duration of the three, with a firm texture that cannot be reversed. Hybrid hyaluronic acid improves hydration and skin quality but does not build structural collagen. The full comparison of biostimulators is in my collagen biostimulator guide.
CaHA side effects and risks
Swelling, bruising, tenderness and mild firmness are common for a few days. Undiluted or lightly diluted CaHA placed too superficially, particularly in thin or darker skin, can show as visible lumps or nodules, because the microspheres sit close enough to the surface to be seen and felt. As with any filler, an injection into a blood vessel can block it, and this is the most serious risk. Blanching, mottling or pain out of proportion to the injection in the hours after treatment are the warning signs, and they are treated as an emergency. Unlike hyaluronic acid, CaHA cannot be dissolved with hyaluronidase, so prevention depends on knowledge of the vascular anatomy, injection technique, dilution and the choice of cannula or needle for each area. I review every patient after treatment.
Dr Gerard Ee, Aesthetic Doctor in Singapore
Dr Gerard Ee is an aesthetic doctor in Singapore and the Medical Director of his practice at 50 Raffles Place. He graduated from St George’s, University of London, trained in surgery at Singapore General Hospital and the National University Hospital, and holds the MRCS (Edinburgh) and a postgraduate diploma in practical dermatology from Cardiff University.
He has practised aesthetic medicine since 2012, is the author of sixteen peer-reviewed papers, and writes and medically reviews every article on this site. Read more about Dr Gerard Ee.
Book a consultation with Dr Gerard Ee at The Clifford Clinic
Dr Gerard Ee consults and performs acne treatment at The Clifford Clinic, 50 Raffles Place, Singapore. Consultations are by appointment. Message the clinic on WhatsApp, or call 6532 2048.
Common questions about CaHA filler in Singapore
Is CaHA worth it?
CaHA is worth considering when a face needs structure and firmer skin together, because it gives volume on the day and builds collagen over months. It is not the right choice for the lips, the area around the eyes, or for anyone who wants a filler that can be dissolved.
Is CaHA better than hybrid hyaluronic acid?
The two products do different jobs. Hybrid hyaluronic acid hydrates the skin and improves its surface quality. CaHA stimulates structural collagen and, undiluted, adds contour. Some patients benefit from both.
What is better, CaHA or hyaluronic acid filler?
Hyaluronic acid filler is reversible and softer, which suits the lips, tear troughs and first-time patients. CaHA is firmer, lasts longer and stimulates collagen, which suits the jawline, chin and cheeks.
Is CaHA a filler?
Undiluted CaHA is a filler that also stimulates collagen. Diluted, it acts mainly as a collagen biostimulator for skin tightening, with little or no filling effect.
Can CaHA be dissolved?
CaHA filler cannot be dissolved. Hyaluronidase, the enzyme used to reverse hyaluronic acid filler, has no effect on calcium hydroxylapatite. The microspheres are broken down by the body over 12 to 18 months.
Selected References
Published studies cited on this page
- Jacovella PF. Use of calcium hydroxylapatite (Radiesse) for facial augmentation. Clin Interv Aging. 2008;3(1):161–174. doi:10.2147/cia.s2065
- van Loghem J, Yutskovskaya YA, Werschler WP. Calcium hydroxylapatite, over a decade of clinical experience. J Clin Aesthet Dermatol. 2015;8(1):38–49.
- Goldie K, Peeters W, Alghoul M, et al. Global consensus guidelines for the injection of diluted and hyperdiluted calcium hydroxylapatite for skin tightening. Dermatol Surg. 2018;44 Suppl 1:S32–S41. doi:10.1097/DSS.0000000000001685
- de Almeida AT, Figueredo V, da Cunha ALG, et al. Consensus recommendations for the use of hyperdiluted calcium hydroxyapatite (Radiesse) as a face and body biostimulatory agent. Plast Reconstr Surg Glob Open. 2019;7(3):e2160. doi:10.1097/GOX.0000000000002160
- Massidda E. Starting point for protocols on the use of hyperdiluted calcium hydroxylapatite (Radiesse) for optimizing age-related biostimulation and rejuvenation of face, neck, décolletage and hands, a case series report. Clin Cosmet Investig Dermatol. 2023;16:3427–3439. doi:10.2147/CCID.S420068
- Doyle A, Looi I, Chu P. Microfocused ultrasound with visualization (MFU-V) and hyperdilute calcium hydroxylapatite (CaHA-CMC) of the lower face and submentum to treat skin laxity. Aesthet Surg J. 2024. doi:10.1093/asj/sjae226
- Yutskovskaya YA, Sergeeva AD, Kogan EA. Combination of calcium hydroxylapatite diluted with normal saline and microfocused ultrasound with visualization for skin tightening. J Drugs Dermatol. 2020;19(4):405–411. doi:10.36849/JDD.2020.4625
- Ramirez S, Puah IBK. Effectiveness of combined microfocused ultrasound with visualization and subdermal calcium hydroxyapatite injections for the management of brachial skin laxity. J Cosmet Dermatol. 2021;20:3871–3879. doi:10.1111/jocd.14573
- Goldberg DJ, Amin S, Hussain M. Acne scar correction using calcium hydroxylapatite in a carrier-based gel. J Cosmet Laser Ther. 2006;8:134–136. doi:10.1080/14764170600891632
- Casabona G. Combined use of microfocused ultrasound and a calcium hydroxylapatite dermal filler for treating atrophic acne scars, a pilot study. J Cosmet Laser Ther. 2018. doi:10.1080/14764172.2017.1406606
This page is written by Dr Gerard Ee from his own clinical practice and the published studies cited above. It is general information and not a substitute for a consultation. Prices are before GST unless stated and may change.
