TOPIC: HArmonyCA; New Filler Product

HArmonyCA is a dual-effect filler combining: Hyaluronic Acid (HA) and calcium hydroxyapatite (CaHA).
Calcium hydroxyapatite functions similarly to PMMA spheres in that it stimulates the body to create collagen; the difference with regards to PMMA is that the calcium hydroxyapatite within HAmonyCA eventually fully dissolves -- thus, it is not permanent (PMMA spheres are permanent)... but should still be a very long lasting product. The HA-filler slowly dissolves over 1-2 years; The calcium & collagen matrix (once formed) lasts...what... 5-years? Theoretically, one would only need to return for a new procedure once every 5-7 years... a substantially better financial & physical proposition.
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Mechanistically: It seems the purpose of the HA-filler in the HArmonyCA product, although acting as a filler itself -- its true purpose here is simply a carrier for the calcium hydroxyapatite (whereas PMMA uses bovine collagen as carrier) -- and was likely chosen b/c HA is perhaps cheaper compared to Bovine Collagen, but not necessarily because it functions "better" as a carrier... perhaps it's somehow a poorer choice of carrier due to it dissolving at a far slower rate than Bovine Collagen.... maybe there is some unknown downside to that...

The exciting part here is that the Calcium hydroxyapatite is both bio-identical & collagen stimulating, while also extremely long-lasting... so it completely removes the main concern of PMMA-type products while maintaining part of its strength (CaHA is not forever but still a long time). On paper at least, this seems to be an excellent product. Personally, I would have preferred the calcium spheres mixed with VOLUX as opposed to HA for the higher gprime for our purposes (general consensus here & elsewhere is that HA is unnaturally too "squishy" in feel & movement, some aren't happy with this) or otherwise use a super fast absorbing carrier so that the spheres are exposed quicker for faster collagen formation. My one big critique: using HA instead of VOLUX (based solely upon experiences shared of others, most seem to agree VOLUX is superior in feel & behavior but I don't actually know). If this product used VOLUX as opposed to HA it would have almost no downsides, in my mind.

This product is available outside the USA & reportedly will be available state-side possibly next year (2026).
Interesting product & with not much information yet available. In terms of filler technology, not aware of any other novel products in development... one would think that it's only a matter of time before these companies catch-on and design a fully ground-up product specifically for use in the penis. It's a pile of gold waiting to be picked up.

If I'm not mistaken, @LeonardoMedicine basically does this very combination --> CaHA are basically the microspheres used in Radiesse and he already employs Hyaluronic Acid (H.A.) in conjunction with this -- I can see the marriage of the two in one syringe potentially being cost saving down the road, especially when it becomes available state-side.

Mind if I ask where you got this information regarding both the product and its potential release in the US?

Yes, I’ve been using the CaHA-HA hybrid since 2021. I blend my own. I prefer doing that as opposed to relying on the manufacturer. That way I can blend to the exact specifications I want. Not all HA play well with CaHA. There are some that lead to more nodules/hard lumps than others. There are some that lead to a nice smooth Flesh-like texture.

FYI, Volux is a type of HA. It is a Vycrossed HA that has been implicated with granuloma formation. I do not recommend blending Vycross products with CaHA as it may actually trigger an immune response creating these granulomas which typically need to be surgically removed. Although Volux is a stiffer product, blending it with another product creates a different consistency probably less stiff than unblended product. This new hybrid product most likely has been tested out on the face and not penis. It may not be appropriate for Girth enhancement.

CaHA does not last 5-7yrs. I do have patients who have returned after 32 months that still retained much of their volume compared to baseline. Longevity may be irrelevant as most of my patients return for more because they love it so much and want to top off their Girth long before it completely breaks down.

Just my experience. I’ll be curious to see how the product behaves and the price point compared to blending on my own.

Would Voluma be safer than Volux if someone wanted to transition to the mix later?

Voluma is also Vycrossed HA so not a suitable blend with CaHA. Voluma and Volux are over-rated and overly priced HA fillers. Luckily in Canada we have more options that are better and a fraction of the price. If you are attracted to these Vycrossed products because of longevity, FYI the package insert for Voluma states the injection must be repeated within 6-9 months (Something in that time frame. I haven’t used Voluma in ages) in order for the results to last at least 18 months. That’s true for just about every other HA filler out there.

Voluma Longevity & Touch-Up Timing
In the pivotal trial, the optional touch-up was done within the first month—not at 6 or 9 months—and this is standard across almost all filler studies. Currently PI in a filler trial and touch ups are allowed at one year. The trial showed that the majority of patients still had visible correction at 24 months. I regularly see Voluma lasting 24 months or longer in practice, especially when injected structurally and in the right tissue plane.

2. Vycross HA and CaHA Compatibility
There is no evidence that Vycross HAs like Voluma or Volux are incompatible with CaHA. I've blended them for years without a single case of granuloma or delayed nodule.

3. Nodules with HA Fillers
Delayed-onset nodules are a known, rare risk with all HA fillers—not just Vycross. In over 15 years and thousands of syringes, I’ve had only two minor cases with Vycross, both easily managed. These are not granulomas in the PMMA sense, and they absolutely do not “typically” require surgical removal. Thats the beauty of HA any issues and the filler can be dissolved. I have seen delayed nodules with all the HA fillers.

4. Texture and “Squishiness”
The complaint that HA is “too squishy” is usually only relevant when large volumes are used. In my opinion, any filler at too high a volume can feel less natural. When used properly, Voluma and Volux feel extremely natural, and the result integrates well into the tissue. Technique, depth, and layering matter more than the HA itself in determining how it feels.

5. Mixing fillers: I prefer using an FDA-approved HA-CaHA hybrid over mixing my own, simply because of consistency, safety, and predictability. With a manufactured product, I know the exact ratios, stability, and performance characteristics have been rigorously tested and standardized. When mixing HA and CaHA manually, even small variations in technique, viscosity, or syringe agitation can affect how the product behaves in tissue, potentially increasing the risk of nodules or uneven results. While I’ve done my own blends in the past, I believe a pre-formulated option—if well-designed—offers a more controlled, reproducible, and ultimately safer outcome for patients.

Bottom line: Voluma is an excellent filler—long-lasting, safe, and versatile. The data backs it, and my experience supports it. Let’s be careful not to generalize rare issues or subjective impressions into broad product criticisms. There are pros and cons to each filler.

Video about HArmonyCA getmoregirth.com/faq/harmonyca-for-penile-enhancement/
Video about NodulesTypes: getmoregirth.com/nodules/

I haven’t used Voluma on a regular basis in about 6yrs. It was advertised at the time as a product with a very high G’ but when compared to products like Restylane Lyft it was much softer. Revanesse Contour and Shape came out and were also much stiffer than Voluma. It seemed pointless to buy Voluma for its viscoelastic properties. In terms of longevity, I do stand corrected. I recall telling my under eye filler patients in order for the product to last as long as they claim, it did require redosing. However for the under eye, often the correction did not warrant an extra syringe of volume after 1 month for the sake of longevity. If it were to be topped off at a later time, say 6-9 months afterwards, any other filler would be suitable.

Reading up on HArmomyCA, I see that it is approved for facial injection. Penile augmentation would be considered off-label much like mixing one’s own hybrid. One of the HAs I blend with CaHA is Belotero Volume which was used in published studies by Drs. Nabil Fakih and Jonathan Kadouch. Their research demonstrated the safety in facial aesthetics. I didn’t wait around for a product to be developed years later before using it for penile augmentation. I’ve come across my favorite ratio of the products that work great for penile augmentation but something I would never use for facial aesthetics.

My problem also with Vycross products is sometimes they can be very difficult to dissolve. They are designed to be persistent. Although CaHA is not dissolvable, it can be hyperdiluted and/or dispersed such that you can erase a poor aesthetic outcome. Using a non-Vycross HA within the hybrid, makes dissolving much easier.

From a price point, we have high quality HA fillers in Canada that cost 1/3 - 2/3 less than Voluma and Volux. I don’t see an advantage to using them to justify the price difference especially when I’ve seen my hybrid blend last past 32 months.

Bottom line, there are so many approaches to penile augmentation. We all have our different experience and history with various products. It’s about the injector and what they can do with the product. I can use HA exclusively and get a great result. I’ve had to dissolve other people’s work because the technique was poor or for whatever reason and not because of what was used.

Dr_Sullivan wrote: Voluma Longevity & Touch-Up Timing
In the pivotal trial, the optional touch-up was done within the first month—not at 6 or 9 months—and this is standard across almost all filler studies. Currently PI in a filler trial and touch ups are allowed at one year. The trial showed that the majority of patients still had visible correction at 24 months. I regularly see Voluma lasting 24 months or longer in practice, especially when injected structurally and in the right tissue plane.

2. Vycross HA and CaHA Compatibility
There is no evidence that Vycross HAs like Voluma or Volux are incompatible with CaHA. I've blended them for years without a single case of granuloma or delayed nodule.

3. Nodules with HA Fillers
Delayed-onset nodules are a known, rare risk with all HA fillers—not just Vycross. In over 15 years and thousands of syringes, I’ve had only two minor cases with Vycross, both easily managed. These are not granulomas in the PMMA sense, and they absolutely do not “typically” require surgical removal. Thats the beauty of HA any issues and the filler can be dissolved. I have seen delayed nodules with all the HA fillers.

4. Texture and “Squishiness”
The complaint that HA is “too squishy” is usually only relevant when large volumes are used. In my opinion, any filler at too high a volume can feel less natural. When used properly, Voluma and Volux feel extremely natural, and the result integrates well into the tissue. Technique, depth, and layering matter more than the HA itself in determining how it feels.

5. Mixing fillers: I prefer using an FDA-approved HA-CaHA hybrid over mixing my own, simply because of consistency, safety, and predictability. With a manufactured product, I know the exact ratios, stability, and performance characteristics have been rigorously tested and standardized. When mixing HA and CaHA manually, even small variations in technique, viscosity, or syringe agitation can affect how the product behaves in tissue, potentially increasing the risk of nodules or uneven results. While I’ve done my own blends in the past, I believe a pre-formulated option—if well-designed—offers a more controlled, reproducible, and ultimately safer outcome for patients.

Bottom line: Voluma is an excellent filler—long-lasting, safe, and versatile. The data backs it, and my experience supports it. Let’s be careful not to generalize rare issues or subjective impressions into broad product criticisms. There are pros and cons to each filler.

Video about HArmonyCA getmoregirth.com/faq/harmonyca-for-penile-enhancement/
Video about NodulesTypes: getmoregirth.com/nodules/

@Dr_Sullivan Are there any other commercially produced HA-CaHA hybrids aside from HArmonyCA (including ones outside of Western markets if you know of any)? When you were mixing your own at what ratio were you mixing your HA to CaHA and what CaHA product did you use, Radiesse? A number of practitioners I have asked seem to do approx 50% +/- 5% by volume or greater to yield a more flesh-like consistency, whereas it seems HArmonyCA is about 30% CaHA by volume (~55% w/w although I'm not completely sure). How much would this 30% vs 50%+ difference affect the end result/longevity in your opinion?

An excellent discussion from our sponsors. Dr. Sullivan, are you currently offering a blended product for Girth enhancement? I certainly like the idea of blended CA-HA over the permanence of Bellafill, but I live in East Texas and it seems my options are Florida or Canada.

I'm only chiming in as a patient of two board sponsors (Avanti for PMMA and Leonardo for HA).

I've referred quite a few guys to Dr Leonardo online simply because we're in Canada where options were somewhat limited and he had been nothing short of great with my outcomes.

I can totally see where he's coming from with blending his own and also see why Sullivan likes the idea of a prepackaged product mixed to certain specs, I can see the merit to both approaches. The reality is that basically every single product that has proven safe for this was used off label.

I also would heavily stress what Skeptical has said in that the actual injector (to me) matters more than the product (so long as the product is safe and legitimate). I had some HA injected prior to Dr Leonardo and it was too superficial/too much in one location and I can personally say that's why some guys say HA is too soft. If it's injected correctly I am 100% of the opinion of most docs that the texture of different products really only is different in a Flaccid state and once you have a full Erection they all should feel pretty much firm because it's essentially a gel under pressure/a hydraulic effect of sorts.

I have an absolute boat load of Revanesse Contour (and some of the Versa I believe it's called) and I can say it's very firm Erect. Because I have so much I'd almost say more like a non discernible implant but I absolutely love the feel of it and it has almost zero squish when hard. Once you have some volume of any type of product you will not have that 100% natural feel where the skin is thin and right on top of all the structure but that doesn't mean it should have squish Erect or be like a balloon.

I also can say that almost every guy I've referred for Leonard's Radiesse hybrid blend has messaged me saying they're happy/want more/have a typical minor aesthetic thing but are going to adjust it and still happy with the size and feel. All very normal outcomes with it. So it's nice to see a product coming along that may mimic that for many more guys.

I honestly wish all these open and honest discussions between doctors and patients were happening years ago because it helps to rapidly improve this for all parties.

Thanks a lot @justn8 your post/opinion definitely puts my mind more at ease. It think it may even have been you that forwarded me to Leo in the first place although I will probably wait 6-12 months before pulling the trigger since I'm not in the country. I am Canadian but only in Canada a couple times a year/every other year so I will almost certainly go with Dr Leo since I'm near Toronto when I'm there. However just keeping my mind open on other products/injectors that might change in the future before I get it done. I actually came across HArmonyCA when researching Radiesse. Apparently it is very common these days to use hyper-dilute CaHA (with saline) for facial procedures, so it got me in the rabbit hole of looking into studies on if it could be diluted with other fillers, what is the best HA to mix with, or if any combination products were available since that is essentially what some other docs were doing including Dr. Leo. Knowing myself I will most likely want to try 1-3 rounds of CaHA-HA and then I would probably want PMMA to prevent trips for life. I've also read that some docs that do PMMA want an initial HA treatment anyway but wondering if the CaHA component of hybrids complicate that, but it seems like most people that actually did PMMA did not bother trying other fillers first, or got PMMA before their additional HA-based fillers.

Not that I know of. I’ve never mixed CaHA for enhancement—only for facial rejuvenation—so I don’t have a good answer to your question.