TOPIC: The History of the Radiesse-HA Hybrid

Providers are most comfortable with using Hyaluronic Acid (HA) filler for their augmentation procedure. It’s forgiving in that mistakes and adverse events can be reversed. Aesthetic injectors are introduced to HA fillers then with more experience advance to semi-permanent or even permanent (I do not use permanent products).

My initial choice of penile filler was Radiesse, calcium hydroxylapatite (Ca-Ha). I like that Ca-Ha is biocompatible, typically avoids an immune response (therefore, less prone to granuloma formation), and forms Collagen Type 1 & 3 along with Elastin. It is essentially a synthetic material that eventually becomes you such that it behaves and feels like flesh. HA is hydrophilic. It draws and retains water such that it may feel bulky but spongy depending on product choice and placement. One intimidating aspect of Ca-Ha is that it may lead to nodule formation, development of a firm ball or lump. Most of the time these are self-limiting and require no action. They will eventually go away on their own at their own time whether it is weeks to months.

Ca-Ha is highly viscoelastic and stands head and shoulders above any HA product on the market. This means that it is stiff and excellent for contouring bony structures like the cheeks, chin, and mandible. For areas of the body with thin skin (lips and the under eye), it is contraindicated. This makes Ca-Ha a strange choice for the penis as the skin here can be thin as well. However, when Ca-Ha is blended down with Normal Saline, the product becomes softer and less bulky but it is still capable of creating Collagen 1 &3 and Elastin. If diluted too much, it no longer provides filling capabilities but it acts more like a skin conditioner.

As early as 2019, I tried various dilutions with exclusively Ca-Ha. I had very good results. The only problem at the time was that Ca-Ha tends to swell and often the bulk immediately after procedure did not amount to the same retained volume making a second stage common and to be expected. Jani van Loghem, MD, one of the world leading experts in Radiesse, saw my work and was impressed with this off label cutting edge indication. He invited me to author the penile augmentation chapter of his forthcoming text book devoted specifically to Ca-Ha, “Calcium Hydroxylapatite Soft Tissue Fillers: Expert Treatment Techniques.” The book was released in the Fall of 2020.

During the pandemic, I was invited twice to appear on his Live Webinars, Calcium Hydroxylapatite Expert Innovations. There were two other key figures that appeared on his webinar, Drs. Nabil Fakih and Jonathan Kadouch. They presented their work on blending Ca-Ha with HA filler for facial aesthetics. They demonstrated the safety of the perfect marriage of fillers. The hybrid took on the best characteristics of each component. The hybrid was bulky because of the HA component. It had increased longevity due to the development of collagen and elastin. The skin quality also improved. Adverse events were few, basically bruising, swelling, and self-limiting nodules (0.6%) . Their work was published later in the year.

Shortly after their presentation, on Jan 22, 2021 I reached out to Dr. Fakih regarding penile augmentation using a hybrid filler. He had no experience with penile augmentation but was very interested in my technique and the outcome. 3 days later, I performed possibly the world’s first Radiesse-HA Hybrid Penile Augmentation. My technique and formulation have changed and is constantly being perfected. I have had over 4 yrs experience with the hybrid blend. It has a high satisfaction rate. Complications are uncommon and easily managed as the hybrid is dissolvable to an extent. If you are concerned or intimidated by others who have had poor outcomes with Radiesse, this does not apply to my practice. I’d encourage you to contact my office for more information:

info @leonardomedicine .com or 1-647-223-4436

Attached are some of the conversations exchanged between Dr. Fakih and myself.

Thank you so much for this information.

This is very interesting and gives me lots to consider.