# Expert Panel Guidelines for Hybrid CaHA‐CMC/CPM‐HA Fillers in the Mexican Population

## TL;DR

This paper provides guidelines for using hybrid fillers in aesthetic treatments for the Mexican population, focusing on preparation, injection techniques, and patient outcomes.

## Contribution

The paper introduces expert-derived guidelines for hybrid CaHA-CMC/CPM-HA filler use tailored to the Mexican population.

## Key findings

- A 1:1 ratio of CaHA-CMC to CPM-HA is preferred for filler preparation and administered subcutaneously.
- 90% of experts believe the benefits of hybrid fillers justify their higher cost.
- High patient satisfaction and prolonged results are key factors for adopting hybrid treatments.

## Abstract

Combination of calcium hydroxylapatite‐carboxymethylcellulose (CaHA‐CMC) and hyaluronic acid (HA) in a single syringe has shown effectiveness and safety. In light of the growing popularity of hybrid fillers in aesthetic medicine, there is a need to establish treatment guidelines, especially focusing on diverse populations, including Mexicans.

By combining the clinical expertise of 10 Mexican injectors with scientific evidence, recommendations were established for the use of hybrids in treating patients from a Mexican population. The panel reached consensus on 10 topics: skin preparation, anesthetic use, hybrid filler preparation, syringe choice, injection protocol by anatomical zone, duration of treatment, complications/adverse events, patient perspective, treatment costs and future perspectives.

Regardless of the CPM‐HA or anatomic area, a 1:1 ratio of CaHA‐CMC to CPM‐HA, was the preferred ratio for filler preparation and was administered subcutaneously using fanning and retro‐injection techniques. Almost all experts (9/10, 90%) believed the clinical outcomes obtained with hybrid fillers and the reduced treatment time (number of visits required) justify the increased cost. Main factors in driving increased adoption of hybrid treatments in clinical practice were high patient satisfaction, clinical efficacy, innovation, and prolonged duration of results. The choice of CPM‐HA for the hybrid filler should be guided by skin quality, degree of sagging, volume loss, underlying anatomy, and patient expectations.

This paper provided recommendations regarding the preparation and injection of CaHA‐CMC and CPM‐HA combinations across different anatomical regions. These contributions aim to support clinical decision‐making, optimize outcomes, and improve patient safety in aesthetic treatments.