Eduardo Chicarelli

Faculdade de Medicina de Marilia, Brazil

Title: Approach to acne scar with concomitant improvement of facial flacidity: Association of botulinum toxin and calcium hydroxyapatite


Introduction: The search for aesthetic procedures has not increased considerably in recent years. A challenge in dermatological clinical practice is the management of acne scars. The association of injectables and technologies is necessary in therapy for better aesthetic satisfaction. A new protocol involving microdoses of toxin, subcision and facial biostimulator showed promising results in clinical practice, since, while treating the complaint, it is still possible to have managed the aging process globally in the face. 
Objective: To investigate the improvement of facial morphology in acne scars and, also, globally, in patients with facial flaccidity and atrophic and hypertrophic scars identified by the combined technique of microdoses of botulinum toxin (Xeomin®; Merz Pharmaceuticals GmbH, Frankfurt - Germany) and calcium hydroxyapatite (Radiesse®; Merz Pharmaceuticals GmbH, Frankfurt – Germany). 
Case series: Here we report the results of three cases of patients, two female and one male, aged between 28 and 37 years, seeking to improve the aesthetic appearance of acne scars. In each patient, subcision was performed with a 22G cannula, followed by application of calcium hydroxyapatite in a 1:1 dilution – it was applied in the posterior temporal region, medial and lateral malar, with greater volume in the lateral malar, posterior to the ligaments of the zygomatic bone and jaw bone, totalling 3 ml of biostimulator on each hemiface. After performing injections in multiple points of highly diluted botulinum toxin (20U in 1 ml of saline solution) every 0.8-1.0 cm in the dermis or at the interface between the dermis and the affected muscles, in the region of scars. Each of the three patients showed improvement in facial morphology, with concomitant improvement in the appearance of acne scars and also in support, with consequent non-surgical face lifting and improvement in skin sagging in the upper, middle and lower regions.
Conclusion: The technique for approaching acne scars with botulinum toxin and a collagen biostimulator is a viable alternative for the treatment of patients with concomitant complaints of sagging facial skin, providing a harmonious and progressive improvement in overall facial morphology.


Eduardo Chicarelli is a doctor graduated from the Faculty of Medicine of Marília (FAMEMA). He is a specialist in dermatology and aesthetic medicine by the Superior Nucleus in Human and Health Sciences – BWS. Fellowship in complications of aesthetic procedures by the American Academy of Dermatology (AAD). Fellowship in clinical dermatology and cosmiatry by the Istituto Dermatologico San Gallicano (Sapienza Università di Roma), in Italy. He is a professor of the specialization course in dermatology at the Nucleo Superior em Ciencias Humanas e da Saude - BWS.

Constant performance in congresses and national and international scientific events of Dermatology and Cosmiatry, with an approach to healthy aging, through the performance of surgical and body procedures with the aid of technologies to obtain natural, harmonious and safe results.