Advertorial: Case Study: Concertina Lines

07 Sep 2022

Miss Rachna Murthy explores how she approaches treatment of fine lines on the face

This article is produced and funded by Allergan Aesthetics and is intended for healthcare professionals.

Improving concertina lines with the products we have in our toolkit has been extremely difficult in the past. These lines, also known as accordion lines, are caused by years of repetitive muscle movement due to smiling, alongside a reduction of skin quality through ageing.1 They are notoriously difficult to treat. Hyaluronic acid (HA) can have an impact, but there is the risk of over-filling, particularly when injecting high cohesivity products directly into the lines. Energy-based devices like radiofrequency with microneedling are also an option. HArmonyCa is a new hybrid collagen stimulating injectable, which combines calcium hydroxyapatite (CaHA) microspheres and HA in a single syringe for both an immediate and sustained lifting effect from one week to at least a year.2-4 It improves collagen stimulation, while also tightening and lifting the skin to provide definition without needing to use high volumes.4,5

Case study

This patient (aged 49 at time of treatment, now 51) presented to my clinic because she wanted to improve the signs of ageing, with her main focus being the concertina lines. I first recommended a good medical-grade skincare regime, consisting of retinol, vitamin C and an SPF, which helped improve her skin quality. However, I felt HArmonyCa was the ideal product to use to further these results to provide an immediate lift effect with sustained collagen stimulation.4,5

Treatment was mostly lateral to the line of lateral ligaments and subdermal, and I focused on the lateral cheeks and jawline to address the concertina lines and improve the appearance of her jowls. I used two syringes of HArmonyCa in total (each 1.25ml).2 I treated along the zygomatic arch (CK1), inserted product into the concertina lines directly and just above laterally (CK4) and along the jawline (JW2 & 4). I also used 1ml of Juvéderm Voluma into the deep medial fat pad (CK3) to indirectly treat the tear trough and the chin (C1) to address midline concerns.6 Following treatment with HArmonyCa, adverse events are typically manageable and self-limiting.7 Common adverse events include erythema, oedema (swelling), pain, tenderness, and itching. Treatment site reactions typically resolve within 24-48 hours and swelling within a week.8 The patient was very happy with her results. As early as one month of treatment, all concertina lines were softened and there was more definition to the zygomatic arch, along with improvement to the jawline and lifting of the jowls. By two months, my patient had noticed continued improvement in the look and feel of her skin and this continued to improve and was sustained in the year review.

Developing techniques

With more experience using newer products, our techniques and approaches develop. Rather than injecting directly into the concertina lines, I now inject HArmonyCa into the landmarks where a direct and indirect improvement can be seen, including near the zygomatic arch, the jawline, and the lateral to the jowl. With more studies, which are currently being conducted by Allergan Aesthetics, we may see further progression in techniques.

HArmonyCa training

Allergan Aesthetics runs regular HArmonyCa training days for healthcare professionals. To find out about the next training days, contact Allergan Medical Institute Training at Note that the Allergan Medical Institute is promotional – Allergan products will be discussed.


©AbbVie 2022. All rights reserved. Material produced and funded by Allergan Aesthetics, an AbbVie company. HArmonyCa is for patients over the age of 18. Individual patient results may vary. UK-HAR-220268 DOP: August 2022.

Adverse events should be reported. Reporting forms and information can be found at: UK adverse events reporting Adverse events should also be reported to Allergan Ltd. or 01628 494026 Irish adverse events reporting Adverse events should also be reported to Allergan Ltd. UK medinfo@allergan. com or 01628 49402.

Miss Rachna Murthy is a consultant oculoplastic surgeon at FaceRestoration. She consults for Allergan and is part of its AMI faculty. This article is based on Miss Murthy’s personal experience and ultimate decisions regarding patient care lies with the treating HCP and the patient.

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