Calcium hydroxylapatite-induced skin necrosis occurred in 2 patients after injection in the glabella and the nasolabial fold, respectively. Supportive treatment with oral steroids, nitroglycerin paste, and warm compresses was initiated more than 48 hours after injection, and its role in recovery is uncertain. Both patients underwent microdermabrasion and used hydrocortisone ointment to flatten the scar, which resulted in gradual improvement with a reasonable cosmetic outcome 4 months after injection. This is the first report of calcium hydroxylapatite-induced skin necrosis. Injectors should be aware of this potential adverse event and counsel their patients appropriately.