Objectives: Proposal of clinical guidelines for deep injection in the part of the anterolateral midface with bony support. Illustration of distortion of animation by superficial injection. Illustration of correctly deposited filler in a cadaver dissection.
Introduction: Treatment of the midface is considered pivotal in facial reshaping and for support of the lower eyelid. Superficial, subdermal injection may interfere with lower periorbital animation and malar mound oedema. It does not provide support to the lower lid. While appropriate more inferiorly in the tissues overlying the oral cavity, deep injection on bone provides stable reshaping respecting facial expression.
Materials / method: A case of unnatural animation after subcutaneous injection and successful treatment by dissolving the filler is presented. Film fragments and representative before and after clinical photography illustrate deep injection of the midface from one access point, along two axes. Coloured agarose was injected in a cadaver head to study filler depth and spread with a dissection.
Results: The midline of the malar eminence and the continuation of the tear trough are traced on the face for guidance. Injections, all from the intersection, allow real-time observation of light reflection changes in the malar area during the treatment. Anteriorly, a 30 G needle deposits filler close to bone. Medially and laterally, a 22 G cannula minimises trauma and ensures the filler stays deep enough. Cadaver dissections confirm deep filler placement, without subdermal spread.
Conclusion: Anterolateral midface volume deficits can be treated adequately by deep injection of diverse fillers along two easily traceable axes, with the least possible distortion of facial animation.
Declaraciones
¿Ha recibido algún tipo de financiamiento para realizar su investigación sobre esta temática?
No
¿Ha recibido algún pago, honorario u otra compensación por su trabajo acerca de esta investigación?
No
¿Tiene vínculos financieros con alguna entidad que podría llegar a competir estrechamente con los medicamentos, materiales o instrumentos tratados en su investigación?
Si
Por favor especifique las entidades (individuo, empresa, sociedad): Honoraria received from Merz, Abbvie-Allergan, AAT and stock options AAT
¿Posee o ha solicitado una patente relacionada a los materiales, productos o instrumentos utilizados en su investigación?
No
Este trabajo no cuenta con el apoyo de ningún financiamiento directo o indirecto. El autor asume plena responsabilidad sobre el mismo.