Objectives: Through my talks, I would like to introduce the US anatomical findings of the face and provide the reference images on each landmark of the face. Therefore, an in-depth morphological study using an US imaging system can yield depth and orientation on the facial muscles, blood vessels, and fascial structures of the facial area that were previously impossible to obtain. This provides crucial anatomical knowledge that can be utilized in various clinical applications such as the US-guided injections with safety and effectiveness.

Introduction: The use of ultrasonography (US) guidance to perform diagnostic and therapeutic injections is increasing rapidly, as is the evidence supporting its use. However, despite the increased popularity of US, there remains a lack of formal standard references, especially for procedures involving the face. Moreover, while there is a considerable amount of information available in the literatures related to US, there is very little information related to US imaging of the face. Recently, the importance on the facial anatomy has been reconsidered as the interest on the facial aesthetics is increasing.

Materials / method: The BoNT-A and filler injection are widely-applied techniques for managing masseteric hypertrophy, gummy smiling, several facial wrinkles, volume augmentation, and facial asymmetry that includes the asymmetrical smile. However, inaccurate injections sometimes may result in mild side effects such as bleeding, bruising, or muscle bulging, along with more serious side effects including skin necrosis and blindness.

Results: Despites wide ranges of cadaveric studies to prevent the side effects, the US-guided injection technique could be the first choice of procedure than other blind techniques. I believe that the procedures under US leads to more accurate injections into the targeted area with less complications.

Conclusion: For these reasons, it is crucial to understand the regional topography of the skin, facial superficial fat and underlying fascia structures when performing various minimally invasive procedures under the ultrasonography.

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Objectives: 1. To find out how to inject fillers to create balanced mid & lower facial contouring using injectables.
2. To find out that combining PDO threads and HA fillers can be used for midface recontouring

Introduction: To naturally contour the midface, it essential to address both layer 2 and 4. Therefore, recently, there is a tendency to approach these two layers at the same time using HA fillers
However, when recontouring the face only with filler injections, it is prone to cause an excessive volumization that may result in unnatural treatment results.
Therefore, if the amount of filler required can be reduced by combining with PDO threads which can reposition subcutaneous fat tissues, better contouring result of the mid and lower face could be achieved.

Materials / method: Ten patients with mild to moderate sagging of the midface were successfully treated with highly cohesive HA fillers and PDO threads with bidirectional cogs. The threads were inserted first from the entry point on the lateral orbital thickening heading to nasolabial folds and jowl fats. And then highly elastic and cohesive HA filler was injected into infraorbital hollows and deep pyriform fossa. The posterior cheeks volumizaton was selectively performed depending on the degree of the concavity.

Results: Nine patients with mild to moderate sagging of the mid and lower face were successfully treated with HA filler and PDO cog-thread in combination.
Addressing layer 2 using only HA filler injections could result in facial overfilled syndrome due to overcorrection. However, multilayering and multimodal approach can produce better and optimal facial recontouring.
Since HA fillers should target layer 4, it is better to choose HA filler with high lifting capacity and cohesiveness.

Conclusion: 1. A multilayering approach for the facial contouring is essential to achieve better results.
2. It is strongly suggested that PDO threads insertion into layer 2 and injections of HA filler with strong lifting capacity injection into layer 4 can create an effective and natural mid and lower face recontouring results.

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