A small aliquot of anaesthetic placed over the periosteum just inferior and lateral to the orbital margin blocks the zygomaticofacial nerve before cheek enhancement without obscuring the anatomy unduly.
The foramen is oriented inferomedially, so cannulae should approach this area from laterally to avoid inadvertent injection directly into the foramen when placing filler preperiosteally. The infraorbital nerve exits its foramen just medial to the mid-pupillary line 8-10mm below the orbital margin. Regional nerve blocks are useful before panfacial volume restoration using fillers. “The hallmark of a youthful face is appropriate facial volume or fat and seamless smooth transitions between the various units of the face.” Pertinent anatomy In men, more prominence of the bony features is acceptable. There may be a shadow created by the prominence of the zygomatic arch, but a shadow created by skeletonisation around the superior temporal crest is undesirable. The jawline should be defined and the lower lip and chin should be twice the height of the upper lip.
The lid-cheek junction should be smooth and difficult to identify. The most projected point of the midface, the cheekbone point or zygomaxillary point, lies 20-25mm below and slightly lateral to the lateral canthus.
CONTOUR CHEEKS WITH FILLER FULL
In females, the midface should be adequately full with tapering over the defined jawline toward the chin. The hallmark of a youthful face is appropriate facial volume or fat and seamless smooth transitions between the various units of the face. Fairfield NJ) b) Gray tool using same image that allows volume assessment c) same patient before and d) after mid- and lower face volume restoration with hyaluronic acid fillers. Patients are more accepting of panfacial volume restoration when they see the results that might be achieved.įigure 2: a) Pre-treatment image capture using Vectra 3D M3 (Canfield Scientific Inc.
CONTOUR CHEEKS WITH FILLER SOFTWARE
The imaging software allows manipulation of the image and simulation of various cosmetic procedures, including volume restoration and contouring using fillers. The three-dimensional image obtained is used to highlight and to educate the patient in the role of volume in facial ageing. Fairfield NJ) to generate a high-resolution image of the patient’s face (Figure 2). The author utilises the Vectra 3D M3 system (Canfield Scientific Inc. It is easy to identify facial volume loss: shadows at the lid-cheek junction, flattened midface, temporal shadowing and a small or receding chin with jowling. Upon immediate inspection, a general idea of the age and health of the patient can be ascertained. The strategy for facial contouring with fillers begins with an assessment using inspection and facial imaging.įigure 1: a) Before and b) after diffuse volume restoration with hyaluronic acid fillers combined with laser resurfacing for photoaging. (Courtesy of Dr Peter assessment The involutional and atrophic changes that occur with ageing in the face are ameliorated using fillers (Figure 1).
CONTOUR CHEEKS WITH FILLER SKIN
Attenuation of facial ligaments and deterioration in the quality of the skin through intrinsic and extrinsic ageing compound these signs. Therefore, a pseudoptosis of the nasolabial fat and jowls due to volume loss, rather than excess, occurs. The relative resistance of nasolabial and jowl fat to atrophy exacerbates the nasolabial grooves and jowls as the fat in the midface and elsewhere disappears. The deep and superficial fat compartments of the face also atrophy asynchronously, such that various hollows, grooves and shadows appear as one ages. As the mandible, zygoma and periorbital bones resorb, structural support for the soft tissues of the jawline, midface, and brows lessens and ptosis becomes apparent. The bony skeleton, deep and superficial fat compartments of the face deflate over time. It is primarily an involutional process, rather than a gravitational one. The need for volumeĪgeing affects the soft and hard tissues of the face. The ability of a treatment that uses hyaluronic acid fillers to make a patient appear more attractive, more youthful or refreshed, depends on the operators understanding of the ageing process, aesthetic ideals and proper patient assessment. These include the enhancement of bony features, facial shaping and the lifting of soft tissues. When fillers are placed in deeper planes, using needles or cannulae, there are many possibilities for facial rejuvenation and beautification.
Fillers are placed in the dermis using needles in order to improve the appearance of wrinkles, soften folds or hydrate the skin. In 2013, there were over 1.8 million treatments using hyaluronic acid performed in the US alone, representing a 31% increase from the previous year. Hyaluronic acid fillers are becoming increasingly popular amongst patient who seek facial enhancement. With the advent of hyaluronic acid fillers, safe and effective non-surgical facial rejuvenation has been advanced.
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