Cheek and Lip filler-anatomy and technique

Question 1

What are the 4 layers of the face?

Answer 1

4 layers of the face (superficial to deep):
-layer 1:skin
-layer 2: superficial fat. contains superficial fat pads
-layer 3: muscle and superficial musculoaponeurotic system (SMAS)
-layer 4: deep fat layer. Contains deep fat pads and ligaments from muscle

Question 2

Describe the superficial fat pads of the face. Which layer is this in?

Describe the function of superficial fat pads:
-biologically
-aesthetically

Ageing:
What does ageing do to superficial fat pads?

Answer 2

Superficial fat pads is in layer 2, between the skin and SMAS (superficial musculoaponeurotic layer)

Function of superficial fat pads:
-biologically as energy reserve
-allows muscles to glide easily

Aesthetically, creates a more voluminous appearance of the face-> more youthful

Ageing:

Ageing causes atrophy of the deep fat pads thus causing superficial fat pad to lose structural support. Superficial fat pads start to:
-atrophy and cause volume loss-> sagging in the skin
-overall volume shift in the face: increase in volume in the lower 1/3 of the face (jowls) and decrease in volume in the upper 2/3 of face (lose fat in forehead and cheek area)

Question 3

Describe the deep fat pads of the face. Which layer is this in?

Describe the function of deep fat pads:
-biologically
-aesthetically

Answer 3

Deep fat pads is in layer 4. Beneath the SMAS (superficial musculoaponeurotic layer).

Function of the deep fat pads:
-biologically as energy reserve
-provides cushion support for muscles esp when they are stretched a lot-> deep fat pulls in to provide support

Aesthetically, creates a more voluminous appearance of the face-> more youthful

Question 4

Cheek filler

What areas of the face are you treating in cheek filler?

Answer 4

Cheek filler

-zygoma (particularly at the fusion point between the zygoma-temporal bone between the superior and inferior border)
-apex of cheek
-deep medial fat pads of cheek
-superficial lateral temporal fat pads of cheek

Question 5

Apex of cheek
What is hinderer’s line?
What is wilkinson’s line?

Answer 5

Hinderer’s line
-1 line between the ala of nose to the tragus of ear
-1 line between the lateral canthus and oral commisure
-point in which they intersect is known as apex

Wilkinson’s line
-1/3 down the lateral orbital rim

Question 6

Practice marking face for cheek filler
How much ml would you inject at these points

What technique is used for injection?

Answer 6

0.2ml in apex
0.1ml in 3 injection points (however you may use 0.2ml in areas which are more hollow)

Injection technique:
-supraperiosteal bolus (above bone in layer 5) full needle length; 90 degrees
-aspirate for 5 seconds before injecting slowly
-slowly remove needle

Question 7

Lip filler
What are the layers of the lips?

Where is the superior labial artery located and at what depth?

Answer 7

Lip layers (from outermost to inner most)
-superficial skin (dermis)
-hypodermis
-fat (tubercles)
-muscle (orbicularis oris)
-mucosa

Superior labial artery is located 4-5mm in depth beneath the orbicularis oris muscle