The Midface - Dermal filler Flashcards
Borders
Glabella to subnasale
Type of filler used
High G prime
Juvederm
Voluma deep fat
Volift superficial fat
Teoxane
Teosyal Deep/RHA4
Belotero
Volume
Injection technique
Supreperiosteal bolus
Cannula
Compartments
Zygomatic Arch
Lateral cheek
Apex
Medial cheek
Hinderers lines
Intersecton of lines for the cheek apex
- Horizonal line nose ala to tragus
- Diagonal line lateral canthus to oral commissure
Midface superficial fat pads - layer 2
Infraorbital
Nasolabial medial - increases with age
Middle cheek
Lateral cheek - reduces with age
Temporolateral
Midface deep fat pads - layer 4
Medial + Lateral portions of SOOF (suborbicularis oculi fat) - divded by lateral canthus
Deep medial
Deep lateral
Vasculature
Facial (angular branch)
infraorbital arteries (branch of maxillary artery)
Transverse facial artery (branch of superficial temporal artery)
Facial vein more lateral to artery
Sensory innervation
Maxillary branch of trigeminal nerve - emerges from the infraorbital nerve
Motor innervation
Zygomatic and buccal branch of facial nerve - arrises deep to parotid gland
Bone aging process
Maxilla recession
Maxillary angle reduces
Orbits widen
SMAS
Superficial Musculoaponeurotic System
Lymphatics
Medial and lateral channels
Submandibular and parotid nodes respectively
Wilkinsons’ line
Vertical line from Lateral canthus to mandible - apex is 1/3 of line from lateral canthus
Ogee curve
enhance the contours of the face along the Ogee Curve to create a more youthful and balanced appearance
Men vs women mid face
Cheek bone is flatter in men
Apex is more medial and lower in men
Women have more medial SC fat
Supraperiosteal technique for cheek filler
0.2ml at apex, followed by 3 x 0.1ml injections along zygoma
Piriform fossa
Treat maxillary recession
Improving nasolabial fold appearance
Piriform fossa technique
Supraperiosteal bolus
Pull lateral tisses away to move facial artery laterally in layer 2
Aim needle towards contralateral oral commisure - 45 degress onto bone
Aspirate for 5-10 seconds
0.3ml filler
Order of treatment in mid face
Apex
Zygomatic arch
Piriform fossa
Cannular entry point for deep cheek filler
Medial cheek fat apex
Insert pilot needle in vertical line with lateral orbit
Pass through SMAS into deep planes
Cannular entry point for nasiolabial fold
Base of nasolabial fold
Cannula passes through layer 2
Ligament of the midface
Orbicularis retaining ligament
Zygomatic cutaneous ligament
Aging process in the midface
resorption of maxilla bone
maxillary angle reduces
pyriform apeture of nose widens
orbit widens
Layer 4 components
SOOF - suborbicularis oculi fat (medial and lateral)
DLCF - deep lateral cheek fat
DMCF - deep medial cheek fat
Location of SOOF
inferior to orbicularis retaining ligament
superior to zygomatic cutaneous ligament
What is the SMAS
Layer 3
Superficial musculoaponeurotic system
Fibrous continuation of facial muscles
Tightens with layer 4 expansion
Superficial fat pads which hypertrophy with age
Nasolabial
Superficial fat pads which atrophy with age
Lateral cheek fat pad
Transient piriform fossa filler side effect
Temporary upper lip anaesthesia from lidocaine infiltration to trigeminal nerve
Terminal branch of the facial artery
Angular artery
becomes the angular artery after the lateral nasal artery branch
Artierial supply in the midface
Transverse facial artery
Infraorbital artery
Facial artery
Aspiration length
5-10 seconds
What divides the medial and lateral SOOF
Lateral canthus of the eye
Glide planes of the midface
Pre-septal space
Pre-zygomatic space
Buccal space
What technique addresses maxillary recession
Deep piriform space filler
Technique of piriform fossa injection
pull tissues laterally
needle aimed towards contralteral oral commissure at 45 degree angle
Supraperiosteal bolus up to 0.3ml filler
Supraperiosteal treatments of midface
Cheek apex - zygomatic bone
Lateral cheek - zygomatic arch - zygomatic bone & temporal bone
Piriform fossa - maxilla
Point of insertion of cannula in midface deep fat pad treatment
Vertical plane of lateral orbit
Deep fat pad targets for treatment
deep medial and lateral cheek pad
Superficial targets for treatment
Lateral fat pad - Pre auricular
Nasiolabial fold
Point of insertion for lateral superficial fat pad treatment
Vertical plane of anterior masseter
Lateral cheek fat pad/preauricular treatment technique
Cannular fanning with mid-prime
Layer of prezygomatic space
layer 4
Movement of the facial fat pads
Deep - static
Superficial - dynamic - use soft filler that moves with expression
Pre-zygomatic space borders
posterior - preperiostel fat
anterior - SOF
ORL - superiorly
zygomatic ligament - inferiorly
