Facial Assessment and Injection Guide for Botulinum Toxin and Injectable Hyaluronic Acid Fillers: Focus on the Upper Face

Abstract

Techniques for the administration of injectable fillers and neuromodulators for facial aesthetic rejuvenation and enhancement continue to evolve. As the number of physicians with limited experience in providing aesthetic treatments expands, the need for guidance and training from more experienced injectors has become apparent. The use of a slow, careful, and methodical injection technique is imperative in all treatment settings and for all facial areas. Constant attention to local anatomy, particularly arteries, veins, and nerve bundles, is critical for minimizing complications. This first article of a three-part series addresses techniques and recommendations for aesthetic treatment of the upper face. Traditionally, the upper face has been considered a basic area for treatment with neuromodulators but an advanced area for treatment with fillers. Injectable fillers may be used for temple volumization, eyebrow shaping, and forehead contouring. Neuromodulators are well suited for diminishing the appearance of dynamic facial lines such as forehead, glabellar, and crow's feet lines, and eyebrow lifting and eye-aperture widening. These techniques may be used independently or together, sequentially or concurrently, to address rejuvenation of individual or multiple facial regions. Overall, this series provides a practical framework of techniques for physicians who desire to perform safe and effective aesthetic treatments using a multimodal approach.

Treatment of the tear trough and infraorbital hollow with hyaluronic acid fillers using both needle and cannula

“…A perpendicular line was drawn from the lateral canthus and injection point A was marked on it just 1‐2 mm below the inferior orbital rim 15 . Injection point B was marked just below the inferior orbital rim 2 mm lateral to the mid‐pupillary line 16 .…”

<p>Expert Consensus on Injection Technique and Area-Specific Recommendations for the Hyaluronic Acid Dermal Filler VYC-12L to Treat Fine Cutaneous Lines</p>

“…Key recommendations for VYC-12L injection technique were to use micro-depot injections, inject into the deep dermis at an angle less than 45 degrees from the skin surface, and space injections approximately 0.5 to 1.0 cm apart ( Table 1). [22][23][24][25] The depth and spacing of the injection may be individualized to the patient and the treatment area based on the severity level of the skin lines, roughness, and photodamage.…”

“…Further, patient concerns about the forehead generally relate to dynamic lines, typically addressed with a neuromodulator. 22,26,27 However, clinical data have demonstrated the efficacy and safety of VYC-12 without lidocaine for the treatment of forehead lines, and there is clinical practice experience in this facial area.…”

Techniques of Eyebrow Lifting: A Narrative Review

“…Supraorbital foramen should be respected. [9] Erythema and ecchymosis, foreign body granulomas, and migration of filler material are among the complications that may happen with fillers. Serious adverse events with soft tissue fillers include infection, biofilm reaction, cutaneous vascular compromise (skin/tissue necrosis), and most worrisome, blindness from retrograde injection into the ocular arterial system.…”