PEER-REVIEW | FACIAL VOLUMISATION |
Figure 2 Cheek bone curve injection point anatomically defined points from which the
augmentation treatment is carried out must be identified. Before treatment, the treating doctor should determine
the aim of treatment with the patient and plan the procedure. To do this, the face is divided into specific areas using reference lines. The most important line for dividing the mid-face into top and bottom halves is the line running from the top end of the nasolabial fold to the tragus (Figure 1 ® black line). The volume filler is normally implanted deep (i.e. supraperiosteally) above this line, and below this line it is usually implanted subdermally (with the exception of the chin line). The orbital margin and the infraorbital nerve exit points are identified as no-go areas. Therefore, certain anatomical structures
have to be identified to find the final injection points (entry points) where the different vectors will be carried out (Figures 1–5).
Identifying the injection points To illustrate the precise procedure, Figures 2–4 show the typical injection points for 3D volumisation.
Top half of the face Figure 2 shows the entry point on the cheek bone curve. It is placed at the middle point between the top and bottom edges of the zygomatic bone. For the second point it is necessary to find the highest
point of the cheek, or the ideally highest point (the point of maximum anterograde projection). A perpendicular line from the outer orbital margin has to projected vertically downwards. The second line goes from the middle of the chin upwards through the corner of the mouth. The intersection point of these two blue lines determines the point of the second injection (Figure 3).
44 ❚ January/February 2013 |
prime-journal.com
Figure 3 Central cheek injection point The most
important line for dividing the mid-face into top and bottom halves is the line running from the top end of the nasolabial fold to the tragus.
Lower half of the face Before an augmentation of the lower half of the face, a line should be drawn parallel to the tragus vertically downwards. At the point where this line meets the extension of the chinÐ jaw line, is the rearmost implantation point (near the angle of the jaw) from which the jaw line can be shaped (Figure 4). Depending on the desired result, it may be necessary
to place a number of entry points in the lower cheek area over the whole cheek area to place the filler in a fan shape in order to even out superficial wrinkles.
Treatment and progress The treatment begins with the first injection point on the cheek bone curve. A local anaesthetic may be administered to the entry point beforehand, after which a 1.5 cm-long, blunt-tip, flexible cannula is inserted in a medial ventral direction. Its tip comes to rest at the supraperiosteal area. A number of linear threads of CaHA should be placed in a fanning manner supraperiosteally.
Figure 4 Jaw line injection point
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