| INJECTABLES | PEER-REVIEW
because there are no bony or hard structures against which to mold the filler, so while good results may be obtained, the author is currently testing other non- surgical modalities to better treat this area.
Chrinkle (or chest wrinkle) technique Patients with large breasts or with too much sun damage may have unsightly wrinkles in the cleavage or décolleté between the breasts from excessive skin laxity. The author originally placed the pilot hole superior to the chrinkle, but found working around the patient’s head difficult, so the pilot is now placed using the inferior approach injecting at the base of the chrinkle. The author uses a 27 Gauge 1½” microcannula with Juvederm Ultra Plus XC and occasionally with Juvederm Voluma using the long microcannula double cross-hatched fan technique.
Figure 11 (A) Restylane injection showing tip of TSK by Air-Tite microCannula. (B) Before and (C) after 50% correction of tear trough with Restylane using TSK by Air-Tite Microcannula
Tear trough technique The tear trough is an area only for advanced injectors because of the risk of retinal artery cannulation, which may result in permanent blindness18
. Other risks include
stroke and necrosis leading to ulcer formation and scarring18
. Microcannula use is deemed safer because the
blunt tip is thought to be less likely to penetrate blood vessels. Another particular observation in this area is the natural tendency for hyperpigmentation19
to be naturally The traditional method of injecting Juvederm Voluma is to demarcate Hinderer’s
Lines dividing the cheek into four distinct zones which should be injected sequentially in order to give the most efficient lift to the cheek.
Figure 12 (A) Before and (B) after cosmetic filler injections with TSK by Air-Tite microcannula
present here, which may create the appearance of volume loss even when
corrected.
Consequently, the protocol favoured by the author is to take high
resolution digital
photography prior to treatment and to point out the difference between volume loss and the
shadowing effect versus skin discolouration. Indeed, hyperpigmentation may become even more evident
Figure 13 (A) Before and
(B) after Juvederm treatment of crow’s feet using TSK by Air-Tite microcannula
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