| INJECTABLES | PEER-REVIEW
patients with hypotrophic middle cheek fat, treat this compartment to reduce the concavity of the cheek. In type 3 and 4 patients, the author does not treat the superficial cheek fat compartments because in these patients they are already hypertrophic and any treatments could increase their ptosis. Special reference needs to be made to the lateral
temporal-cheek fat. It is characterized by a hypotrophic aging process and for this reason it can often be treated with fillers. The volume restoration of this compartment causes the reduction of the pre-auricular hollow and gives a lifting effect to the middle cheek fat and the soft tissue of the jawline.
Injection technique The author regularly treats the deep fat compartments of the midface with a volumizer filler of hyaluronic acid (HA) or of calcium hydroxyapatite (CaHA) with a high elastic and viscous moduli (G’ and G’’). The use of filler with lidocaine reduces the pain and makes the treatment more comfortable for patients24–26 The injection technique used for
.
the treatment of deep fat compartments is the preperiostal bolus technique. In the author’s experience, it is the most effective and least traumatic because it allows for a precise injection and the path of the needle through soft tissues is as short as possible. With good experience, physicians are able to treat every single fat compartment with a single injection. In this way, physicians no longer need to perform other injections, which increases the possibility of bleeding and bruising. Volumetric restoration occurs at the level of the deep fat
The injection technique used for the treatment of deep fat
compartments is the preperiostal bolus technique. In the author’s experience, it is the most effective and least traumatic.
in the superficial fat compartments that prevalently undergo ptotic/hypertrophic aging. The bolus technique is suitable in the treatment of single
compartments that are most subject to hypotrophy and, therefore, the bolus technique guarantees an anatomically correct volumetric correction. The volume is increased in the deep fat compartments subject to hypotrophy and not
compartments because it allows an anatomical precision of injection superior to other techniques. The bolus is injected inside the specific fat compartment and all the filler contributes to the volumetric correction of the compartment without useless dispersion in other anatomical localizations. This causes a better performance of the injected product.
Table 2 Treatment strategy for deep fat compartments in the different aging types
In type 1 and 2 patients the first injection is done at the DMCF and then in the lateral and medial SOOF.
In type 3 and 4 patients the first injection is done in the lateral SOOF and then in the upper DMCF.
3 1 2 3 1 2 3 2 1 2 3 1
Figure 8 (A) Treatment of lateral SOOF with bolus technique, (B) Treatment of superficial fat
compartment with cannula
Type 1
Hypotrophic 1st bolus in DMCF 2nd bolus in lateral SOOF 3rd bolus in medial SOOF
Type 2
Hypotrophic/ptotic 1st bolus in DMCF 2nd bolus in lateral SOOF 3rd bolus in medial SOOF
Type 3
Ptotic/hypertrophic 1st bolus in lateral SOOF 2nd bolus in DMCF 3rd bolus in medial SOOF
Type 4
Hypertrophic/ptotic 1st bolus in lateral SOOF 2nd bolus in DMCF 3rd linear injection of NLF
prime-journal.com | October 2015 39
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