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ARTICLE | VOLUMISING TECHNIQUES | under the influence of the main engine of this


area — the orbicularis oculi muscle. It relaxes and sags with ageing in an inward and downward rotation, sagging by the nasolabial fold. This sagging creates the three main grooves of the ageing of the face: ■ The palpebromalar groove ■ The mid-cheek groove ■ The nasolabial fold. The medial part of the palpebromalar groove, and


the upper and medial parts of the mid-cheek groove, form the tear trough in a ‘Y’ shape. As a result, there is fixed static fat (i.e. deep), and mobile and dynamic fat (superficial), which moves with expression and sags with ageing. Therefore, the skin, the superficial malar fat, and the orbicularis oculi muscle are mobile and dynamic. The sliding (sagging) space is at the level of the orbicularis oculi, between the deep malar fat and the orbicularis oculi muscle, and between the orbicularis oculi muscle and the superficial malar fat, and also (to a lesser extent) between the superficial malar fat and the skin. This will impact treatments using fillers and volumisers. It will be essential to analyse the movements of the soft compartments of the face when the face moves, to appreciate whether to fill the fixed part (deep malar fat pad) or the mobile part (superficial malar fat pad).


The skin envelope The skin expresses the shape and curve of these soft compartments and bone support. The surface of the skin conveys that which exists at a depth (volume, movement, sagging), as well as the impact of ageing.


Zygomaticus major muscle and levator labii superioris The zygomatic major inserts on the malar bone. Covered at its origin by the lateral and lower part of the orbicularis oculi, it descends through the cheek as a ribbon. Obliquely inward and downward at 45°, this band descends to the lip corner, joined at this level with other muscles to form the modiolus, which elevates the corners of the lips upwards and laterally, as well as accentuating the nasolabial fold. The levator labii superioris alaeque nasi, a thin muscle,


inserts at the top of the inner rim of the orbit, which is overlain by the orbicularis oculi. Its fibres descend vertically as a ribbon to the nasolabial groove to fix under the skin of the posterior edge of the nose and under the skin of the upper lip. It elevates the philtrum and upper lip, and aids in the expression of discontent and when crying. The deep levator labii superioris inserts at the top on


the inner part of the lower edge of the orbit. Its insertions are covered by the orbicularis oculi and then by the levator labii superioris alaeque nasi, with which it is inseparable. Its fibres descend vertically in a fleshy wide band to attach to the deep side of the skin of the upper lip and to the skin of the posterior edge of the nostrils. It elevates the philtrum and the upper lip, and aids expression when crying.


32 ❚ January/February 2012 | prime-journal.com


Figure 3 The two fat compartments (deep and superficial malar fat pad separated by the orbicularis oculi muscle)


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