Facial fillers: Relevant anatomy, injection techniques, and complications

Abstract

ObjectiveThe aim of this review article is to discuss the currently available facial fillers, their differences and indications, relevant anatomy, injection techniques, and avoidance and management of complications.Data SourcesClinical experience and scientific papers.ConclusionsReversal of facial aging via filler injection has been around since the late 1800s with the initial use of detrimental products. Today, many safe and effective products exist and can be tailored to the individual patient's desired effect. With the evolution of both products and injection techniques, the rate of complications with facial filler use is low. Nonetheless, providers offering facial filler injections should have detailed knowledge of facial anatomy, including facial planes and soft tissue compartments. Multiple injection techniques exist. Different techniques should be used, depending on the anatomic target. Providers should also know how to avoid and manage complications.

Nonsurgical Chin and Prejowl Modification

“…The senior author advocates for a deep subcutaneous injection with a cannula in a plane superficial to the DAO and DLI using a fanning technique to augment soft tissue volume and camouflage the marionette lines or melomental folds. 1,23,27 This technique and result for chin and prejowl modification are demonstrated by the senior author in ►Video 1, with the patient's results showcased in ►Fig. 2.…”

Nonsurgical Chin and Prejowl Modification

“…The senior author advocates for a deep subcutaneous injection with a cannula in a plane superficial to the DAO and DLI using a fanning technique to augment soft tissue volume and camouflage the marionette lines or melomental folds. 1,23,27 This technique and result for chin and prejowl modification are demonstrated by the senior author in ►Video 1, with the patient's results showcased in ►Fig. 2.…”

Injectable Fillers for Atrophic Acne Scars: A Systematic Review of Mechanisms, Evidence, and Clinical Algorithms

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Filling the Gap: Facial Anatomy and Safe Lower Lip Injection Practices

“…Conversely, ILA was found to run superficially to depressor labii inferioris 31%, suggesting special consideration should be made when injecting lateral to the lower midface where depressor labii inferioris lies. Previous literature discussing techniques for lower lip rejuvenation suggest remaining superficial to these muscles when injecting dermal fillers [ 16 ]. With this, we can infer that injecting superficially to the orbicularis oris muscle will offer a safe plane for providers.…”

“…As this study suggests—and as supported by prior literature—injectors can reduce the risk of vascular complications by remaining superficial to the orbicularis oris and depressor muscles. This anatomically safe region, often referred to as the “plane of safety”, corresponds to the subdermal plane or supra-SMAS [ 16 ], which lies just beneath the dermis and above the subcutaneous fat, as demonstrated in Figure 9 .…”

Nonsurgical Chin and Prejowl Modification

“…The senior author advocates for a deep subcutaneous injection with a cannula in a plane superficial to the DAO and DLI using a fanning technique to augment soft tissue volume and camouflage the marionette lines or melomental folds. 1,23,27 This technique and result for chin and prejowl modification are demonstrated by the senior author in ►Video 1, with the patient's results showcased in ►Fig. 2.…”

Injectable Fillers for Atrophic Acne Scars: A Systematic Review of Mechanisms, Evidence, and Clinical Algorithms

“……”

Filling the Gap: Facial Anatomy and Safe Lower Lip Injection Practices

“…Conversely, ILA was found to run superficially to depressor labii inferioris 31%, suggesting special consideration should be made when injecting lateral to the lower midface where depressor labii inferioris lies. Previous literature discussing techniques for lower lip rejuvenation suggest remaining superficial to these muscles when injecting dermal fillers [ 16 ]. With this, we can infer that injecting superficially to the orbicularis oris muscle will offer a safe plane for providers.…”

“…As this study suggests—and as supported by prior literature—injectors can reduce the risk of vascular complications by remaining superficial to the orbicularis oris and depressor muscles. This anatomically safe region, often referred to as the “plane of safety”, corresponds to the subdermal plane or supra-SMAS [ 16 ], which lies just beneath the dermis and above the subcutaneous fat, as demonstrated in Figure 9 .…”

Nonsurgical Chin and Prejowl Modification

“…The senior author advocates for a deep subcutaneous injection with a cannula in a plane superficial to the DAO and DLI using a fanning technique to augment soft tissue volume and camouflage the marionette lines or melomental folds. 1,23,27 This technique and result for chin and prejowl modification are demonstrated by the senior author in ►Video 1, with the patient's results showcased in ►Fig. 2.…”

Injectable Fillers for Atrophic Acne Scars: A Systematic Review of Mechanisms, Evidence, and Clinical Algorithms

“……”

Filling the Gap: Facial Anatomy and Safe Lower Lip Injection Practices

“…Conversely, ILA was found to run superficially to depressor labii inferioris 31%, suggesting special consideration should be made when injecting lateral to the lower midface where depressor labii inferioris lies. Previous literature discussing techniques for lower lip rejuvenation suggest remaining superficial to these muscles when injecting dermal fillers [ 16 ]. With this, we can infer that injecting superficially to the orbicularis oris muscle will offer a safe plane for providers.…”

“…As this study suggests—and as supported by prior literature—injectors can reduce the risk of vascular complications by remaining superficial to the orbicularis oris and depressor muscles. This anatomically safe region, often referred to as the “plane of safety”, corresponds to the subdermal plane or supra-SMAS [ 16 ], which lies just beneath the dermis and above the subcutaneous fat, as demonstrated in Figure 9 .…”