Facial rejuvenation with fillers: The dual plane technique

Abstract

Background:Facial aging is characterized by skin changes, sagging and volume loss. Volume is frequently addressed with reabsorbable fillers like hyaluronic acid gels.Materials and Methods:From an anatomical point of view, the deep and superficial fat compartments evolve differently with aging in a rather predictable manner. Volume can therefore be restored following a technique based on restoring first the deep volumes and there after the superficial volumes. We called this strategy “dual plane”. A series of 147 consecutive patients have been treated with fillers using the dual plane technique in the last five years.Results:An average of 4.25 session per patient has been carried out for a total of 625 treatment sessions. The average total amount of products used has been 12 ml per patient with an average amount per session of 3.75 ml. We had few and limited adverse events with this technique.Conclusion:The dual plane technique is an injection technique based on anatomical logics. Different types of products can be used according to the plane of injection and their rheology in order to obtain a natural result and few side effects.

Simplifying injectables for volumetric rejuvenation of face

“…This is often the first restoration that a physician prefers to achieve. Malar zone restoration has an impact of restoration in the same zone and a lift in the surrounding zones[ 8 13 ] [ Diagram 2 ]. This point is also called as “ogee curve” as coined by Swift and Remington[ 13 ] and is a crucial point for cheek enhancement in women, and the impact of this restoration is immediate because of the reflection and projection of light from cheek counter for point lifts [ Figure 7 ].…”

“…Impact of fillers on malar zone on surrounding areas [ Diagram 3 ]. The deep medial malar area restoration has a great impact on the midface and also lateral tear trough as well as the upper half of the nasolabial fold[ 8 ] [Figures 11 and 12 ].…”

“…A deep support is created over the bone to support and lift the malar area. [ 8 ] The lateral-to-medial sequence of injection helps in achieving a tenting effect so that less material is needed in the more medial compartment. This enables enhancement of mid cheek and also anterior projection.…”

“…A few important aspects that need to be considered while understanding the depletion patterns of facial fat have led to important insights, which are as follows[ 7 8 9 ]:…”

“…The deep plane of fat in supraperiosteal layer is the first to deflate in orbital zone laterally and medially; medial cheek and chin fat is subsequently lost. [ 4 8 ] Superficial pad fat compartment shows more lateral, temporal, and preauricular fat loss than that of the middle and medial cheeks. [ 3 8 10 11 ] The nasolabial and jowl fold accentuation is more because of the loss of ligament strength than the fat loss, which happens much later[ 8 ] [ Diagram 1 ].…”