Injection Guidelines for Treating Midface Volume Deficiency With Hyaluronic Acid Fillers: The ATP Approach (Anatomy, Techniques, Products)

Abstract

Midface rejuvenation is among the most valuable indications of Hyaluronic Acid (HA) dermal fillers, as malar projection and full upper cheeks significantly contribute to a youthful appearance. HA fillers have evolved over the past two decades to meet specific clinical needs such as strong projection capacity and adaptability to facial dynamism. As a result, they now represent the treatment of choice for midface rejuvenation throughout age ranges, by offering the potential for non-invasive treatment, immediate results and minimal downtime. As the five-layered structure of the midface plays a central role in the human face, injecting the midface area may also indirectly improve other aesthetic concerns such as infraorbital hollowing and nasolabial folds. Nonetheless, midface rejuvenation requires a tailored treatment approach and a thorough knowledge of anatomy to minimize procedural risks and achieve natural-looking results. This article provides an extensive anatomical description of the midface and of the usual course and depth of vascular structures circulating nearby, to delineate a treatment area, minimizing procedural risks. Furthermore, taking into account the differential mobility and mechanical constraints of each layer of the midface, a multilayer treatment algorithm is proposed for adapting the treatment strategy to patient specificities (including age, gender, skin type, and morphology). Emphasis is also placed on desirable filler properties to create deep structural support on the one hand and accompany facial movement on the other hand.

Superselective Ophthalmic Artery Thrombolytic Therapy for Hyaluronic Acid Embolization: A Case Report

“…Injectable fillers are popular for mid-face rejuvenation, replacing lost volume and providing contour support. 6 Meanwhile the incidence of filler embolism has increased significantly in recent years. Retinal artery occlusion is an ophthalmic emergency that can result from HA filler cosmetic injections and is characterized by sudden painless and catastrophic vision loss.…”

Introducing an esthetic treatment of malocclusion: Ultrasound‐assisted augmentation of premaxilla with injectable hyaluronic acid filler

“…1,2 Employing tailored and layering methods of injection instead of the traditional superficial and predefined "onepoint fits to all" injection methods is one of the promising advancements in the face esthetic treatment by injectable fillers. [3][4][5] The layering injection technique addresses deep layers at first and if such deep injection does not result in the desired outcomes, it can be proceeded by injecting in more superficial layers. This method can lead to more natural long-lasting results and avoid superficial overfilling.…”

“…9 Correction of esthetic issues due to structural face imperfections is one of the neglected areas which can be successfully obtained by the mentioned advancements. The focus of the esthetic procedures is commonly on facial rejuvenation and volumization, 1,2,4,5 and there is a paucity of evidence regarding esthetic treatment of face structural problems. Most young clients that request for esthetic face treatments are cases with structural imperfections and have not lost tissue due to aging.…”

“…Hyaluronic acid (HA) injectable fillers are the most popular fillers that are ubiquitously used by esthetic practitioners for various indications 1,2 . Employing tailored and layering methods of injection instead of the traditional superficial and predefined “one‐point fits to all” injection methods is one of the promising advancements in the face esthetic treatment by injectable fillers 3–5 . The layering injection technique addresses deep layers at first and if such deep injection does not result in the desired outcomes, it can be proceeded by injecting in more superficial layers.…”

Efficacy and Safety of Resilient Hyaluronic Acid Fillers Injected with a Cannula: A Randomized, Evaluator-Blinded, Split-Face Controlled Study

“…RHA 4 provides a suitable balance between the filler strength, which provides support and volume to deep folds and depressed areas, and the capacity to stretch, which allows it to accompany facial movements during muscle contraction (eg, during smiling). 29 Several randomized controlled trials (RCTs) have demonstrated the clinical efficacy and safety of RHA dermal fillers (RHA 2, RHA 3, and RHA 4) injected with a needle, for treating moderate to severe NLFs. 30–33 …”