Lifting vs volumizing—The difference in facial minimally invasive procedures when respecting the line of ligaments

Abstract

Background The arrangement of the facial soft tissue layers is different with respect to the line of ligaments: medially oblique and laterally in parallel. Aims This split‐face study was designed to investigate the effects on midfacial volumization if the same medial vs lateral injection points are targeted in various sequences. Methods Twelve patients (3 males, 9 females; 46.67 years ± 4.5) were included in this interventional study. On the right side of the face, lateral injection points were performed first, whereas on the left side, medial injection points were executed first. The infraorbital hollowness score, the upper cheek fullness score, the global aesthetic improvement scale, and the injected volume were assessed. Results No side differences were observed after the intervention with P = 1.00 for all scores. When the lateral injection points were performed first, the volume injected into the medially located injection points (0.46 ± 0.26 cc vs 0.73 ± 0.31 cc [P = .037]), into the lateral injection points (0.79 ± 0.40 cc vs 1.15 ± 0.28 cc [P = .017]), and overall (1.26 ± 0.64 cc vs 1.88 ± 0.57 cc [P = .02]) was significantly reduced. Conclusion The results of the present study emphasize the importance of respecting the layered arrangement of the facial soft tissues when performing minimally invasive soft tissue filler injections. Targeting injection points lateral to the line of ligaments first reduces the volume needed to symmetrically and aesthetically appealing manner and volumizes the infraorbital and upper cheek regions.

Full‐face effects of temporal volumizing and temporal lifting techniques

“…Slight influences were detected in all of the other scores except in the visibility of the lateral orbital rim. This evaluation reveals that the subdermal injection technique can induce aesthetic effects beyond the temple and into the lower face, which is confirmatory with previous publications 2,9 . From an anatomic perspective, this is conceivable as the product is injected superficial to the superficial temporal fascia and into the subdermal fatty layer with its respective superficial inferior temporal fat compartment.…”

“…The number of soft tissue filler injections performed is constantly increasing, as these procedures beget predictable aesthetic effects to ameliorate the signs of facial aging 1‐4 . The treatments are tailored based on patient's needs, aesthetic indication, anatomic region targeted, and product selected 5‐9 .…”

Clinical validation of the temporal lifting technique using soft tissue fillers

“…They argued that the lateral face injection preconditioned the ipsilateral midface for a more efficient injection‐related outcome. Another example was provided when injecting the midface lateral to the line of ligaments and targeting the infraorbital region in a second step 3 . Here, the authors reported a statistically significant repositioning of the midfacial soft tissues though they were not a priori targeted.…”

“…Recent research however has suggested that some areas of the face can influence other facial regions when specifically targeted, that is, an increase in local volume can influence soft tissue position of adjacent facial regions. Examples for these interesting biomechanical effects were provided by Casabona and colleagues 2,3 . In one of their studies, the authors injected soft tissue fillers to volumize the midface, on one side injecting lateral to the line of ligaments 3 before injecting medial, and on the contralateral side injecting medial prior to lateral.…”

“…Examples for these interesting biomechanical effects were provided by Casabona and colleagues 2,3 . In one of their studies, the authors injected soft tissue fillers to volumize the midface, on one side injecting lateral to the line of ligaments 3 before injecting medial, and on the contralateral side injecting medial prior to lateral. They found that the injected volume required medial to the line of ligaments was statistically significantly reduced when the lateral midface was injected first, compared to the contralateral side where the medial midface was injected prior to the lateral.…”