Subperiosteal injections during facial soft tissue filler injections—Is it possible?

Abstract

Background It can be hypothesized that safety during soft tissue filler injection could be enhanced if the product could be positioned between the periosteum and the bone surface i.e. subperiosteal. Aim This study investigated the feasibilityof subperiosteal injections. Patients/Methods We analysed 126 injection procedures performed in seven Caucasian body donors (4 males, 3 females) with a mean age of 75.29 ± 4.95 years [range: 70 – 87] and a mean body mass index of 23.53 ± 3.96 kg/m2 [range: 16.46 – 32.23]. The injection procedures were performed in the forehead, scalp, zygomatic arch and the mandible bilaterally. Injection procedures were conducted using 25G, 27G and 30G sharp‐tip needles (TSK Laboratory, Tochigi, Japan) and at various angles from the bone surface measured with a goniometer: 90 degrees (perpendicular), 45 degrees and 10 degrees (as tangential as possible to bone surface). Results Cadaveric dissections of the injection sites showed that no product was located deep to the periosteum in any of the investigated regions. This indicates that all performed injection procedures positioned the product superficial to the periosteum (100%) with a zero‐success rate of subperiosteal injections. Conclusion In the setting of this cadaveric investigation, despite varying needle size and injection angle, subperiosteal injection could not be achieved. This indicates that the product can spread uncontrolled into more superficial layers yielding an increased risk for adverse aesthetic and vascular events.

To click or not to click – The importance of understanding the layers of the forehead when injecting neuromodulators – A clinical, prospective, interventional, split‐face study

“…The application of the neuromodulator product which has viscoelastic properties close to water results in the distribution of the product retrograde along the created injection canal. This retrograde distribution behavior was previously documented for filler injection on the forehead 14 and confirmed in several consecutive studies investigating materials with different viscoelastic properties 15,16 . These studies have provided evidence that injected products with low viscoelastic properties (= low G‐prime), that is, fluid products migrate more easy along the created injection canal as products with high viscoelastic properties (= high G‐prime) with a correlation coefficient of r p = −.651 and P < .001 between G‐prime and retrograde product spread.…”

Soft tissue distribution pattern of facial soft tissue fillers with different viscoelastic properties

“…These fillers have gained popularity given that they are a nonsurgical option, come at a relatively lower cost, and require little downtime. They have been shown to provide long‐term, natural‐looking results for both correcting facial aging and enhancing facial features . The range of products used for injections has also greatly expanded.…”

“…shown to provide long-term, natural-looking results for both correcting facial aging and enhancing facial features. [2][3][4][5][6][7][8][9][10][11][12][13][14] The range of products used for injections has also greatly expanded. Of the injectable fillers, hyaluronic acid and calcium hydroxylapatite are the two most widely used, comprising 88% of soft tissue filler injections in 2018.…”

Aesthetic Enhancement of the Brow using Hydroxyapatite

“…Commercially available injectable hydroxyapatite mixtures such as Radiesse are not designed for subperiosteal application. Moreover, as this is placed using percutaneous needle injection, it is not possible to place the volume in the subperiosteal plane [60]. The plane of injection would therefore be the preperiosteal fat layer, which does not provide the same longevity as subperiosteal hydroxyapatite granules, because only granules situated directly on the bone surface become incorporated into the bone.…”