Facial Volumization with Fillers

✍ Scribed by Kyle K. Seo

• Publisher: Springer
• Year: 2021
• Tongue: English
• Leaves: 299
• Category: Library

✦ Synopsis

This book is a comprehensive guide to the use of injectable fillers for facial volumization. Traditionally, fillers have been used for anti-aging purposes such as for wrinkle treatments, but they are increasingly being applied in various ways to achieve beautification such as the augmentation of the nose, chin and lips, leveraging the volumizing effect of fillers. This trend is especially evident in Asian countries but can be expected to flourish elsewhere in the future. The book opens by explaining the specifics of pretreatment assessment and relevant aspects of the basic science of fillers. It then provides a detailed description of the anatomy, injection depth and injection amount relevant to each regional indication, easy to follow for even a novice injector, based on a rich assortment of anatomical illustrations, ultrasound imaging and cadaveric photos provided to assist their understanding. And guidance is also provided on combination treatments in conjunction with botulinum toxin, thread lifting, fat-dissolving injection, etc. Potential complications and countermeasures specific to volumization with fillers are identified. The book features a wealth of illustrations showing the relevant anatomy and before and after appearances, as well as video clips for each indication. Written by a specialist with extensive experience, it provides safe and effective guidance for both beginners and advanced practitioners.

✦ Table of Contents

Preface
Acknowledgment
Contents
About the Author
1: Pretreatment Assessment
1.1 Introduction
1.2 Individualized Assessment
1.2.1 Subjective Factors
1.2.2 Objective Factors
1.2.3 Facial Assessment Flow Chart
1.2.4 Sociocultural Aspects
1.2.5 Gender-Specific Differences
1.2.6 Past Medical History of Aesthetic Procedures
1.2.7 Financial Aspects
1.3 Consideration of Ethnic Differences in Filler Procedures
1.3.1 Definition of the Asian Population and Asian Facial Morphotypes
1.3.2 Differences in the Skull Shape Between Caucasians and Asians
1.3.3 Differences in Facial Beauty Standards Between Caucasians and Asians
1.3.4 Different Filler Treatment Strategies for Caucasians and Asians
1.3.4.1 Different Strategies for Facial Contouring Based on Underlying Anatomical Differences
1.3.4.2 Different Strategies for Shaping Facial Features (Table 1.5)
1.3.4.3 Summary
References
2: Volumizing Fillers
2.1 Types of Injectable Fillers
2.2 Hyaluronic Acid Fillers
2.2.1 Characteristics of HA
2.2.2 Hyaluronic Acid Filler Manufacturing Process
2.2.2.1 Production of HA Raw Material
2.2.2.2 Incorporation of Cross-Linking Agent/Cross-Linking Reaction
2.2.2.3 Hyaluronic Acid Concentration
2.2.2.4 Monophasic vs. Biphasic HA
2.2.3 Choice of HA Filler
2.2.4 Rheological Properties of HA Filler (Table 2.2)
2.2.4.1 Elasticity
2.2.4.2 Viscosity
2.2.4.3 Tan Delta (δ)
2.2.4.4 Cohesivity
2.2.4.5 Clinical Implications (Table 2.3)
2.3 Major HA Filler Products
2.3.1 Restylane®: The Golden Standard of HA Fillers (Fig. 2.26)
2.3.2 Juvéderm®: The First Original Soft HA Filler (Fig. 2.28)
2.3.3 Belotero®: HA Filler with a Reputation for Safety (Fig. 2.30)
2.3.4 YVOIRE®: Korea’s First HA Filler (Fig. 2.32)
2.3.5 Neuramis®: Representative Korean Soft HA Filler (Fig. 2.33)
2.3.6 e.p.t.q.®: HA Filler with a Top Priority on Safety (Fig. 2.34)
2.4 Other Types of Injectable Fillers
2.4.1 Collagen Fillers
2.4.2 Permanent Injectables
2.4.2.1 PMMA (Polymethyl Methacrylate)
2.4.2.2 PAAG (Polyacrylamide Gel)
2.4.3 Collagen-Stimulating Fillers
2.4.3.1 Calcium Hydroxylapatite (CaHA) Filler
2.4.3.2 PCL Filler (Fig. 2.43)
2.4.3.3 PLLA (Poly-l-Lactic Acid) (Fig. 2.45)
2.4.3.4 P-d,l-LA (Poly-d,l-Lactic Acid)
References
3: Hyaluronic Acid (HA) Filler Injection Procedure
3.1 Preparation Prior to the Injection
3.1.1 Preparation of Tray
3.1.2 Dispensing
3.1.3 Dilution of HA Filler
3.1.4 Disinfection
3.1.5 Anesthesia
3.1.5.1 Topical Anesthetic Cream
3.1.5.2 Nerve Block
3.1.5.3 Anesthetic Injection of the Cannula Entry Point
3.1.5.4 Intravenous Anesthesia/Sedation
3.1.5.5 Distraction Method
3.2 Injection Method
3.2.1 Needle vs. Cannula
3.2.2 Linear Thread Technique
3.2.3 Tower Technique
3.2.4 Fern Pattern Technique (Multiple Intradermal Injection)
3.2.5 Subcision Technique
3.2.6 Double-Layering Technique
3.2.7 Injection Technique for Deep Static Grooves
3.2.8 Volumizing Injection Technique
3.2.9 The Role of the Nondominant Hand
3.3 HA Filler Injection Training Employing the Use of Pig Trotters
References
4: Regional Particulars
4.1 Forehead Augmentation
4.1.1 Anatomical Considerations
4.1.2 Pretreatment Assessment
4.1.3 Injection Technique for Forehead Concavity and Forehead Sloping (Table 4.1)
4.1.4 Combination Treatment
4.1.5 Complications
4.2 Temple Augmentation
4.2.1 Anatomical Considerations
4.2.2 Pretreatment Assessment
4.2.3 Injection Technique (Table 4.2)
4.2.4 Complications
4.2.4.1 Bruising
4.2.4.2 Embolism
4.2.4.3 Headache
4.2.4.4 Irregularity
4.3 Deep Glabella Furrow
4.3.1 Anatomical Considerations
4.3.2 Pretreatment Assessment
4.3.3 Injection Technique (Table 4.3)
4.3.4 Complications
4.4 Sunken Eyes Volumization
4.4.1 Anatomical Considerations
4.4.2 Pretreatment Assessment
4.4.3 Injection Technique (Table 4.4)
4.4.4 Complications
4.5 Pretarsal Roll Augmentation
4.5.1 Anatomical Considerations
4.5.2 Pretreatment Assessment
4.5.3 Injection Technique (Table 4.5)
4.5.4 Complications
4.6 Inferior Orbital Hollow, Tear Trough, and Palpebromalar Groove
4.6.1 Anatomical Considerations
4.6.2 Pretreatment Assessment
4.6.3 Injection Technique (Table 4.6)
4.6.3.1 Tear Trough
4.6.3.2 Central Inferior Orbital Hollow
4.6.3.3 Palpebromalar Groove
4.6.3.4 Combination Treatment
4.6.4 Complications
4.7 Nasojugal Groove
4.7.1 Anatomical Considerations
4.7.2 Pretreatment Assessment
4.7.3 Injection Technique (Table 4.7)
4.7.3.1 Combination Treatment
4.7.4 Complications
4.8 Malar Eminence
4.8.1 Anatomical Considerations
4.8.2 Pretreatment Assessment
4.8.3 Injection Technique
4.8.4 Complications
4.9 Nose
4.9.1 Anthropometry of the Nose
4.9.2 Ethnic Differences
4.9.3 Anatomical Considerations
4.9.4 Pretreatment Assessment
4.9.4.1 Pretreatment Assessment Flowchart (Fig. 4.55)
4.9.5 Injection Technique (Table 4.11)
4.9.6 Nasal Dorsum Augmentation (Fig. 4.57)
4.9.7 Glabella Correction
4.9.8 Nasal Tip Correction
4.9.9 Columella Correction
4.9.10 Nasolabial Angle Correction
4.9.11 Injection Techniques for Special Indications
4.9.11.1 Humped Nose (Fig. 4.65)
4.9.11.2 Wide Nasal Base (Fig. 4.66)
4.9.11.3 Bulbous Nose
4.9.11.4 Pulling Nose (Arrow nose) (Fig. 4.67)
4.9.11.5 Deviated Nose
Curved Nose
Slanted Nose (Deviated Septum)
4.9.12 Combination Treatment
4.9.13 Complications
4.10 Sunken Cheek Augmentation
4.10.1 Anatomical Considerations
4.10.2 Pretreatment Assessment
4.10.3 Injection Technique (Table 4.12)
4.10.4 Complications
4.11 Nasolabial Folds
4.11.1 Anatomical Considerations
4.11.2 Pretreatment Assessment
4.11.3 Injection Method (Table 4.13)
4.11.3.1 Deep Static Nasolabial Folds
4.11.3.2 Dynamic Nasolabial Folds
4.11.3.3 Combination Treatment
4.11.4 Complications
4.12 Lip Filler
4.12.1 Anthropometry of the Lips
4.12.2 Anatomical Considerations
4.12.2.1 Sagittal View of the Lips
4.12.2.2 The Labial Artery
4.12.2.3 Age-Related Changes in the Lips
4.12.3 Pretreatment Assessment
4.12.4 Injection Technique (Table 4.14)
4.12.4.1 The Upper Lip
4.12.4.2 The Lower Lip
4.12.4.3 The Needle Technique
4.12.4.4 Combination Treatments
4.12.5 Complications
4.13 Marionette Lines
4.13.1 Anatomical Considerations
4.13.2 Pretreatment Assessment
4.13.3 Injection Technique (Table 4.15)
4.13.3.1 Deep Static Marionette Lines
4.13.3.2 Combination Treatment
4.13.4 Complications
4.14 Chin Augmentation
4.14.1 Anthropometry of the Chin
4.14.2 Anatomical Considerations
4.14.3 Pretreatment Assessment
4.14.4 Injection Technique (Table 4.16)
4.14.5 Improvement of Anterior Projection
4.14.6 Lengthening of Chin Height (Elongation of the Chin)
4.14.7 Widening of the Chin Width
4.14.8 Correction of Chin Asymmetry
4.14.9 Combination Treatment
4.14.10 Complications
4.15 Jawline Filler
4.15.1 Anatomical Considerations
4.15.2 Pretreatment Assessment
4.15.3 Injection Technique (Table 4.17)
4.15.3.1 Jawline Augmentation
4.15.3.2 Mandibular Angle Augmentation
4.15.3.3 Correction of Asymmetry
4.15.4 Complications
4.16 Earlobe Filler
4.16.1 Anatomy of the Outer Ear
4.16.2 Injection Technique
4.17 Atrophic Scar volumization for Soft Tissue Depressions from Autoimmune Diseases
4.17.1 Pretreatment Assessment
4.17.2 Injection Technique
4.17.3 Complications
4.18 Facial Asymmetry Correction
4.18.1 Pretreatment Assessment
4.18.2 Principles and Injection Technique for Facial Asymmetry Correction
4.18.3 Combination Treatment
4.19 Neckline Treatment with HA Filler
4.19.1 Pretreatment Assessment
4.19.2 Injection Technique
4.20 Hydrolifting (Multiple Intradermal Injections of HA Filler)
4.20.1 Pretreatment Assessment
4.20.2 Injection Technique
4.20.2.1 Manual Injection Method
4.20.2.2 Manual Injections Using a Cannula
4.20.3 Use of Injectors
4.20.4 Laser-Assisted Needleless Injector
4.20.5 Cocktail Therapy
4.20.6 Wrinkles Above the Knee
4.20.7 Complications
References
5: Complications
5.1 Vascular Complication
5.1.1 Symptoms
5.1.2 Prevention
5.1.3 Treatment
5.1.4 Cause and Treatment of Blindness Following HA Filler Injection
5.2 Inflammation from Delayed-Type Hypersensitivity to  HA Filler
5.2.1 Cause of Delayed-Type Hypersensitivity Following HA Injection
5.2.2 Symptoms
5.2.2.1 Case
5.2.3 Differential Diagnosis
5.2.4 Treatment
5.2.5 Summary
5.3 Posttreatment Contour Irregularity
5.3.1 Inadequate Placement
5.3.1.1 Inadequate Positioning
5.3.1.2 Inadequate Technique
5.3.1.3 Insufficient Injection Volume
5.3.2 Inadequate Balance
5.3.3 Delayed Irregularity
5.3.3.1 Aggregation of Filler Due to Muscle Contraction
5.3.3.2 Postinjection Swelling of HA Filler
5.3.3.3 Different Durations of Effect by Facial Region
5.3.4 Solution: Administration of Hyaluronidase
5.4 The Adequate Use of Hyaluronidase
5.4.1 Pharmacological Characteristics
5.4.2 Products (Fig. 5.7)
5.4.3 Use of Hyaluronidase in the Correction of HA Filler Placement (Table 5.3)
5.4.3.1 Dilution and Concentration of Hyaluronidase
5.4.3.2 Injection Dosage of Hyaluronidase
5.4.3.3 Cannula vs. Needle
5.4.3.4 Timing of HA Filler Reinjection
5.4.3.5 Reinjection of Hyaluronidase
5.4.4 Use of Hyaluronidase for Managing Inflammation from Delayed-type Hypersensitivity to HA or Bacterial Infection
5.4.5 Use of Hyaluronidase in the Treatment of Vascular Complications from HA Filler Injection
5.4.6 Allergic Reaction to Hyaluronidase and Allergy Testing
5.4.7 Skin Atrophy
5.4.8 Use of Ultrasonic Imaging to Establish the Presence of HA in the Tissue
References