Treating Aging Changes of Facial Anatomical Layers with Hyaluronic Acid Fillers

Krishan Mohan Kapoor, Deasy Indra Saputra, Catherine Ellen Porter, Ligia Colucci, Catherine Stone, Elian Elisabeth Anne Brenninkmeijer, Jake Sloane, Karim Sayed, Ketut Kwartantaya Winaya, Dario Bertossi, Krishan Mohan Kapoor, Deasy Indra Saputra, Catherine Ellen Porter, Ligia Colucci, Catherine Stone, Elian Elisabeth Anne Brenninkmeijer, Jake Sloane, Karim Sayed, Ketut Kwartantaya Winaya, Dario Bertossi

Abstract

The aging process affects every anatomical layer of the face. Improved knowledge of how aging occurs in each anatomical layer of the face has helped evolve the facial rejuvenation strategies with HA fillers. Understanding the age-related changes in the anatomical facial layers, including their time of onset and how the changes occur in the different tissue layers, an injector can provide much more targeted and refined HA filler treatments. As fillers' use has increased, there has been a distinct shift away from procedures lifting the skin and SMAS. We can selectively target the anatomical facial layers with HA fillers for more refined and predictable outcomes. An extensive range of HA filler variants is now available. Each filler type is optimized and designed to be injected into specific tissue planes for the best results. Knowing the predictable aging changes in the different tissue layers of the face is crucial as this guides the optimum filler choice. Working knowledge of the individual characteristics of the numerous HA-based products allows for their effective placement in the correct layer. Familiarity with the correct HA product may also help to minimize the downtime and risk of adverse events.

Keywords: facial aging; facial anatomy; filler complications; filler injections; filler procedures; fillers; hyaluronic acid.

Conflict of interest statement

Dr Catherine Ellen Porter reports personal fees from Allergan Aesthetics, outside the submitted work. Dr Ligia Colucci is member of Allergan Training Faculty and a consultant for AbbVie Allergan. Dr Catherine Stone reports personal fees from Allergan, outside the submitted work. Dr Jake Sloane reports personal fees from Allergan Aesthetics, outside the submitted work. Dr Karim Sayed reports personal fees from Allergan, personal fees from Teoxane, personal fees from AbbVie, outside the submitted work. No financial disclosure with respect to this paper from all the other authors as no financial support/ grant received by any of the authors for writing and publishing this review paper.

© 2021 Kapoor et al.

Figures

Figure 1
Figure 1
Before and after pictures of a patient treated for skin quality fillers. Treatment description: Neck- Juvederm Volite, 1mL per side, in the most superficial layer of skin using a needle. (contributed by Catherine Ellen Porter).
Figure 2
Figure 2
Before and after pictures of a patient treated for skin quality fillers. Treatment description: Neck- Juvederm Volite, 2mL total, in the superficial subcutaneous layer using a needle; Face- Juvederm Volite, 1mL each side, in the superficial subcutaneous layer using a needle. (contributed by Ligia Colucci).
Figure 3
Figure 3
Treatment description: Lateral Cheekbone area- Juvederm Voluma, 0.1mL at 3 points each side, on periosteum with a needle; Temporal fossa: Juvederm Voluma, 0.5mL each side, on periosteum using a needle; Cheekbone projection: Juvederm Voluma, 0.2mL each side, on periosteum using a needle; Malar region- Juvederm Voluma, 0.5mL each side, in the deep malar fat pad, using a needle; Pre-auricular area- Juvederm Voluma, 0.5mL each side, in the subcutaneous layer using a cannula; Labiomental crease: Juvederm Voluma, 0.7mL each side, in the subcutaneous layer using a cannula; Chin/pogonion- Juvederm Volux, 0.3mL each side on the periosteum, using a needle; Posterior jawline//pre-auricular area- Juvederm Volux, 0.3mL each side in subcutaneous layer using a cannula; Medial to the angle of the jaw: Juvederm Volux, 0.4mL in the subcutaneous layer, cannula; Jawline- Juvederm Voluma, 0.5mL each side, in the subcutaneous layer of the pre-jowl sulcus and medial jawline using a cannula; Malar area- Juvederm Voluma, 0.5mL each side in deep malar fat pad using a cannula; Malar area: Juvederm Volift, 0.5mL each side, in SOOF layer using a cannula; Periorbital region- Juvederm Volbella, 0.5mL each side, in SOOF including tear trough using a cannula; Lips- Juvederm Volift, 0.5mL total, in the subcutaneous layer using a needle. (contributed by Ligia Colucci).
Figure 4
Figure 4
Treatment description: Lateral Cheekbones area: Juvederm Voluma 0.1mL in 3 points each side on periosteum with a needle. Pre-auricular area: Juvederm Voluma, 0.7mL each side, in the subcutaneous layer using a cannula; Malar area: Juvederm Voluma, 0.5mL each side, in deep malar fat pad using a cannula; Malar area: Juvederm Volift, 0.5mL each side, in SOOF using a cannula; Temporal fossa- Juvederm Voluma, 0.5mL each side, on periosteum using a needle; Labiomental crease- Juvederm Voluma, 0.7mL each side, in the subcutaneous layer using a cannula; Chin apex/pogonion- Juvederm Volux, 0.3mL each side, subcutaneous/intramuscular (mentalis muscle) plane using a needle; Medial to marionette lines- Juvederm Voluma, 0.5mL each side, in the subcutaneous layer using a cannula; Jawline: Juvederm Voluma, 1mL each side, in the subcutaneous layer of the pre-jowl sulcus and medial jawline using a cannula; Nasolabial folds- Juvederm Volift, 0.5mL each side, in the subcutaneous layer using a cannula. (contributed by Elian Elisabeth Anne Brenninkmeijer).
Figure 5
Figure 5
Treatment description: Lateral Cheekbones: Juvederm Voluma, 0.1mL in 3 points each side, on periosteum with a needle; Pre-auricular area: Juvederm Voluma, 0.7mL each side, in the subcutaneous layer using a cannula; Malar area- Juvederm Voluma, 0.5mL each side, in the deep malar fat pad, using a cannula; Malar area: Juvederm Volift 0.5mL each side, in SOOF layer, using a cannula; Temporal fossa- Juvederm Voluma, 0.5mL each side, on periosteum using a needle; Labiomental crease- Juvederm Voluma, 0.7mL each side, in the subcutaneous layer using a cannula; Chin apex/pogonion: Juvederm Volux, 0.3mL each side, subcutaneous/intramuscular (mentalis muscle) using a needle; Medial to marionette lines- Juvederm Voluma, 0.5mL each side, in the subcutaneous layer using a cannula; Jawline- Juvederm Voluma, 1mL each side, in the subcutaneous layer of the pre-jowl sulcus and medial jawline using a cannula; Nasolabial folds- Juvederm Volift, 0.5mL each side, in the subcutaneous layer using a cannula. (contributed by Elian Elisabeth Anne Brenninkmeijer).
Figure 6
Figure 6
Before and after pictures of a patient given filler treatment in various facial layers. Treatment description: Lateral and medial malar area- Juvederm Voluma, 0.2 and 0.3mL per side, on periosteum using a needle; Labiomental crease: Juvederm Voluma, 0.5mL each side, in the subcutaneous layer using cannula; Chin- Juvederm Volux, 1mL total, on periosteum using a needle; Angle of the jaw- Juvederm Volux, 0.3mL each side, on periosteum using a needle; Posterior jawline/pre-auricular area: Juvederm Volux, 0.3mL each side, in the subcutaneous layer using cannula; Medial to the angle of the jaw- Juvederm Volux, 0.4mL each side, in the subcutaneous layer using a cannula. (contributed by Catherine Ellen Porter).
Figure 7
Figure 7
Before and after pictures of a patient treated for lower face shaping and contouring. Treatment description: Labiomental crease- Juvederm Voluma, 0.7mL, each side, in the subcutaneous layer, using a cannula; Chin/pogonion- Juvederm Volux 0.3mL each side, on periosteum using a needle; Jawline- Juvederm Volux, 0.5mL each side, in the subcutaneous layer of the pre-jowl sulcus and medial jawline using a cannula; Angle of the jaw- Juvederm Volux, 0.5mL each side, in the subcutaneous layer using a cannula. (contributed by Jake Sloane).

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