Class 5: facial implants 2

12 fatty paniculus
3 frontals
Infraorbital, supra and lateral
Nasolabial
Middle, lateral of the cheek
Upper and lower jowl
Mental

Facial artery and vein

External carotid artery that runs making
bilateral anastomosis in the area of the
bridge of the nose and also with the
ophthalmic that comes from the carotid
internal high-risk area

Facial muscles
Anterior zone thin muscles of mimicry
Side area masticatory muscles of different branchial arches

Middle third
We define it as an area that extends from an imaginary line from the
external canthus of the eye to the lowest part of the tragus, which divides between the
middle zone in a previous one and another lateral
Ligamentos que son verdaderos “arboles” que cruzan verdaderos planos
from periosteum to layer 1
In layer 2, they create the cutaneous retinaculum. ligament elongation
true ones that are observed in the two-dimensional plane.
We see how all the tissues function in a compact manner and
synergistically the clinician says that the skin is like the 'paint', the
fat panniculus the 'packing', the third area would be the lining,
fourth layer the thermal insulation and zone five the rough work.
If we have alterations in the rough work and the insulation is affected.
all tissues.

Facial anatomy - review

Beneath this orbicular muscle we have the SOOF, immediately there we have a true ligament.
(ORL), from the center line towards the front, there is the tear drop, the two bands of the ORL join and form
the tear drop
Elevador propio del ángulo de la nariz
Pyriform space
Below the ORL we have the precigomatic space (more towards the medial minor zygomatic and more towards the area
greater zygomatic projection
Modeolus zone of the most superficial face (0.8 cm outward), then it deepens to plane 4 and
After giving the upper lip, it is called angular, it passes below plane four where the DMC is.
Deep medial cheek fat
DMC first, it will be reabsorbed due to the effects of aging.
Fatty panicles
We know that in front of the ligamentous line the panicles
adipocytes are very mobile and behind the line they are
fewer mobiles and more fibrous.
Deep adipose panniculus: medial SOOF and lateral
SOOF, below the zygomatic cutaneous ligament
Between the DMC (it looks dark purple in the photo) and the side
here is the angular vein.

Ligaments
True ligaments
False ligaments: masseteric
In the area in front of the nasogenian groove and labial chin, there is a firmer fat than the one that is by
independent back of Glogau.

Clinical anatomical repair - periorbital area

Inferior frontal septum injections lower than this structure are more efficient
Surco
what is it
shape of the superficial zygomatic ligament as we age

Beneath the orbicular

Outer canthus of the eye lateral orbital ligament
Tear trough ligament near the inner corner of the eye below, the vein
the angular is close to the tear trough
Sagittal section
{"Zona ósea":"Bone zone","globo ocular":"eyeball","piel":"skin"}
ORL
Subcutaneous fat
Orbicular muscle
SOOF
Prezygomatic space
YELLOW POINTS: ORL
Orange point: zygomatic ligament
Cuando vamos a tratar esta zona lo primero
What we are looking at is the zygomatic ligament.
cutaneous and how we are going to reposition it for
acid ball technique
that it does not get marked
hyaluronic to see the support.
Multiplane work is done. with hyaluronic acid
of high G prime in plane 5 (at the base of
true ligament
Low G prime acid for the uppermost area and the groove that forms like a true Y.

Approach to dark circles

We will always evaluate the cheekbone area and if
requires cheekbone and dark circle, first we perform the cheekbone and
then the dark circle because when we reposition the point of
light affects the dark circles due to the lifting of the area and so on
use less product in the under-eye area.
Sequence: first cheekbone and then dark circle
McGregor's technique or lateral approach with catheter
long needle with a blunt tip (we open with a needle and
then we get into the cannula). From the external edge of
eye 2 cm outward and two down in shape
horizontal we enter the zone below the
orbicular, we are doing retro injection like a drip
and then with a massage everything comes together plan 4/5
It is a soft filling. since it is a very thin area
It can look bad if a high filler is used.
prime or a low prime filling but very
superficialized
There are cases where the dark circle has a herniation of fat, it looks like.
puffed up like in the photo on the right.
If the groove is filled, the fat is still there, so
ideally a product should be put first of
mesotherapy called adipo that eliminates fat
and once the fat is reduced, the appropriate plane is filled.
It can be done with the McGregor technique or also with a
point from the wing of the nose to the tragus and from the outer corner of the eye
towards the corner and where the two lines intersect we make
the approach with the cannula.
PHOTO: Towards the mid area, the TTD (the ear drop) and the nasoyugal groove (NG) formed by the zygomatic.
superficial, the medial cheek groove (MCG) and the palpebromalar groove (PMG).

The infraorbital foramen has a bony flap like a ceiling downward (from bottom to top it is easy.
to introduce oneself, but not in reverse.

Opening provided by the zygomaticofacial artery be careful not to produce bruises

Dark circle resolution

Infraorbital approach can be done in different ways
C. McGregor Approach
 B. Insertion line from the nose tragus - external edge of the commissure and its intersection, and we see in which area it is lacking more.
and we directed the cannula.
A. Behind the iris line by 1.5 cm and then move to the under-eye filling.
Another technique after finishing with the cannula, finish details with a needle and I'm going to level 5. Inject.
small lumps on the bony edge and massage.
Pupillary line 1 cm from the bony edge infraorbital foramen
Always an injection for dark circles with hyaluronic acid about plan 5
Snap test: the skin of the lower eyelid is pulled and it is checked how flaccid it is. indicate when we can do it
something for the patients or is it a surgical solution.
we can get into that area and make a
The outermost area of the SOOF also suffers from ptosis.
a kind of fan on two planes to give them more volume

Middle third of the face

Risk areas in relation to the facial nerve
When we are going to treat this area, do not forget anatomy and anatomical relationships between one structure and another.

Light points according to previous projection or lateral malar volume

Women: point of light Ideally, we want to project to maintain a youthful appearance for the face.
Inverted triangle or heart shape
As we age, the point of light shifts downward.
In men, it's always lower.

Under-eye filler
Dr. Di Mayo
Tragus marking - nostril and outer edge - commissure
The intersection of both is the entry point of the cannula.
Palpating the orbital bony rim mark Tt1 (in front of the pupil), Tt2 (external canthus) and Tt3 (canthus)
internal) at 1mm or 0.5mm from the orbital rim
Infiltration order: tt2, tt11, and tt3 (from the outside in filling in)
Very small amount, a maximum of 0.4ml per side, then repeat the treatment after 45 days.

Patient Profile
Good candidates: young people with good elasticity, thick and smooth skin, good skin tone (snap test),
minimal laxity, mild to moderate dark circles
 Poor candidates: elderly patients with poor elasticity, very thin skin, transparent skin or des
pigmented, significant skin laxity, extremely deep dark circles.

Anatomy of the central midzone of the face

Skin
2. Superficial fat compartment (nasolabial and medial cheek)
3. SMAS and portion of the orbicularis oculi muscle
4. Deep nasolabial compartment. Relationship with the premaxillary space
5. Muscle that elevates the upper lip and nasal. Muscle that elevates the upper lip.
6. Piriform space medial to the infraorbital foramen
a. DMC between the infraorbital nerve and angular vein
b. DLC: between the angular vein and the zygomaticus major muscle
7. Periosteum

Subcision before injection

the fibers break and the filling is placed
Fibrosis between the dermis and the second layer
Fibrous septum: medial facial fibrous partition it has the function of raising the adipose tissue when
we smile, lift the cheekbone. Pull the DMC and DML when smiling.
Tabique originating from the lower part of the greater zygomatic muscle that forms a boundary.
transversal between the oral cavity and the deep middle facial fat compartments.
Dynamic filling, injecting small amounts of filler and asking the patient to smile
Repeatedly during the procedure, it seems to be a viable way to prevent this adverse event during
the injection of soft tissue fillers.
As we tense the septum, we raise more and let the adipose pannicles rise more.
deep. It functions like a ligament.
So when working on the cheekbone, structural tightening and volumization are performed, those two
techniques.
To volumize: mark 3 points in the area of
to grind every 1 cm towards the zygomatic arch (photo) and it
they inject hyaluronic acid boluses at level 5
making the area rise, regaining the point
high at the level of the malar bone.
In static: palpate bony prominences and identify
soft structures.
In dynamic: finding ligamentous structures

Filling cheeks / cheekbones

Marking: tragus - nasal wing, outer corner of the eye - commissure, corner
external to the tragus and then mark the equidistant point
Outer corner of the eye - to the wing of the nose and the equidistant midpoint
Bisection from the outer edge of the eye
Join both equidistant midpoints
Mark ck1, ck2, ck3
Ck3 coincides with the Ristow point
Inject deeply into plane 5 supraperiosteal (touch
bone, aspirate, inject slowly volumes. Planned from 0.1 to
0.4/0.5ml
In cx1 and ck2, pillar technique can be done (0.1 is injected)
supraperiosteal and 0.1 in retroinjection just before reaching the
superficial dermis
 In CK3, only a hole in the infra-Obritarian area.
Recommended order 1, 2 and 3
In the lady's photo, the point towards the middle should be in the equidistant area (at the intersection of lines of
under where it is

Transverse septum: delimitation

with high G' filler
Inject in the piriform fossa
Lower and anterior border injection of the zygomatic bone of 0.2 make the patient smile several times
Malar point injection

Anatomical prices lower third, lateral zone: parotid region - masseteric

Skin
2. Superficial fatty behavior LCF - MCF (lateral and medial)
3. SMAS and platysma
4. Sub SMAS or pre-masseter space
5. Parotid fascia - masseteric, branches of the facial nerve, and parotid gland and duct
6. Masseter muscle
7. Deep buccal fat compartment

Anatomical planes lower third, medial zone

Skin
2. Superficial fat compartment of the upper Jowl SJF and the lower Jowl LJF
3. SMAS and platysma
4. Deep fat compartment of the JOWL DJF
5. Periosteum

Superficial fat compartments

LCF: lateral fat of the cheek
2. MCF: medial fat of the cheek
3. SJF: upper fat of the jowl
4. IJF: lower fat of the Jowl

Aging of the JOWL line

The jowl is behind the mentolabial groove.
Weight is never added to the jowl area because it would sag more with added weight.
Insertion of the mandibular body of the mandibular septum
Lax mandibular septum or decreased lax tissues could be the cause of the jowl.
 Compartimentos:
Superior
the Inferior
Submandibular
The mandibular septum separates both compartments.

Vertical labiomental artery:

Rama of the submental terminal, which with deep and superficial arms seeks anastomosis with the
inferior labial artery (ILI)
Treatment area for the lower medium: plane 2
One of the first things we notice is a very pronounced mentolabial groove.
A subsision is first performed with a cannula. 0.5 cm from the commissure and break fibers to release fibrosis
and then we do a retro injection to fill that area.

Basilar edge treatment

We will ALWAYS work with a cannula to have a greater degree of protection due to proximity to the
facial artery and vein.
Only the gonion is worked with a needle. puncture with a flat needle 5-6y and there we will just insert a
Speak to produce a lateral projection with respect to this area.
From the gonion upwards always a cannula.

Male mandibular marked

In the gonion, a bolo is placed in plan 5 of volumization to achieve angular reference projection.
Mandibular ramus: from the gonion upwards re-injection in P2, in the form of columns of
necessary volume to achieve lateral projection
Jawline: desde el gonion hacia adelante retroinjection in P2 in lines parallel to the mandibular border,
of volume necessary to achieve lateral projection
Mental projection: wide squared chin, bolus in P5.

Female profile
Mandibular angle: bolo in plane 5 only of referential projection
Mandibular branch: retroinjection in P2, in column form only in cases of extreme thinness. Level 2 to
1 cm from the tragus because that's where the superficial temporal artery is.
Jawline: retroinjection in plane 2 in parallel lines to the mandibular edge, with the necessary volume for
achieve lateral projection
Mentonian projection: angled chin, single bolus in P5, with anterior projection in V.

Definición de reborde y ángulo mandibular

Marking: palpate the masseter and mark the anterior and posterior edges
Draw a vertical line 1cm in front of the tragus and a horizontal one.
about the basal edge of the jaw forming an angle between
both
Draw a line 2 cm from the angle, forming an isosceles triangle.
which will later be filled with a fan
Mark an entry point for the cannula in the middle of the jowl,
taking into account the exit of the facial artery
In some patients, a bump can be placed on the gonion and also
behind the gonion to create more support
ALWAYS ENTER WITH CANNULA FROM FRONT TO BACK (IN JOWL IN THIS CASE OF
THE PHOTO) AND ALWAYS IN PLAN 2

Plans anatomical of the

temporal fossa
Skin
2. Superficial fat pad
Superficial temporal fascia
4. Deep fat pad
5. Deep temporal fascia
6. Fat pad superficial. Temporal
7. Deep layer of the deep temporal fascia
8. Deep temporal fat pad (continuation of Bichat)
9. Temporal muscle
10. Periosteum

COTOFANA: FILLMED IS IN THEIR VIDEOS.

Técnica one up one over

Low supraperiosteal volumizing technique
We must mark the temporal crest and the bony tubercle, and
we inject in plane 5, 1 cm up and 1 cm sideways at 90º,
one up and one next to it.
 It will have an effect that lifts the upper third and also the eyebrow.
Direct access
A 27 G needle is inserted perpendicular to the skin surface until bone contact is established.

Supra-auricular technique or three-dimensional dynamic lifting

Anterior third of the zygomatic arch, supra-auricular direction with
22 or 25 G cannula of 50 mm.
1 cm in front of the tragus and around the insertion, a bolus is placed.

Temporal or V up lifting technique

1cm in front of the tragus, 7 cm above and a bolus is left.
22G cannula of 70 mm
G'mediano is applied 0.5 ml
By pulling the hair area, it stands out much more what is the
gonial angle.

Conclusion
Get to know our patient
To know the techniques
Prevention and early treatment
Real and natural expectations
COMBINE techniques and planes