Hyaluronic acid injections – a routine procedure for a modern cosmetologist, which is carried out in order to beautify, rejuvenate and restore the face. But hyaluronic acid, long used exclusively for tissue volumization, continues to surprise doctors and patients with additional benefits. One of them is myomodulation – change in the muscle activity of the face due to a relaxing or stimulating effect.
This phenomenon is described in the article estet-portal.com by Drs. Lakhdar Belhaouari, Manuela Tomasseti, Pierre Quinodoz and Conrad de Boule.
- Decreased muscle activity: relaxing effect of hyaluronic acid injections
- Increased muscle activity: stimulating effect hyaluronic acid injections
Reduced muscle activity: relaxing effect of hyaluronic acid injections
Estimating the results of face correction with hyaluronic acid, practitioners came to the conclusion that after injection into certain areas, this substance leads to myomodulation due to relaxation of the facial muscles. This effect is observed in the case of direct contact of HA with the muscle, including intramuscular injection of the filler:
- in the chin area;
- to the back of the lower jaw;
- forehead;
- on the lips;
- into the lateral part of the orbit;
- in the upper part of the nasolabial folds, etc.
When hyaluronic acid comes into direct contact with the muscle, it is distributed between its fibers and has a relaxing effect.
It is important to remember that the part of the orbicular muscle of the eye that lowers the tail of the eyebrow has no antagonist.
In the lateral-orbital part of the orbicular muscle of the eye, at the level of the crow's feet, injections of hyaluronic acid are aimed at changing the shape of the posterolateral part of the middle third of the face. Correction results:
- volumization of the upper outer part of the middle third of the face, the formation of a harmonious S-shaped bend;
- lifting of the eyebrow tail, which is achieved due to myomodulation (relaxation) of the lateral part of the orbicular muscle of the eye;
- reducing the appearance of crow's feet.
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To improve facial contour, HA boluses are injected deep into the bone at the posterior part of the horizontal ramus of the mandible. In fact, filler injections fall on the masticatory muscle, where hyaluronic acid provides a double effect:
- beautification and rejuvenation of the contour, a clearer line of the lower jaw;
- relaxation of the chewing muscle, the hypertonicity of which leads to an increase in the width of the face in the lower third and bruxism.
Fig. 1: before and after deep injection of 0.8 ml of HA volumizing gel into the posterior part of the horizontal mandibular ramus, at the level of the insertion of the masseter muscle
Injections of hyaluronic acid in the forehead area improve contours and fill in depressions. With supraperiosteal injection, the filler is in direct contact with the frontalis muscle, since there is practically no space between the frontal bone and the muscle. The frontalis muscle raises the eyebrow and contributes to the formation of forehead wrinkles. HA modulates function m. frontalis due to its relaxing effect and can reduce the appearance of horizontal forehead wrinkles.
Read also: Harmony and naturalness of the lips: non-surgical lifting technique
Filling the upper nasolabial fold is performed using the deep bolus technique. At this level, hyaluronic acid is injected into the muscle that raises the upper lip and ala of the nose. Due to the effect of myomodulation, slight reduction in the severity of the gingival smile.
Injections of hyaluronic acid into lips allow to correct the shape and volume of this zone. By reducing the activity of the orbicular muscle of the mouth, which is injected, the effect of softening the smile is achieved, along with an increase in the fullness, projection, eversion and hydration of the lips.
Once in the muscle, the hyaluronic acid gel is distributed between the muscle fibers, reduces their activity and contraction force, without blocking or changing their viscoelastic properties. Muscle function is preserved but modulated.
When working in the temporal area HA is injected either superficially over the temporal fascia or deep into the temporal fossa, under the deep temporal fascia. Result – reshaping and alignment of the temporal zone. With deep injection, the drug de facto is injected into the temporalis muscle, where it is distributed between the fibers and relaxes them, partially relieving the tension of the masticatory muscles.
Fig. 2: before and after deep injection of 1.2 ml of HA volumizing preparation at the level of the chin (pogonion)
In retrogenia, HA injections at the level of the chin have a double effect:
- change the shape of the chin by increasing the volume;
- smooth the "orange peel" on the chin, excessive anterior projection of the lower lip and chin lift, slightly lengthen the line of the lower jaw due to the effect of myomodulation (relaxation) of the mental muscle.
Increasing muscle activity: the stimulating effect of hyaluronic acid injections
Hyaluronic acid bolus injections into deep malar fat pad provide beautification and restoration of volumes, as well as the effect of lifting the middle third of the face. The drug is injected behind the orbicular muscle of the eye, the myomodulation of which is provided by the stimulating effect of HA.
Mechanical action: the middle third of the face is shortened and raised due to the additional volume and rounding.
Even minimal amounts of HA volumizing gel, injected into the deep malar fat pad, provide a lifting effect in the middle third of the face.
Rheological Properties of HA: Requires a highly elastic gel to create projection G’ and cohesiveness. Such a filler is able to withstand vertical pressure, providing tissue lifting. High cohesiveness prevents drug migration.
Read also: Temporal zone: features of aging and correction with fillers
Physiology: the main motor element at the level of the middle third of the face is the orbicular muscle of the eye. It lifts the superficial compartments formed by the skin and superficial malar fat, while the deep malar fat, attached to the bone tissue, remains immobile. Like all striated muscles, the circular muscle of the eye, due to its tone, is in constant tension, which persists even during voluntary relaxation. This tone depends on the reflex activity of the medullary nature.
Fig. 3: myotatic reflex resulting from myomodulation (stimulation) of the orbicular muscle of the eye after HA injections into the deep malar fat
Even the minimum amount of GK – 0.5-1 ml, injected into the deep malar fat behind the orbicular muscle of the eye, mechanically creates an anterior projection of the orbicular muscle of the eye and lengthens its fibers (the muscle resembles a stretched bow).
In response to muscle lengthening, its reflex contraction occurs. As a result, those located above m are raised. orbicularis oculi tissues, superficial malar fat compartment and overlying skin.
The lifting effect is achieved by:
- raising the medial part of the middle third of the face;
- raise of the palpebral-malar furrow due to the lifting of the superficial masking fat;
- shortening the lower eyelid;
- slight reduction in the severity of the nasolabial fold due to the lifting of superficial malar fat and skin.
Tension caused by the lengthening of the orbicular muscle of the eye and the lifting effect is maintained for the duration of the presence of HA in the tissues.
You may also be interested in: Anatomy of the forehead for injectionists: important nuances of the structure and correction of the zone
It is logical to assume that with an increase in the amount of HA and the length of the orbicular muscle of the eye, the degree of lifting increases. However, this theory is not confirmed in practice. On the contrary, excessive volumization does not lead to a lifting effect, since with a strong lengthening of the muscle, the reverse myotatic reflex.
Fig. 4: the main facial muscles. Green indicates the muscles on which HA has a relaxing effect. Blue indicates the injection of HA into the deep malar fat pad, which stimulates the activity of the orbicular muscle of the eye
Understanding the mechanism of myomodulation, facial muscle balance and the work of agonist and antagonist muscles will allow the practitioner to improve the results of beautification, volumization and facial rejuvenation with hyaluronic acid injections.
According to Prime magazine.
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