Medonecheek sulcus – a linear depression that divides the anterior part of the cheek into the malar and nasolabial segments. With age, the furrow becomes more pronounced and gives the face a tired look. This is one of the most common topographic defects of the middle third of the face, which can be successfully corrected with hyaluronic acid fillers. Dr. Bulent Bagci in the article estet-portal.com presents the liquid lifting technique with HA fillers, which can be used for correction of the midcheekal sulcus. As part of the procedure, the doctor works with superficial and deep fat pads.
- Causes of the midcheek sulcus and a description of the liquid lifting technique
- Protocol and results of application of liquid
liquid lifting technique with HA fillers Causes of the mid-buccal sulcus and a description of the liquid lifting technique
The middle third of the face – a multilayer structure that includes superficial and deep fat compartments. They play an important role in the formation of facial contours and the appearance of various topographical changes – sagging, furrows and flattening, including
median buccal sulcus. According to the results of research, it is possible to reduce the severity of the furrow in the middle third of the face by restoring the volumes of deep fat packs of the cheeks lost during the aging process – medial and lateral.
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simultaneous injection of the HA filler into the superficial and deep cheek fat pads in the following sequence:
deep medial fat pad;- deep lateral fat pad;
- superficial fat pads.
- Filler injections into the
plane provide an increase in the anterior projection of the middle third of the face and smooth the transition between the anterior and lateral parts of the cheeks. Deepening of the mid-buccal sulcus is the result of ptosis of
superficialfat pads, which can also be corrected by filler injections. Filler injection into superficial fat compartments with cannulas – relatively safe procedure.
The advantages of the liquid lifting technique are:harmonious result;
- preservation of natural facial expressions;
- lack of filler migration in
- deep fat pads. Protocol and results of liquid lifting technique with HA fillers
In the case presented, a 32-year-old patient underwent an MRI to:
determine the location of the filler;
- objectively assess the effect of injection correction of the mid-cheek sulcus.
- The mid-cheek furrow on the right side of the face was deeper than on the left.
: Anatomy and recommendations for filling the nasolacrimal trough with fillers
Cannula entry point: 2 cm lateral to the junction of a vertical line passing through the lateral part of the orbital rim and a horizontal line crossing the junction of the nasal septum and upper lip.
Hazardous areas:
- facial vein
- , which emerges from under the zygomaticus major muscle at the insertion site; it crosses the deep adipose tissue above the levator labii and runs along the anterior border of the infraorbital fat in the malar septum; infraorbital nerve
- , which emerges from the infraorbital foramen and, together with the infraorbital artery and vein, enters the fascial layer.
The medial border of the deep medial buccal fat pad is formed by the fascial layer.
- Angular vein forms the lateral border of the deep medial buccal fat pad and the medial border of the deep lateral buccal fat pad.
- A monophasic filler based on
. was used to correct the mid-buccal sulcus.
Protocol for correction of the mid-cheek sulcus in the Liquid Lifting technique:
The patient's skin was cleansed with alcohol.
- Local anesthetic (0.1 ml lidocaine 2%) was injected intradermally at the cannula insertion site.
- After 10 minutes, the cannula insertion point was created with a 21-gauge puncture adapter.
- A 22G 50 mm cannula was inserted through the entry point to the maxillary bone; a 0.4 ml bolus of filler was injected supraperiosteally at the first point – deep medial cheek fat pad.
- Then, the cannula was slowly redirected upwards to the zygomaticomaxillary suture line and 0.4ml of filler was injected supraperiostally into the deep lateral cheek fat pad (1–3 small boluses).
- The cannula was redirected to the superficial fat compartments (SmedialCF and SMiddleCF) located under the deepest part of the midbuccal sulcus and 0.1 ml of filler was injected in a linear retrograde technique.
- A similar procedure was performed to correct the mid-cheek sulcus on the other side of the face:
- deep lateral – small boluses of 0.2 ml of the drug;
- superficial fat compartments – 0.1 ml filler linear retrograde.
- Thus,
deep medial cheek fat (1 bolus);
- deep lateral cheek fat (several small boluses);
- superficial fat compartments (linear retrograde).
Fat-saturated coronal and axial MRI was performed before the procedure and one week after the filler injection. Purpose – an objective assessment of the effectiveness of the liquid cheek lift technique.
ResultsMRI: 43% increase on the right (5.7 mm) and 10% on the left (1.3 mm). The filler is introduced predominantly above the bone structure into the deep medial and deep lateral cheek fat compartments. The results of mid-buccal sulcus correction with HA fillers last for 12-18 months.
In older patients, the severity of the mid-buccal sulcus is affected by a deeper deflation of the soft tissues. Therefore, to correct deep fat compartments, a larger amount of filler will be required. However, when working with superficial fat pads, a larger volume of the drug is required for young patients.
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Botulinum toxin injections for beautification of the middle third of the face Correction of the mid-cheek sulcus using liquid lifting technique with HA filler – a safe and effective method of rejuvenation of the middle third of the face, which allows you to get natural and harmonious results.
Based on Plastic and Reconstructive Surgery.
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