According to the analysis of the world's "beauty arenas", beauty standards have not changed in recent years, but, fortunately, the right approach has been formed – naturalness. Thus, a doctor of aesthetic medicine must, in addition to professional skills, have a sense of harmony. In addition, perfect knowledge of the anatomy of the face is very important for the doctor, since corrections are made in areas where the most important nerves and arteries are located close.

The most commonly used cannula technique for volumetric restoration in contouring greatly expands the possibilities of anti-aging correction.

soblyudenie-arkhitektoniki-litsa-vazhnyj-orientir-dlya-vracha-estetistaIn his report "Injection management: algorithms for the restoration of the middle third of the face" Maxim Andreevich Krasnoselskikh, maxillofacial, plastic surgeon, head physician "Clinic Aesthetic" (St. Petersburg) presented clinical algorithms for the harmonious assessment of the "age face" and proposed correction techniques.

Features of working with the upper third person

One of the standard markings when working on the upper third of the face is a line from the corner of the nose to the tragus of the ear. Many people use this markup, which indicates that above this line we can work at different levels (from periosteal to intradermal injection), and below – only at superficial levels, do not go deep under the skin.

There are dangerous zones in the orbit area: a centimeter in the area of ​​the medial angle of the eye (the exit point of the artery), the infraorbital nerve combined with vessels, the exit of the sensory nerve.

The area is very prone to edema, so pay attention to the amount of filler injected. As a rule, I do not recommend injecting more than 1 ml into the nasolacrimal sulcus and premal area in one session. Very often, the filler causes compression of the lymph outflow tracts, and then we get a patient with edema.

I'll tell you a little more about the depth of filler injection in the area of ​​the upper and lower bony margins of the orbit. Be sure to use SOOF and ROOF layers (these are fat packs located along the upper and lower bone edge of the orbit), consider the ratio between these layers of fatty tissue. They are located under the circular muscle of the eye. That is, any introduction of a filler over the circular muscle of the eye threatens that the filler will be contoured, some irregularities will appear. SOOF is the target layer in this regard. It is located above the periosteum.

If we consider the layered structure of fat packages in the eye socket, the most superficial – this is a malar fat pack (it is located subcutaneously), then under the circular muscle of the eye – SOOF, the same targeted package in which we inject fillers to restore volume, and orbital fat, which is removed only surgically during blepharoplasty.

Basics of safe work – hotspots

Relatively safe areas for working with needles and cannulas – this is the area of ​​the body of the zygomatic bone where the zygomatic bone is not covered by muscles, as well as the angle of the mandible, the zygomatic arch of the body of the zygomatic bone and the lowest palpable pole of the bone as one of the options for making an access point when working on the middle third of the face.

If you're looking for specific guidelines for restoring volume to your zygomatic area, there are some interesting markings. One of them – called the "golden ratio" when you mark the middle third of the face between the level of the wings of the nose and the level of the eyebrows.

Another face assessment technique – the Wilkinson technique, which has long been used to determine the placement of permanent zygomatic implants, and then migrated to contouring. If you work with bolus techniques, you can draw a plumb line from the lateral corner of the eye, divide this distance into three parts, and between the upper third and the lower two thirds you get the most advantageous point for increasing the projection of the zygomatic zone.

Another – the marking is drawn from the lateral corner of the eye to the commissure of the mouth, this line is divided into three parts, and the border of the upper third – this is also one of the most advantageous points for increasing the volume of the area above the zygomatic bone if you are working with the technique of vertical injections.

Method of assessing the face

If we superimpose all the techniques for finding the most advantageous injection point, it becomes clear why the Hinderer technique is currently the most popular markup. That is, all these points – they practically fall exactly into the zone that was identified by Hinderer back in 1960 as the most advantageous zone for the permanent location of zygomatic implants.
This technique – an oval inscribed in the upper outer quadrant, which is created by lines drawn from the lateral corner of the eye to the commissure of the mouth and from the tragus of the ear to the ala of the nose.

There are several recommendations for working in these techniques: it is performed from both the upper and lower injections. Upper vcol – this is approximately the anatomical middle of the upper zygomatic arch, and the lower vcol – at the intersection of the Hinderer lines.

If you use an additional marking in the form of an oval, you can safely work with both a needle and a cannula, and place the preparation as close as possible to the bone in the form of small portions of approximately 0.1 ml.

Another – linear retrograde introduction, the marking is carried out according to Hinderer, the injection is made from a point in the middle of the upper zygomatic arch, the upper vector is directed to the wing of the nose, the lower vector is directed to the commissure of the mouth, and two vectors in the middle – to create extra volume. The drug is injected as close as possible to the surface of the zygomatic bone, so that it has a support under it and gives a good volume. If you do not go beyond the markup, then you do not lose volume, and the drug does not remain in your soft tissues, where it does not have a bone support.

A solid preparation is injected approximately 0.25 ml from the upper access. If you use bottom access – the same: four vectors, injection point at the intersection of the Hinderer lines, the drug is injected in a volume of 1 ml in several movements, linearly retrograde.

If you make these markings, you will accordingly get the opportunity to bypass the zygomatico-facial nerve, and your preparation is located strictly in the projection of the zygomatic bone.

One of the well-known facial markings – marking according to M. Landau (five stars). Today it has received a small new interpretation in the form of a cannula injection: if you work with injections and make five injections, evenly spaced along the line of the base of the small triangle, then inject 0.4 ml into the central point, 0.2 – in neighboring and 0.1 ml – to the extreme points. If you work with a cannula – then from one injection place the drug along the Landau line pointwise at 0.1-0.2 ml. The technique is very effective.

Tear trough correction

Markup required – this is the bony edge of the orbit. The intersection of lines drawn vertically – from the corner of the eye and horizontally – through the tip of the nose. When working with cannulas, this injection point – the most profitable. It is located far enough from the eye, from which you can very easily reach the periosteal level, you do not pass through the superficial tissues, the entire drug is injected as close as possible to the surface of the upper jaw. With this marking, you bypass the exit site of the infraorbital nerve and work tangentially to the septum of the lower eyelid.

The drug should be injected fractionally, not linearly retrograde, then it keeps very well in soft tissues and does not migrate anywhere. The smaller the portion, the more even the effect will be, the total volume – approximately 0.5 ml, the number of crushing – at your discretion.

The palpebro-paint furrow is also processed with a cannula or a long needle – introduction of fractional portions along the bony edge of the orbit.

Today, a large number of scales and algorithms for assessing a patient's face, methods for correcting its volume are presented, however, only the observance of personal architectonics allows obtaining the most individualized results.

According to the results of the report "Injection Management: Algorithms for Restoring the Middle Third of the Face" by M.A. Krasnoselskikh held a master class, where he clearly demonstrated the technique for determining the optimal injection points and working with cannulas when modeling the middle third of the face using fillers. Master class video:

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