3D face modeling: prevention of possible complications

Many patients want to get rid of superficial aging – smooth wrinkles and increase the volume of the face. However, the 3D approach is best used to address deeper causes of volume loss. Dr. Danny Vieggaar talked about the use of poly-L-lactic acid, calcium hydroxyapatite and fillers for deep tissue regeneration.

At first, in the process of fighting aging, we focused on the superficial component of aging – skin aging or photoaging. However, over time, we began to understand that the smooth surface of the skin – by no means a fountain of youth. To look young, you need to pay attention to other elements – projection, volume, contour and integrity.

Selection of patients for 3D facial modeling

The selection of patients for deep tissue regeneration is very important. Most patients have only an idea of ​​classical facial rejuvenation aimed at superficial aging of the skin, so they constantly complain of wrinkles, pigmentation and telangiectasia. Therefore, the doctor should explain to them the importance of a global approach aimed at restoring a deeper loss of volume.

The patient must understand that he is only seeing the tip of the aging iceberg. The purpose of 3D facial modeling is to work with the entire face, restoring balance to create a natural, youthful face.

Features of the patient's face to consider

There are significant differences between the male and female face. The shape of the male and female skull is different, which affects the position of the soft tissues. If you are performing deep tissue regeneration, it is necessary to provide deep volume – through the introduction of a product or stimulation – in the most pronounced areas of the male and female face.

It is important to remember that when 3D modeling a face, you should not pay attention to small wrinkles, folds, etc., as patients do. You need to see the patient's face from a wider angle.

When using poly-L-lactic acid, PMMA, calcium hydroxyapatite or other stronger fillers, there are points where they should not be injected:

• highly dynamic areas such as lips;
• thin areas of the eyelids;
• tear troughs.

We are targeting bony prominences where we can insert the product in a stable position and mimic the presence of either deep layers of fat or bone.

Side effects of deep tissue regeneration

In the case of injection of products into the periorbital region, one-sided visual impairment is observed in rare cases. Approximately 90% of side effects occur as a result of the imperfection of the doctor's technique, lack of skills or knowledge, so it is very important to have a good understanding of the anatomy of the face. There are a large number of anastomoses in the periorbital zone, the location of which is not always possible to predict.

If you want to avoid the risk of visual impairment, do not introduce products into:

• whiskey;
• periorbital zone;
• eyebrow;
• nose.

And in general, side effects can appear anywhere – even on the nasolabial fold. How to avoid such problems? If you know how the artery runs, you can inject the product perpendicular to the artery instead of into its stream. Before insertion, move back to make sure that the selected point is correct. Take your time: place the needle in the target area and check the injection site carefully.

Instances of blindness or visual impairment do not rule out any administered product. Most of these disorders are observed with the introduction of fat injections in the middle part of the face. There has also been a case of visual impairment following the injection of poly-L-lactic acid into whiskey. In other cases, injections of hyaluronic acid, calcium hydroxyapatite or collagen appeared in the middle part of the face. 

When hyaluronic acid is injected, occlusion of the central retinal artery may occur. This does not mean that hyaluronic acid – bad product. It's just that deep injections into certain areas don't always go smoothly – this should never be forgotten.

Deep injections of calcium hydroxyapatite are dangerous due to local vascularization. Of course, such cases are rare (only 30-40 cases in the last two decades), but they are serious side effects. Therefore, it is necessary to know the anatomy of the face well, not to inject the product with great force and speed.

3D facial modeling can be very effective if the correct fillers are selected and injected into the midface, piriformis, maxillary and temporal regions. It is these areas that are key in facial rejuvenation – minor improvements or changes can provide a fantastic rejuvenating effect.

However, be aware of the side effects of deep tissue regeneration, which, although rare, are quite serious. Therefore, the doctor must know exactly where the arteries pass, and always work very carefully and slowly.