๐ ็ธฝ็ฎ้ ๏ฝ ๐ ่ฑๆๅๆ๏ผๆฌ็ฏ๏ผ ๏ฝ ๐ ๅฎๆด็ฟป่ญฏ ๏ฝ โญ ็ฒพ่ฏ็ญ่จ
Fillers
Fillers
Juvederm Voluma had a duration of 19 months when used for the zygomaticomalar cheeks.77 Product placement is aimed toward the preperiosteal fat and prezygomatic space just above the body of the zygoma for volumizing; treatment of the malar eminence helps with facial lifting and conveying a youthful appearance; and fillers over the zygomaticotemporal suture line cause facial lifting through a tent-like effect on the SMAS. Small boluses and towering placements using sharp 30 or smaller needle injections are more precise but are associated with higher risk of bruising and intravascular injections. Cannulas are commonly used for midface product placement. Various cannula insertion points have been described. Surek et al. advocate three insertion points to allow volumization.84 The first insertion point is positioned 1.5 cm inferolateral to the lateral canthus to create a lateral midface viaduct to approach the preperiosteal fat, prezygomatic space, lateral SOOF, and infraorbital fat compartment. An injector can use blunt or sharp cannulas to place small boluses or fanning threads within the same areas injected with the sharp needle. This can be achieved with a 25 1ยฝ-in gauge blunt cannula through the insertion point described, gliding it through deeper planes for filler deposition. Knowledge of the facial fat pads is essential for successful filler placement (Fig. 75-12).
Botulinum toxin BTX-A may be suitable for treating hyperdynamic โaccordionโ cheek lines with 1 to 6 units of intracutaneous BTX-A to each side.27 This can be achieved by one to two injection points over the mid-to-lateral malar eminence (Figs. 75-13 and 75-14).85
Figure 75-12. Knowledge of the facial fat pads is essential for successful filler placement.
Figure 75-13. Preprocedure photographs.
Figure 75-14. After treatment with fillers in the upper medial cheeks, marionette lines, and zygomatic arch (upper lateral cheek).