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Anatomic Guidelines for Augmentation of the Cheek and Infraorbital Hollow

Carruthers, Jean MD, FRCSC1; Rzany, Berthold MD, ScM2; Sattler, Gerhard MD3; Carruthers, Alastair MD, FRCPC4

doi: 10.1111/j.1524-4725.2012.02478.x

BACKGROUND Mid-face reflation requires a sophisticated knowledge of bony and soft tissue anatomy.

OBJECTIVE To blend knowledge of the relevant anatomy with clinical experience to generate procedural guidelines for reproducible volumization of the midface.

METHODS AND MATERIALS A demonstration of cadaver head dissection was followed by injection of colored hyaluronic acid and calcium hydroxylapatite fillers into cadaver heads in the anatomy laboratory. The injected cadaver heads were then dissected to assess the anatomical position of the injected fillers. Live patient injections followed using the anatomic learning.

RESULTS Best practice guidelines for midface and infraorbital hollow injections were discussed.

CONCLUSIONS Aesthetic augmentation of the midface requires knowledge of the properties of each filler and of the underlying anatomy, as well as an understanding and documentation of the subject's aesthetic concerns.

1Department of Ophthalmology, University of British Columbia, Vancouver,

2dEBM, Klinik für Dermatologie, Venerologie und Allergologie, Charité-Universitätsmedizin Berlin, Berlin

3Rosenparkklinik GmbH, Darmstadt,

4Department of Dermatology, University of British Columbia, Vancouver, British Columbia, Canada

Address correspondence and reprint requests to: Jean Carruthers, MD, FRCSC, Jean Carruthers Cosmetic Surgery Inc., 820–943 West Broadway, Vancouver, BC V5Z 4E1, Canada, or e-mail:

Merz provided stipends for the authors and members of the Discussion Group at the Anatomy Conference, Institute of Anatomy, University of Graz, Austria, as listed inAppendix 1

© 2012 by the American Society for Dermatologic Surgery, Inc.
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