Secondary Logo

Journal Logo

Institutional members access full text with Ovid®

Upper Face: Clinical Anatomy and Regional Approaches with Injectable Fillers

Sykes, Jonathan M. MD; Cotofana, Sebastian MD, PhD; Trevidic, Patrick MD; Solish, Nowell MD, FRCP; Carruthers, Jean MD, FRCSC, FRC(OPHTH); Carruthers, Alastair MA, BM, BCh, FRCPC, FRCP(Lon); Moradi, Amir MD; Swift, Arthur MD, CM, FRCS(C); Massry, Guy G. MD; Lambros, Val MD, FACS; Remington, B. Kent MD, FRCP

Plastic and Reconstructive Surgery: November 2015 - Volume 136 - Issue 5S - p 204S–218S
doi: 10.1097/PRS.0000000000001830
Clinical Anatomy and Regional Approaches with Injectable Fillers: Original Articles
Watch Video

Background: The use of facial fillers has been rapidly increased as the range of injectable products and indications continues to expand. Complications may arise from improper placement or technique. This article highlights the importance of anatomic knowledge when using injectable fillers in the face.

Methods: A detailed review of the clinical anatomy of the upper face is performed. Regional approaches are described using the applied anatomy to efficiently and safely augment the different subunits of the upper face.

Results: Key aspects of safe and successful injection of fillers in the upper face include a thorough knowledge of the location of fat compartments and neurovascular structures. Awareness of these structures enables the practitioner to maximize injections, while avoiding damage to important nerves and vessels.

Conclusion: A detailed knowledge of the anatomy and properties of the product is paramount to maximize the efficacy while minimizing the risk of complications.

Supplemental Digital Content is available in the text.

Sacramento, Vista, Los Angeles, Beverly Hills, and Irvine, Calif.; Salzburg, Austria; Paris, France; and Toronto, Ontario, Vancouver, British Columbia, Montreal and Westmount, Quebec; and Calgary, Alberta, Canada

From Facial Plastic Surgery, University of California, Davis Medical Center; Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg; Expert2expert Group; Department of Dermatology, University of Toronto; Department of Ophthalmology and Department of Dermatology, Faculty of Medicine, University of British Columbia; private practice; Westmount Institute of Plastic Surgery; Victoria Park MediSpa; St. Mary’s Hospital, McGill University; Department of Ophthalmology, Keck School of Medicine, University of Southern California; Beverly Hills Ophthalmic Plastic and Reconstructive Surgery; Department of Plastic Surgery, University of California, Irvine; and Remington Laser Dermatology Centre.

Received for publication June 1, 2015; accepted August 6, 2015.

Disclosure: Dr. Solish is a consultant for Allergan and Galderma and researcher for Allergan, Revance, Evolus, and Merz. Dr. Jean Carruthers and Dr. Alastair Carruthers are consultants and researchers for Allergan Pharmaceuticals, Merz USA, and Kythera Biopharma. Dr. Moradi serves as a consultant for Galderma. He did not receive compensation for this article. Dr. Swift is a consultant/clinical investigator for Allergan, Merz, and Galderma. Dr. Massry receives royalties from Elsevier and Springer. Dr. Sykes, Dr. Cotofana, Dr. Trevidic, Dr. Lambros, and Dr. Remington have no financial interest in any of the products, devices, or drugs mentioned in this article. Dr. Remington did not receive any financial aid or reimbursement or honorarium for the project.

Supplemental digital content is available for this article. Direct URL citations appear in the text; simply type the URL address into any Web browser to access this content. Clickable links to the material are provided in the HTML text of this article on the Journal’s website (

Jonathan M. Sykes, MD, 2521 Stockton Boulevard, Suite 6200, Sacramento, CA 95817,; or Plastic and Reconstructive Surgery, 8150 Brookriver Drive, Suite s-415, Dallas, TX 75247,

©2015American Society of Plastic Surgeons