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Facial Assessment and Injection Guide for Botulinum Toxin and Injectable Hyaluronic Acid Fillers: Focus on the Midface

de Maio, Maurício M.D.; DeBoulle, Koen M.D.; Braz, André M.D.; Rohrich, Rod J. M.D.on behalf of the Alliance for the Future of Aesthetics Consensus Committee

Plastic and Reconstructive Surgery: October 2017 - Volume 140 - Issue 4 - p 540e–550e
doi: 10.1097/PRS.0000000000003716
Cosmetic: Original Articles
Journal Club
Podcast

Summary: This second article of a three-part series addresses techniques and recommendations for aesthetic treatment of the midface. Injectable fillers are important for rejuvenation of the midface by replacing lost volume and providing structural support; neuromodulators play a smaller role in this facial region. Fillers are used for volumization and contouring of the midface regions, including the upper cheek and lid-cheek junction and the submalar and preauricular areas. Also, treatment of the frontonasal angle, the dorsum, the nasolabial angle, and the columella may be used to shape and contour the nose. Neuromodulators may be used to treat bunny lines and for elevation of the nasal tip. The midface is considered an advanced area for treatment, and injectors are advised to obtain specific training, particularly when injecting fillers near the nose, because of the risk of serious complications, including blindness and necrosis. Injections made in the midcheek must be performed with caution to avoid the infraorbital artery.

Supplemental Digital Content is available in the text.This and Related “Classic” Articles Appear on Prsjournal.Com for Journal Club Discussions.

São Paulo, Brazil; Aalst, Belgium; Rio de Janeiro, Brazil; and Dallas, Texas

From the Clinica Dr. Maurício de Maio; the Aalst Dermatology Clinic, private practice; and the University of Texas Southwestern Medical Center.

Received for publication April 13, 2016; accepted February 21, 2017.

Disclosure: Dr. de Maio is an Allergan plc consultant for speaking events and marketing strategy. Dr. DeBoulle is an Allergan plc consultant for speaking events and marketing strategy. Dr. Braz is an Allergan plc, Galderma, Merz, Loreal, La Roche Posay, Palomar, Skinceuticals, and Vichy consultant. Dr. Rohrich receives instrument royalties from Eriem Surgical, Inc., and book royalties from Thieme Medical Publishing. No funding was received for this article.

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 (www.PRSJournal.com).

Maurício de Maio, M.D., Clinica Dr. Maurício de Maio, Avenida Ibirapuera, 2907 cj 1202, Moema EP 04029200, São Paulo, Brazil, mauriciodemaio@uol.com.br

©2017American Society of Plastic Surgeons