Filler injection outcomes improved with knowledge of facial layer, neck anatomy

NEW YORK — Understanding the layers and regions of the face and neck is necessary for optimal outcomes of facial rejuvenation with filler injections, according to an educational program presented at Facial Aesthetics New York.

"Think of your needle as a micro-scalpel. When you're passing that needle down to bone, you need to know what layers you're going through; what structures are in the region of where your needle is,” Timothy M. Greco, MD, FACS, said during his presentation.

Timothy M. Greco

The layers of the face that are important in injectable treatments are the skin, the superficial fat compartments, the muscles of facial expression, the deep fat compartments, the sensory and motor nerves, the vasculature of the face, and the craniofacial skeleton.

In reviewing the skin thickness of the face, Greco explained that the thinnest region of skin is the eyelids at 0.38 mm, while the forehead and nasal tip are approximately three times that thickness. Understanding the different regions of thickness is important in determining how deep the injection needs to go to reach the intradermal layers.

Discussing nasolabial fold treatments, Greco reviewed his technique for particularly deep folds, in which he prefers to avoid an overabundance of filler. Instead of using a filler, he incises the medial portion of the nasolabial fat compartment, raises and transposes it, and then uses the fat compartment to fill the deficit in the fold.

Neuromodulator fillers, according to Greco, are particularly useful when injected into the forehead frontalis muscle to reshape and raise the brow. He has used them to affect the shape and animation of the nasal tip, preventing downward rotation, and for treating platysmal bands. The platysmal muscle extends above the jawline, so injections for platysmal treatment should be placed along the jawline as well as the neck. – by Talitha Bennett

Disclosure: Greco reports he receives consulting fees from and is on the speakers bureau for Allergan, Galderma and Merz.

Reference:

Greco TM. Anatomy of the Face and Neck. Presented at: Facial Aesthetics New York; Nov. 3, 2016; New York.