Clinical Anatomy of the Face for Filler and Botulinum Toxin Injection

Preface to the Second Edition
Preface
Contents
About the Authors
1: General Anatomy of the Face and Neck
	1.1	 Aesthetic Terminology
		1.1.1	 Basic Aesthetic Terminology
			1.1.1.1	 Facial Creases
			1.1.1.2	 Skin Folds
			1.1.1.3	 Horizontal Forehead Lines
			1.1.1.4	 Glabellar Frown Lines (Glabellar Creases or Lines)
			1.1.1.5	 Glabellar Transverse Lines
			1.1.1.6	 Blepharochalasis
			1.1.1.7	 Baggy Lower Eyelids (or Cheek Bags, Malar Bags)
			1.1.1.8	 Bunny Lines
			1.1.1.9	 Crow’s Feet (Lateral Canthal Wrinkles)
			1.1.1.10	 Festoon
			1.1.1.11	 Palpebromalar Groove
			1.1.1.12	 Tear Trough
			1.1.1.13	 Nasojugal Groove
			1.1.1.14	 Midcheek Furrow (Indian Band)
			1.1.1.15	 Nasolabial Fold (or Nasolabial Groove)
			1.1.1.16	 Horizontal Upper Lip Lines (Transverse Upper Lip Lines)
			1.1.1.17	 Oral Commissure
			1.1.1.18	 Commissural Lines
			1.1.1.19	 Labiomandibular Crease (Marionette Line)
			1.1.1.20	 Labiomental Creases (or Furrows)
			1.1.1.21	 Ptotic Chin
			1.1.1.22	 Jowl (Jowl Sagging)
			1.1.1.23	 Gobbler Neck Deformity (Platysmal Bands)
			1.1.1.24	 Horizontal Neck Lines
			1.1.1.25	 Temple Depression
			1.1.1.26	 Preauricular Lines
			1.1.1.27	 Vertical Lip Lines (Smoker’s Lines)
	1.2	 Layers of the Face
		1.2.1	 Layers of the Facial Soft Tissues
		1.2.2	 Thickness of the Skin
	1.3	 Muscles of Facial Expressions and Their Actions
		1.3.1	 Forehead Region
		1.3.2	 Temporal Region (or Temple)
		1.3.3	 Orbital Region
		1.3.4	 Nose Region
		1.3.5	 Perioral Muscles
			1.3.5.1	 Intrinsic Muscles of the Lip and Cheek (Fig. 1.16)
				Orbicularis Oris Muscle (OOr)
				Buccinator Muscle
			1.3.5.2	 Dilators of the Lips
				Muscles Inserted into the Modiolus
					Zygomaticus Major Muscle (ZMj)
					Levator Anguli Oris Muscle (LAO)
					Depressor Anguli Oris Muscle (DAO)
					Risorius Muscle
				Muscles Inserting into the Upper and Lower Lip Between the Labial Commissure and the Midline
					Levator Labii Superioris Muscle (LLS)
					Levator Labii Superioris Alaeque Nasi Muscle (LLSAN)
				Modiolus
					Zygomaticus Minor Muscle (Zmi)
					Depressor Labii Inferioris Muscle (DLI)
				Upper Lip Elevators (Fig. 1.22)
				Contracting Muscle of the Chin Mentalis Muscle
				Layers of the Perioral Muscles
				Superficial Layer
					First Layer
					Second Layer
					Third Layer
				Deep Layer
					Fourth Layer
		1.3.6	 Platysma Muscle
	1.4	 SMAS Layer and Ligaments of the Face
		1.4.1	 Superior Temporal Septum
		1.4.2	 Zygomatic Ligament
		1.4.3	 Zygomatic Cutaneous Ligament
		1.4.4	 Orbicularis Retaining Ligament
		1.4.5	 Lateral Orbital Thickening
		1.4.6	 Mandibular Retaining Ligament
		1.4.7	 Masseteric Cutaneous Ligament
		1.4.8	 Platysma-Auricular Fascia (PAF)
	1.5	 Nerves of the Face and Their Distributions
		1.5.1	 Distribution of the Sensory Nerve
		1.5.2	 Distribution of the Motor Nerve
		1.5.3	 Upper Face
			1.5.3.1	 Distribution of the Sensory Nerve
			1.5.3.2	 Distribution of the Motor Nerve
		1.5.4	 Midface
			1.5.4.1	 Distribution of the Sensory Nerve
			1.5.4.2	 Distribution of the Motor Nerve
		1.5.5	 Lower Face
			1.5.5.1	 Distribution of the Sensory Nerve
			1.5.5.2	 Distribution of the Motor Nerve
	1.6	 Nerve Block
		1.6.1	 Supraorbital Nerve Block (SON Block)
		1.6.2	 Supratrochlear Nerve Block (STN Block)
		1.6.3	 Zygomaticotemporal Nerve Block (ZTN Block)
		1.6.4	 Infraorbital Nerve Block (ION Block)
		1.6.5	 Mental Nerve Block (MN Block)
		1.6.6	 Buccal Nerve Block (BN Block)
		1.6.7	 Inferior Alveolar Nerve Block (IAN Block)
		1.6.8	 Auriculotemporal Nerve Block (ATN Block)
		1.6.9	 Great Auricular Nerve Block (GAN Block)
	1.7	 Facial Vessels and Their Distribution Patterns
		1.7.1	 Facial Branches of the Ophthalmic Artery
			1.7.1.1	 Emerging Point of the Ophthalmic Artery
			1.7.1.2	 Supraorbital Artery
			1.7.1.3	 Supratrochlear Artery
			1.7.1.4	 Dorsal Nasal Artery
			1.7.1.5	 Lacrimal Artery
			1.7.1.6	 External Nasal Artery
			1.7.1.7	 Midline Vessels
		1.7.2	 Facial Branches of the Maxillary Artery (Fig. 1.47)
			1.7.2.1	 Infraorbital Artery
			1.7.2.2	 Zygomatic Artery
			1.7.2.3	 Buccal Artery
			1.7.2.4	 Mental Artery
		1.7.3	 Facial Artery
			1.7.3.1	 Facial Artery Branches
				Superior, Inferior Labial Branch
				Inferior Alar Branch
				Lateral Nasal Branch
				Angular Artery
			1.7.3.2	 Typical Distribution Patterns of the Facial Artery
		1.7.4	 Frontal Branch of the Superficial Temporal Artery
		1.7.5	 Facial Veins
			1.7.5.1	 Veins with Cutaneous Nerves and Arteries
			1.7.5.2	 Facial Vein
				Angular Vein
				Intercanthal Vein
				Facial Vein
				External Nasal Vein
				Deep Facial Vein
				Labial Vein
			1.7.5.3	 Retromandibular Vein
			1.7.5.4	 Superficial Temporal Vein
		1.7.6	 Connections of the Vein
			1.7.6.1	 Connection Between Facial Vein and Angular Vein
			1.7.6.2	 Connection Between the Pterygoid Plexus and the Cavernous Sinus
	1.8	 Facial and Skull Surface Landmarks
	1.9	 Anthropological Differences of the Skull and Face Between Asian and Caucasian
	1.10	 Anatomy of the Aging Process
		1.10.1	 Aging Process of the Facial Tissue
		1.10.2	 The Complex Changes of the Facial Appearance with Aging
	1.11	 Organization of Subcutaneous Tissue and Filler Injection Techniques
	1.12	 Comprehensive Understanding of the Facial Anatomy Based on Face Painting (Figs. 1.68 and 1.69)
	Suggested Reading
		Physical Anthropological Traits in Asians
		Muscles of the Face and Neck
		Vessels of the Face and Neck
		Peripheral Nerves of the Face and Neck
		Organization of Subcutaneous Tissue
		Face Painting Based on Ultrasonography
2: Clinical Anatomy for Botulinum Toxin Injection
	2.1	 Introduction
		2.1.1	 Effective Versus Ineffective Indications of Botulinum Toxin for Wrinkle Treatment
		2.1.2	 Botulinum Rebalancing
		2.1.3	 Reconstitution, Dilution, and Storage of Botulinum Toxin
			2.1.3.1	 Reconstitution and Dilution
			2.1.3.2	 Storage
	2.2	 Botulinum Wrinkle Treatment
		2.2.1	 Crow’s Feet (Lateral Canthal Rhytides)
			2.2.1.1	 Target Muscle and Anatomy
			2.2.1.2	 Injection Points and Methods (Figs. 2.10 and 2.11)
		2.2.2	 Infraorbital Wrinkles
		2.2.3	 Horizontal Forehead Lines
			2.2.3.1	 Target Muscle and Anatomy (Fig. 2.14)
			2.2.3.2	 Injection Points and Methods (Fig. 2.15)
		2.2.4	 Glabellar Frown Lines
			2.2.4.1	 Target Muscle and Anatomy
			2.2.4.2	 Injection Points and Methods
		2.2.5	 Bunny Lines
			2.2.5.1	 Target Muscle and Anatomy
			2.2.5.2	 Injection Points and Methods
		2.2.6	 Plunged Tip of the Nose
			2.2.6.1	 Target Muscle and Anatomy (Fig. 2.23)
			2.2.6.2	 Injection Points and Methods
		2.2.7	 Gummy Smile, Excessive Gingival Display
			2.2.7.1	 Target Muscle and Anatomy
			2.2.7.2	 Injection Points and Methods
		2.2.8	 Nasolabial Fold
			2.2.8.1	 Target Muscle and Anatomy
			2.2.8.2	 Injection Points and Methods
		2.2.9	 Asymmetric Smile, Facial Palsy
			2.2.9.1	 Target Muscle and Anatomy
			2.2.9.2	 Injection Points and Methods
		2.2.10	 Alar Band
			2.2.10.1	 Target Muscle and Anatomy
			2.2.10.2	 Injection Points and Methods
		2.2.11	 Purse String Lip
			2.2.11.1	 Target Muscle and Anatomy (Fig. 2.32)
			2.2.11.2	 Injection Points and Methods (Fig. 2.33)
		2.2.12	 Drooping of the Mouth Corner
			2.2.12.1	 Target Muscle and Anatomy
			2.2.12.2	 Anatomy of Muscles Around the Mouth
			2.2.12.3	 Injection Points and Methods
		2.2.13	 Cobblestone Chin (Fig. 2.42)
			2.2.13.1	 Target Muscle and Anatomy
			2.2.13.2	 Injection Points and Methods
		2.2.14	 Platysmal Band
			2.2.14.1	 Target Muscle and Anatomy
			2.2.14.2	 Injection Points and Methods (Fig. 2.50)
	2.3	 Botulinum Facial Contouring
		2.3.1	 Masseter Hypertrophy (Fig. 2.51)
			2.3.1.1	 Target Muscle and Anatomy
			2.3.1.2	 Injection Points and Methods
		2.3.2	 Temporalis Hypertrophy
			2.3.2.1	 Target Muscle and Anatomy
			2.3.2.2	 Injection Points and Methods
		2.3.3	 Hypertrophy of the Salivary Gland (Figs. 2.60 and 2.61)
			2.3.3.1	 Target Structure and Anatomy (Figs. 2.62 and 2.63)
			2.3.3.2	 Injection Points and Methods
	Suggested Reading
		Muscles of the Face and Neck
		Peripheral Nerves of the Face and Neck
		Others
3: Clinical Anatomy of the Upper Face for Filler Injection
	3.1	 Forehead and Glabella
		3.1.1	 Clinical Anatomy
		3.1.2	 Injection Points and Methods
		3.1.3	 Side Effects
	3.2	 Sunken Eye and Pretarsal Roll
		3.2.1	 Clinical Anatomy
		3.2.2	 Injection Points and Methods
		3.2.3	 Side Effects
	3.3	 Temple
		3.3.1	 Clinical Anatomy
		3.3.2	 Injection Points and Methods
		3.3.3	 Side Effects
	Suggested Reading
		Muscles of the Face and Neck
		Vessels of the Face and Neck
		Peripheral Nerves of the Face and Neck
		Subcutaneous Tissue
4: Clinical Anatomy of the Midface for Filler Injection
	4.1	 Tear Trough
		4.1.1	 Clinical Anatomy
		4.1.2	 Injection Points and Methods
	4.2	 Nasojugal Groove
		4.2.1	 Clinical Anatomy
		4.2.2	 Injection Points and Methods
	4.3	 Palpebromalar Groove
		4.3.1	 Clinical Anatomy
		4.3.2	 Injection Points and Methods
	4.4	 Nasolabial Fold
		4.4.1	 Clinical Anatomy
			4.4.1.1	 Facial Arteries and Nasolabial Folds in Asians
		4.4.2	 Injection Points and Methods
			4.4.2.1	 Intraoral Approach for Nasolabial Fold Augmentation
				Filler Treatment of the Nasolabial Fold and Facial Artery
	4.5	 Hollow Cheek
		4.5.1	 Clinical Anatomy
		4.5.2	 Insertion Points and Methods
	4.6	 Subzygomatic Depression
		4.6.1	 Clinical Anatomy
		4.6.2	 Injection Points and Methods
	4.7	 Nose
		4.7.1	 Clinical Anatomy
		4.7.2	 Injection Points and Methods
			4.7.2.1	 Dorsum of the Nose
			4.7.2.2	 Columella
			4.7.2.3	 Nose Hump
				The Anatomy of the Intercanthal Vein in Asians
	Suggested Reading
		Physical Anthropological Traits in Asians
		Muscles of the Face and Neck
		Vessels of the Face and Neck
		Peripheral Nerves of the Face and Neck
5: Clinical Anatomy of the Lower Face for Filler Injection
	5.1	 Lip
		5.1.1	 Clinical Anatomy
		5.1.2	 Injection Points and Methods
		5.1.3	 Side Effects
	5.2	 Chin and Jawline
		5.2.1	 Clinical Anatomy
		5.2.2	 Injection Points and Methods
		5.2.3	 Side Effects
	5.3	 Perioral Wrinkles
		5.3.1	 Clinical Anatomy
		5.3.2	 Injection Points and Methods
		5.3.3	 Side Effects
	5.4	 Marionette Line and Jowl
		5.4.1	 Clinical Anatomy
		5.4.2	 Injection and Methods
		5.4.3	 Side Effects
	5.5	 Earlobe
		5.5.1	 Clinical Anatomy
		5.5.2	 Injection and Methods
	5.6	 Anatomical Considerations of the Symptoms That May Accompany Filler Treatment
		5.6.1	 Vascular Compromise
		5.6.2	 Suggested Methods to Reduce Vascular Problems Related with Filler Injection
	Suggested Reading
		Physical Anthropological Traits in Asians
		Muscles of the Face and Neck
		Vessels of the Face and Neck
		Peripheral Nerves of the Face and Neck
Index