The Art and Science of Filler Injection: Based on Clinical Anatomy and the Pinch Technique

Preface
Contents
About the Authors
1 The Art and Science of Filler Procedures for a More Attractive Face
	1.1 Natural Beauty and Human Attractiveness
	1.2 Differences Between Asian and Western Beauty Concepts
	1.3 Medical Reference Values to Create an Attractive Face
	Bibliography
2 Filler Types and Characteristics
	2.1 Type of Filler
		2.1.1 Number of Various Fillers Used Recently
	2.2 Characteristics of Hyaluronic Acid Filler
		2.2.1 Hyaluronic Acid as a High Molecular Compound
		2.2.2 Hyaluronic Acid Filler Manufacturing Process
			2.2.2.1 Preparation of Raw Materials of Hyaluronic Acid
			2.2.2.2 Dissolution with Strong Base (NaOH)
			2.2.2.3 Cross-Linking Process
			2.2.2.4 Dialysis or Washing
			2.2.2.5 Cutting
			2.2.2.6 Filling
			2.2.2.7 Sterilization Process
		2.2.3 Rheology of Hyaluronic Acid Filler
		2.2.4 Selection of Hyaluronic Acid Filler
	2.3 Calcium Filler
	2.4 Polycaprolactone Filler
	2.5 Filler Selection
	Bibliography
3 Anatomical Considerations for Filler Procedures
	3.1 Vessels and Nerves
	3.2 Fat Compartments and Muscles
	3.3 Retaining Ligaments
	3.4 Layer and Space
	3.5 Identification of SubSMAS Space for Filler Injection: Cadaver Study Using Stained Gelatin
	3.6 SSRT (Skin and SMAS Layer Remodeling Technique) for Volumization and Lifting Effect
	Bibliography
4 Basic Technique for Filler Procedure
	4.1 Design (Method)
		4.1.1 Frontal View-Horizontal/ Vertical Ratio of the Face
		4.1.2 Frontal View—Heart-Shaped Midface
		4.1.3 Oblique View—S-Line/Inverted S-Line/Ogee Curve
		4.1.4 Lateral View-Ricketts Line
		4.1.5 Design for Safe Filler Injection—Mark of Dangerous Area
			4.1.5.1 Design Examples for Safe Procedures
	4.2 Anesthesia—Nerve Block
		4.2.1 Supratrochlear/Supraorbital Nerve
		4.2.2 Zygomaticotemporal Nerve (Fig. 4.14)
		4.2.3 Zygomaticofacial Nerve (Fig. 4.15)
		4.2.4 External Nasal Branch of Anterior Ethmoidal Nerve (Fig. 4.16)
		4.2.5 Infraorbital Nerve (Fig. 4.17)
		4.2.6 Mental Nerve (Fig. 4.18)
		4.2.7 Greater Auricular Nerve (Fig. 4.19)
	4.3 Selection of Cannula or Needle
		4.3.1 Cannula
		4.3.2 Characteristics of Needles
	4.4 Injection Technique
		4.4.1 Types of Injection Techniques
			4.4.1.1 Retrograde Injection and Anterograde Injection (Fig. 4.26)
			4.4.1.2 Fanning (Fig. 4.27a)
			4.4.1.3 Cross Hatching (Fig. 4.27b)
			4.4.1.4 Bolus (Fig. 4.28)
			4.4.1.5 Linear/Serial Threading (Fig. 4.29a, b)
			4.4.1.6 Serial Puncture (Fig. 4.29c)
			4.4.1.7 Micropuncture/Droplet (Fig. 4.29d)
			4.4.1.8 Mantoux Test Injection Technique
			4.4.1.9 Sandwich Technique
			4.4.1.10 Tower Technique (Fig. 4.30)
			4.4.1.11 DPS Technique: Deep Puncture and Separation (Fig. 4.31)
		4.4.2 Injection Techniques for Each Area
	4.5 Basic Techniques by Region
	4.6 Filler Molding and Filler Degradation Test
		4.6.1 Filler Molding
		4.6.2 Filler Degradation Test
	Bibliography
5 Filler Procedures Based on the Facial Area
	5.1 Upper Face
		5.1.1 Forehead and Glabella
		5.1.2 Temple
	5.2 Midface
		5.2.1 Supraorbital Hollowness (Sunken Eyelid) and Flat Eyebrow
		5.2.2 Pre-tarsal Roll (=Lower Eyelid Charming Roll, Pre-tarsal Fullness)
		5.2.3 Infraorbital Groove and Hollowness
			5.2.3.1 Definition and Classification of Terms
			5.2.3.2 Tear Trough and Nasojugal Groove
			5.2.3.3 Palpebromalar Groove and Orbital Retaining Ligament (ORL)
			5.2.3.4 Midcheek Furrow (Groove) and Zygomatico-Cutaneous Ligament
			5.2.3.5 Orbital Fat and SOOF (Suborbicularis Oculi Fat) and Malar Fat
		5.2.4 Dark Circle (Tear Trough and Palpebromalar Groove)
			5.2.4.1 Design
			5.2.4.2 Anesthesia
			5.2.4.3 Choice of Filler
			5.2.4.4 Injection Technique
			5.2.4.5 Side Effect/Precaution
		5.2.5 Midcheek Groove
			5.2.5.1 Causes and Anatomy
			5.2.5.2 Treatment
		5.2.6 Anteromedial, Buccal, and Lateral Cheek Hollow
		5.2.7 Nose
			5.2.7.1 Design and Anatomy
			5.2.7.2 Choice of Filler
			5.2.7.3 Injection Technique
			5.2.7.4 Side Effect
		5.2.8 Nasolabial Fold
	5.3 Lower Face
		5.3.1 Lip and Philtrum
		5.3.2 Marionette Line (Static Labiomandibular Fold)
		5.3.3 Perioral Wrinkles (Smoker’s Line)
			5.3.3.1 Definition of Perioral Wrinkles
			5.3.3.2 Injection Technique
			5.3.3.3 Precaution/Side Effect
		5.3.4 Chin Augmentation and Jaw Line Contouring
			5.3.4.1 Design
			5.3.4.2 Anatomy
			5.3.4.3 Choice of Filler
			5.3.4.4 Injection Technique for Chin Augmentation
			5.3.4.5 Injection Technique for Jawline Contouring
			5.3.4.6 Precaution/Side Effect
	Bibliography
6 Complication of Filler Procedures
	6.1 Type and Treatment of Complication
		6.1.1 Bruising and Hematoma
		6.1.2 Edema
		6.1.3 Neovascularization and Erythema
		6.1.4 PIH (Post-inflammatory Hyperpigmentation)
		6.1.5 Nodule and Granuloma
		6.1.6 Infection
	6.2 Treatment and Prevention of Vascular Complication
		6.2.1 Mechanism and Classification of Vascular Complications
			6.2.1.1 Extravascular Compression
			6.2.1.2 Intravascular Emboli
			6.2.1.3 Commonly Affected Areas
		6.2.2 Skin Necrosis
			6.2.2.1 Predisposing Factors of Skin Necrosis
			6.2.2.2 Influencing Factors with Prognosis of Skin Necrosis
			6.2.2.3 Symptoms of Skin Necrosis
			6.2.2.4 Treatment of Skin Necrosis (Table 6.3)
			6.2.2.5 Tips for Early Detection and Immediate Treatment
		6.2.3 Vascular Complication—Blindness
		6.2.4 Vascular Complication—Pulmonary Embolism
		6.2.5 Prevention of Vascular Complication
			6.2.5.1 Procedural Tips to Reduce Vascular Complications
			6.2.5.2 Prevention of Vascular Complications—Aspiration Test (Fig. 6.1)
			6.2.5.3 Prevention of Vascular Complications—Needle Versus Cannula
			6.2.5.4 Prevention of Vascular Complications—Diameter of Injection Tool
	6.3 Hyaluronidase Usage
		6.3.1 Hyaluronic Acid Turnover
		6.3.2 Use of Hyaluronidase
	6.4 Retrobulbar Injection Technique
	Bibliography