Many injectors, especially when new to the industry, question which dermal filler is the best filler for the specific targeted area on the face. However, other considerations also come into play when making this decision, such as the client’s anatomy and age. It is important to realize that not all dermal fillers are created equal. The most common type of filler is one comprised of hyaluronic acid.
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TARGETING SPECIFIC AREAS
By the age of 30, or even before then in athletic or slim individuals, the fat pads start to shrink and descend the face. There are some obvious dermal filler choices for certain anatomical areas. For example, for correction of age-related midface contour deficiencies, the professional should choose a filler that is good for deep implantation into the facial tissue and have a higher g-prime. Volume loss in the mid-face is a signature hallmark of the aging face. These fillers help replace the deep and superficial fat pads of the cheeks.
Typically, a client will get at least two syringes in the cheeks. Most clients have some asymmetry, so generally, there is a little more dermal filler placed on one side of the face versus the other. For instance, sometimes the left side of the face is asymmetrical due to sun damage from the driver’s side window of a car. Perhaps the right side of the face is flatter because that is the side that the client generally sleeps on. Whatever the cause, take note of the asymmetries when evaluating clients.
Injections in the lips can boost volume to create plumper, younger-looking lips. They can also create symmetry or provide a contour for those with thinner lips. Lip filler does not have to have the appearance of exaggerated lip filler. Lip injectables should be a dermal filler with more flexibility. There are many different lip fillers to choose from. Ultimately, the injector needs to determine the best filler for the client’s goals and a filler that will work well with the client’s given anatomy. Never use a filler with too much g-prime or firmness because that will produce hard, bulky lips. If the client has very thin lips and wishes to have a natural fullness, it is best to build up volume over a couple of sessions.
Many clients complain of their nasal labial folds or a jowling appearance in their lower face as they age. This appearance of the aging face is not only characterized by thinning skin and loss of collagen, but also the loss of deep fat pads in the face. Adding volume and contour to the cheeks should always be targeted first because replacing volume in the mid-cheek can reduce the depth and severity of other mid-facial lines as the nasal labial folds.
Hyaluronic acid fillers for nasal labial folds and marionette lines depend greatly on the client’s anatomy and skin structure. If the client has very thin or aged skin, a filler with a high g-prime could appear heavy. Since these areas are anatomically around the mouth, in turn have more movement, a dermal filler injected here should have some flexibility.
Hyaluronic acid fillers pull water. Thus, when choosing a filler, take this into consideration. For instance, when placing filler in tear troughs, do not use a filler that pulls much water. No one wants swelling and puffiness under their eyes. Filler placed in the tear troughs should not be the first and only filler because that will give an unnatural convexity beneath the eye, causing it to look filled. At this time, there is no filler that is approved for tear troughs, so fillers placed in this area are considered off-label.
Ultimately, no matter where the filler is placed anatomically, take into consideration the depth of where the filler will be placed, client anatomy and skin, the g-prime, and flexibility of the dermal filler.
SAFEGUARD MEASURES
The popularity of temporary dermal fillers continues to rise every year. There are more and more aesthetic injectors offering dermal fillers. Knowing the anatomy of the face is crucial to be a prudent aesthetic injector. There are necessary precautions that an injector must take because anatomic variation and vessel path can vary. Anatomy gives a general sense of important areas to be extra cautious in, but knowing the anatomy is not the only safeguard.
Unintentional injection into a blood vessel can lead to complications such as necrosis, scarring, and even blindness. One key safety measure is aspirating. By pulling back on the syringe pre-injection and not getting blood return in the hub of the needle, suggests that it is not in a blood vessel. This eliminates the risk of an intravascular injection or occlusion complication. The face is one of the most vascular areas of superficial anatomy, and aspirating is not a 100% guarantee that the injector is not in a blood vessel.
Other techniques can decrease the risk of intravascular injection, such as injecting retrograde and anterograde. In doing this, it avoids depositing large amounts of filler into one area, including the intravascular space. Additionally, it is best to inject slowly. This allows the injector to observe reactions like sudden or extreme pain per the client or blanching of the skin, which could indicate intravascular injection. Also, minimize boluses because boluses could occlude a vessel due to external pressure.
Using cannulas is yet another safeguard that has become more popular. They are blunt-tipped, so they theoretically decrease the risk of intravascular injections because the cannula does not enter the lumen of a blood vessel. Another benefit to using cannulas is they may decrease incidences of bruising due to fewer injection sites.
Know the anatomy of the face. In conjunction, distinguishes how the face ages, such as changes in the craniofacial skeletal structure and superficial and deep fat compartments. When injecting around an area of concern, use every safeguard measure to ensure that the injection will be safe. And most importantly, know how to recognize a complication and how to manage one if it arises.
In conclusion, many clients want a natural appearance when getting filler. In fact, sometimes they are even terrified of filler due to clients that look overdone. They want to turn back the clocks of time and appear as they did in their youth. While there are some clients that would prefer to appear more as a caricature of themselves, practitioners must educate these clients because a natural look gives the appearance of a more youthful look.
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Leigh Reese is a board-certified nurse practitioner and certified nurse injector. She earned her bachelor of science in nursing from Texas Women’s University in 2013 and her master of science in nursing from The University of Texas at Arlington in 2019. Her background in the medical field has been in emergency room medicine and aesthetic medicine. Her goal is to create a natural and youthful appearance for her patients and help devise a plan for their aesthetic journey. She has a passion for continuing education, and her position at SkinRX Spa allows her to attend monthly advanced trainings.
