FILLERS IN AESTHETIC

MAXILLOFACIAL SURGERY
 WHAT ARE DERMAL FILLERS???
Dermal fillers are gel-like substances that are injected beneath the
skin to restore lost volume, smooth lines and soften creases, or
enhance facial contours.
Dermal fillers are a non-invasive treatment used to restore youth and
volume to the face.
As we age, our skin begins to lose its elasticity and natural hydration.
This, combined with the effects of gravity, can lead to lines, wrinkles
and sagging of the skin.
Dermal Fillers are injected into the skin to replace hyaluronic acid
that has dissipated over time.
HISTORY
Galadari H. (2018) The History of Fillers. In: Soft Tissue Augmentation.
Springer, Berlin, Heidelberg
Surgeons ASoP: Cosmetic Plasic Surgery Statistics. (ed., 2018,
 FACIAL AGING
 Ageing is a process in which both intrinsic and extrinsic determinants lead progressively to a loss of structural
integrity and physiological function
 Begins with surface and subsurface structural changes in multiple facial tissue layers, including skin, fat, muscle and
bone
Farage MA, Miller KW, Elsner P, Maibach HI. Intrinsic and extrinsic factors in skin ageing: a review. Int J Cosmet Sci.
2008;30(2):87-95. doi:10.1111/j.1468-2494.2007.00415.x
FACIAL OUTLINE CHANGES DUE TO AGING

“Triangle
Of
Beauty”

Triangle Trapezoid or Rectangle

SKELETAL CHANGES DUE TO AGING
Age-related bony changes are mainly in the
periorbital and midcheek zones, including
the superomedial and inferolateral aspects
of the orbit, the medial suborbital and
piriform areas of the maxilla, and the prejowl
area of the mandible.
Arrows indicate the areas of the facial
skeleton susceptible to resorption with
aging.
The size of the arrow correlates with the
amount of resorption.

Mendelson B, Wong CH. Changes in the facial skeleton with aging: Implications and clinical applications in facial
rejuvenation. Aesthetic Plast Surg. 2012;36:753–760
VOLUME LOSS DUE TO AGING
SKIN

BONE
 Racial variation and diversity in the features and
anatomy have gained emphasis because of
structural skeletal differences.
 The Indian faces have comparatively smaller bones,
wide malar angles and mandibles, rounded and
high cheeks, and heavier lower faces with descent
downward and medial while aging, which are
accentuated by the already short lower one-third
and middle one-third of the face in the Indian skin.
 The periorbital area ages fastest in the Indian skin,
reflecting prominent tear trough by mid-20s to 30s

Arsiwala SZ. Simplifying Injectables for Volumetric Rejuvenation of Face. J Cutan Aesthet Surg.
2018;11(2):51-59. doi:10.4103/JCAS.JCAS_67_18
 Kim H, Park KY, Choi SY, Koh HJ, Park SY, Park WS, Bae IH, Kim BJ. The Efficacy, Longevity, and Safety of Combined
Radiofrequency Treatment and Hyaluronic Acid Filler for Skin Rejuvenation. Ann Dermatol. 2014 Aug;26(4):447-456
 Shoshani, David et al. “The modified Fitzpatrick Wrinkle Scale: a clinical validated measurement tool for nasolabial wrinkle severity
assessment.” Dermatologic surgery : official publication for American Society for Dermatologic Surgery [et al.] 34 Suppl 1 (2008): S85-91;
discussion S91 .
INDICATIONS
CONTRAINDICATIONS

A Practical Guide to Dermal Filler Procedures

By Rebecca Small, Dalano Hoang
 KEYS TO PROVIDING SUCCESSFUL DERMAL
FILLER TREATMENTS

Thorough Thorough
understanding of Proper patient
comprehensive selection
skin anatomy consultation
and aging process

Appropriate
Proper injection
Proper filler combination of
selection technique
treatments
SKIN ANATOMY
 FACIAL ANATOMY

APA Sieber, David A. MD; Scheuer, Jack F. III MD; Villanueva, Nathaniel L. MD; Pezeshk, Ronnie A. MD; Rohrich, Rod J. MD Review of 3-dimensional Facial Anatomy:
Injecting Fillers and Neuromodulators, Plastic and Reconstructive Surgery – Global Open: December 2016 - Volume 4 - Issue 12S - p e116
 PATIENT SELECTION
• Skin conditions

HISTORY •
•
•
Systemic disease
Medication
Procedures

• Skin + systemic
• Pretreatment
SELECTION •
•
Dental, vaccinations
Routine procedures
• Dysmorphophobia

ASSESSMENT • Beauty, aging, gender, ethnicity

• Wants vs needs

• Informed consent
CONSENT • Procedure + complications
• Financial consent

Heydenrych I, Kapoor KM, De Boulle K, et al. A 10-point plan for avoiding hyaluronic acid dermal filler-related complications during facial aesthetic procedures
and algorithms for management. Clin Cosmet Investig Dermatol. 2018;11:603-611. Published 2018 Nov 23.
 FILLER SELECTION
BASED ON BASED ON SITE OF
PLACEMENT
LONGEVITY

SEMI
TEMPORARY PERMANENT DERMAL SUBDERMAL SUPRAPERIOSTEAL
PERMANENT

BASED ON
ORIGIN OF
FILLER MATERIAL

SYNTHETIC
HETEROGRAFT ALLOGRAFT AUTOGRAFT
MATERIAL

Vedamurthy M. Standard guidelines for the use of dermal fillers. Indian J Dermatol Venereol Leprol 2008;74, Suppl S1:23-
7
Sarosh F. Dastoor, Carl E. Misch, Hom-Lay Wang; Dermal Fillers for Facial Soft Tissue Augmentation. J Oral Implantol 1 August
2007; 33 (4): 191–204. doi: https://doi.org/10.1563/1548-1336(2007)
PROPER PLACEMENT OF EACH FILLER
Vedamurthy M. Beware what you inject: Complications of injectables—dermal fillers. J Cutan Aesthet Surg 2018;11:606
PROPER INJECTION TECHNIQUES
cannula
PREOPERATIVE PREPARATION

INTRAOPERATIVE PROCEDURE

POST TREATMENT CHECKLIST

Corduff N. The 12-point Revitalization Guide to Pan-facial Application of Injectable Fillers in Older Women. J Clin Aesthet
Dermatol. 2018;11(8):35-40.
A clinician's guide to - Aesthetic Skin Clinic
Farolch-Prats, L., Nome-Chamorro, C. Facial Contouring by Using Dermal Fillers and Botulinum Toxin A: A Practical
Approach. Aesth Plast Surg 43, 793–802 (2019). https://doi.org/10.1007/s00266-019-01361-1
Farolch-Prats, L., Nome-Chamorro, C. Facial Contouring by Using Dermal Fillers and Botulinum Toxin A: A Practical
Approach. Aesth Plast Surg 43, 793–802 (2019). https://doi.org/10.1007/s00266-019-01361-1
COMPLICATIONS
Parada et al. Overview and management of fillers
complications Surgical and Cosmetic
Dermatology 8(4) · January 2016. DOI:
10.5935/scd1984-8773.201684897
Funt, David, and Tatjana Pavicic. “Dermal fillers in aesthetics: an overview of adverse events and treatment
approaches.” Clinical, cosmetic and investigational dermatology vol. 6 295-316. 12 Dec. 2013, doi:10.2147/CCID.S50546
 CONCLUSION

In a short span of time, fillers have come to play an

important role in the nonsurgical management of ageing
skin.
The technique is a safe, simple and effective modality, when
used by a properly trained physician.
Proper knowledge of the anatomy of the area of injection,
aesthetic sense and proper patient selection are essential.
The experts of filler injection must be familiar with each
filler material, the injection techniques, and the potential
complications.
 REFERENCES
 Galadari H. (2018) The History of Fillers. In: Soft Tissue Augmentation. Springer,
Berlin, Heidelberg
 A Practical Guide to Dermal Filler ProcedureBy Rebecca Small, Dalano Hoang
 Surgeons ASoP: Cosmetic Plasic Surgery Statistics. (ed., 2018,
 Farage MA, Miller KW, Elsner P, Maibach HI. Intrinsic and extrinsic factors in skin
ageing: a review. Int J Cosmet Sci. 2008;30(2):87-95. doi:10.1111/j.1468-
2494.2007.00415.x
 Mendelson B, Wong CH. Changes in the facial skeleton with aging: Implications and
clinical applications in facial rejuvenation. Aesthetic Plast Surg. 2012;36:753–760
 Arsiwala SZ. Simplifying Injectables for Volumetric Rejuvenation of Face. J Cutan
Aesthet Surg. 2018;11(2):51-59. doi:10.4103/JCAS.JCAS_67_18
 Kim H, Park KY, Choi SY, Koh HJ, Park SY, Park WS, Bae IH, Kim BJ. The Efficacy,
Longevity, and Safety of Combined Radiofrequency Treatment and Hyaluronic Acid
Filler for Skin Rejuvenation. Ann Dermatol. 2014 Aug;26(4):447-456
 APA Sieber, David A. MD; Scheuer, Jack F. III MD; Villanueva, Nathaniel L. MD;
Pezeshk, Ronnie A. MD; Rohrich, Rod J. MD Review of 3-dimensional Facial
Anatomy: Injecting Fillers and Neuromodulators, Plastic and Reconstructive Surgery