The Lower Face

 

In Taiwan, fillers in the nasolabial area not only fill deep folds, but are also used to increase the forward projection of the upper maxilla, adding support to a depressed mid-face. The chin and jawline can be considered a single treatment unit. Most women here desire an inverted triangle shape to the face, with a slender chin and jaw. Treatment of prejowl sulcus involves augmentation from the posterior edge of the pre-masseter space to the anterior edge of the prejowl sulcus.

 

Augmentation of the marionette lines is often performed in conjunction with treatment of the prejowl sulcus. Although lip augmentation is popular in the West, people in Taiwan typically have thicker upper lips and wish to avoid an unnatural, over-corrected appearance. Younger individuals usually only require augmentation of the central lip.

 

The Fillers Types

 

Currently, there are six main categories of fillers on the market in Taiwan: collagen, hyaluronic acid, polyacryamide, calcium hydroxylapatite, poly-L-lactic acid, and polycaprolactone. Although hyaluronic acid is still the most popular fillers in Taiwan, others are gaining more attention through recent years.

 

As indicators of gel stiffness, viscosity and elasticity are believed to influence filler suitability for particular procedures. In general, the greater the viscosity, the deeper the filler should be injected. Cohesive polydensified hyaluronic acid (such as Esthelis by Anteis) may be superior to collagen injection in the treatment of nasolabial folds.

 

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The efficacy and safety of this type hyaluronic acid are similar to other hyaluronic acid fillers with a duration of up to 12 months. On the other hand, calcium hydroxylapatite is well suited for supraperiosteal, subdermal, and deep-dermal placement with its high level of visco-elasticity. Calcium hydroxylapatite is not indicated in the lips, tear trough, glabella, or for superficial injection because of the high incidence of nodule formation.

 

The Vascular Complications and Others

 

Vascular occlusions are very rare but serious complications attributed to intravascular injection of filler materials. In Taiwan, two cases of calcium hydroxylapatite related blindness following nasal augmentation has been reported.

 

-To be continued