• #12-2. High-risk Areas and Techniques of Dermal Filler Injection




    The supraorbital artery that branches from the internal carotid artery passes in the forehead and filler injection can cause vision loss or cerebral infarction. It is crucial to clearly understand vascular passage in this area to avoid complications.


    The supraorbital artery bifurcates into the deep branch and superficial branch and takes on three types of passage. Mostly, it lies in the subcutaneous layer. Therefore, when injecting in the forehead, avoid the subcutaneous layer and inject onto the upper periosteum for better safety.


    Even at the upper periosteum level, the deep branch can pass immediately above the periosteum, 16-42mm from the supraorbital rim. Up to 12mm from the supraorbital rim, it branches from the periosteum. Avoid injecting below this 12mm limit. Practice great caution between 12mm and 42mm from the supraorbital rim although the injection is above the periosteum.


    To make smooth progression over an extensive area such as the forehead and minimize vascular damage, I use “Koh`s Expanding Technique.” Koh`s Expanding Technique is useful when enhancing volume in wide planes such as the forehead and the temple area. Create a space using a long needle and gradually expand this space with slow, continuous injection to create a smooth, continued volume. 


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    In this technique, place the needle on the edge of the target area and use the free hand to press on the opposite area so that the injected filler is guided into the target area with a lower pressure. This follows the same principle as in the hydro-dissection that uses water pressure. Do not insert the needle into the center of the target area but let the filler flow into it from the edge. This helps reduce the risk of vascular injury as the filler gradually increases the space initially created from the needle.


    Traditional techniques does not enable smooth spread of the filler in the forehead. With short needles that traditional techniques generally use, it takes multiple injections to create enough space. This creates multiple separate spaces under the skin, not a single continuum, and it is very difficult to create a smooth progression of the filler. Also, multiple injections means an increased risk of vascular damage.


    -To be continued

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