One way of maintaining the effect of the filler injection is to inject the filler from the deepest part of the fold as if to layer from bottom to top. The key is to create independent blocks using “Koh`s block masonry technique” that we discussed in the previous article.  

 

A common misconception is that more volume is achieved with a larger injection dose but this is not always true. A large amount of the filler material can cause it to harden and even shrink in volume eventually. It is better to layer the filler from bottom to top and create a desired shape on the skin surface. Use a hard filler at the base of the fold and a soft filler toward the surface of the skin. Injecting excessive amount of filler on the skin surface should be avoided as this may cause hardening. The nasolabial folds smooth to a degree with deep injections but malar creases will not improve without surface injections. This layering technique and surface shaping can be used for marionette lines as well.

 

Table 2. Conclusion of volumetric injection & Solutions of volumetric injection.

 

Caution

We have looked at the basics of dermal filler techniques. It is important to remember that larger amount of injection does not always bring greater volume. Use a moderate amount on the surface to create the desired shape. An excess amount at this level will harden quickly and will not respond to shaping. It is also important to be well-versed in anatomical structures such as retaining ligament, adjacent soft tissues, and hard tissues to prevent migration of the filler to other areas. Use botulinum toxin to reduce the influence of muscles if the target area is subject to muscular movement. Try to achieve the right injection techniques to avoid lumps.

 

[Advertisement] MAGNUM(Q-switched Nd:YAG Laser) – Manufacturer: (www.i-dana.com)]

 

Anatomical knowledge is crucial for the success of dermal filer procedures. This is more important in minimally invasive treatments than in surgery as the tissues can be directly maneuvered during surgery. However, the needle is the only means to provide volume and maintain the aesthetic shape, it is important to be knowledgeable about the anatomical structures.  

 

I hope my colleagues put much effort into understanding the facial anatomy. In Korea, the term “surgical clones” refers to the social phenomenon of many women ending up with the same facial features due to the identical techniques of plastic surgeons. It is important to review our aesthetic standards to avoid this problem in the future. 

 

-To be continued