The Midface - Dermal filler

Question 1

Borders

Answer 1

Glabella to subnasale

Question 2

Type of filler used

Answer 2

High G prime

Question 3

Juvederm

Answer 3

Voluma deep fat
Volift superficial fat

Question 4

Teoxane

Answer 4

Teosyal Deep/RHA4

Question 5

Belotero

Answer 5

Volume

Question 6

Injection technique

Answer 6

Supreperiosteal bolus
Cannula

Question 7

Compartments

Answer 7

Zygomatic Arch
Lateral cheek
Apex
Medial cheek

Question 8

Hinderers lines

Answer 8

Intersecton of lines for the cheek apex

1. Horizonal line nose ala to tragus
2. Diagonal line lateral canthus to oral commissure

Question 9

Midface superficial fat pads - layer 2

Answer 9

Infraorbital
Nasolabial medial - increases with age
Middle cheek
Lateral cheek - reduces with age
Temporolateral

Question 10

Midface deep fat pads - layer 4

Answer 10

Medial + Lateral portions of SOOF (suborbicularis oculi fat) - divded by lateral canthus

Deep medial
Deep lateral

Question 11

Vasculature

Answer 11

Facial (angular branch)

infraorbital arteries (branch of maxillary artery)

Transverse facial artery (branch of superficial temporal artery)

Facial vein more lateral to artery

Question 12

Sensory innervation

Answer 12

Maxillary branch of trigeminal nerve - emerges from the infraorbital nerve

Question 13

Motor innervation

Answer 13

Zygomatic and buccal branch of facial nerve - arrises deep to parotid gland

Question 14

Bone aging process

Answer 14

Maxilla recession
Maxillary angle reduces
Orbits widen

Question 15

SMAS

Answer 15

Superficial Musculoaponeurotic System

Question 16

Lymphatics

Answer 16

Medial and lateral channels

Submandibular and parotid nodes respectively

Question 17

Wilkinsons’ line

Answer 17

Vertical line from Lateral canthus to mandible - apex is 1/3 of line from lateral canthus

Question 18

Ogee curve

Answer 18

enhance the contours of the face along the Ogee Curve to create a more youthful and balanced appearance

Question 19

Men vs women mid face

Answer 19

Cheek bone is flatter in men

Apex is more medial and lower in men

Women have more medial SC fat

Question 20

Supraperiosteal technique for cheek filler

Answer 20

0.2ml at apex, followed by 3 x 0.1ml injections along zygoma

Question 21

Piriform fossa

Answer 21

Treat maxillary recession

Improving nasolabial fold appearance

Question 22

Piriform fossa technique

Answer 22

Supraperiosteal bolus

Pull lateral tisses away to move facial artery laterally in layer 2

Aim needle towards contralateral oral commisure - 45 degress onto bone

Aspirate for 5-10 seconds

0.3ml filler

Question 23

Order of treatment in mid face

Answer 23

Apex

Zygomatic arch

Piriform fossa

Question 24

Cannular entry point for deep cheek filler

Answer 24

Medial cheek fat apex

Insert pilot needle in vertical line with lateral orbit

Pass through SMAS into deep planes

Question 25

Cannular entry point for nasiolabial fold

Answer 25

Base of nasolabial fold Cannula passes through layer 2

Question 26

Ligament of the midface

Answer 26

Orbicularis retaining ligament Zygomatic cutaneous ligament

Question 27

Aging process in the midface

Answer 27

resorption of maxilla bone maxillary angle reduces pyriform apeture of nose widens orbit widens

Question 28

Layer 4 components

Answer 28

SOOF - suborbicularis oculi fat (medial and lateral) DLCF - deep lateral cheek fat DMCF - deep medial cheek fat

Question 29

Location of SOOF

Answer 29

inferior to orbicularis retaining ligament superior to zygomatic cutaneous ligament

Question 30

What is the SMAS

Answer 30

Layer 3 Superficial musculoaponeurotic system Fibrous continuation of facial muscles Tightens with layer 4 expansion

Question 31

Superficial fat pads which hypertrophy with age

Answer 31

Nasolabial

Question 32

Superficial fat pads which atrophy with age

Answer 32

Lateral cheek fat pad

Question 33

Transient piriform fossa filler side effect

Answer 33

Temporary upper lip anaesthesia from lidocaine infiltration to trigeminal nerve

Question 34

Terminal branch of the facial artery

Answer 34

Angular artery becomes the angular artery after the lateral nasal artery branch

Question 35

Artierial supply in the midface

Answer 35

Transverse facial artery Infraorbital artery Facial artery

Question 36

Aspiration length

Answer 36

5-10 seconds

Question 37

What divides the medial and lateral SOOF

Answer 37

Lateral canthus of the eye

Question 38

Glide planes of the midface

Answer 38

Pre-septal space Pre-zygomatic space Buccal space

Question 39

What technique addresses maxillary recession

Answer 39

Deep piriform space filler

Question 40

Technique of piriform fossa injection

Answer 40

pull tissues laterally needle aimed towards contralteral oral commissure at 45 degree angle Supraperiosteal bolus up to 0.3ml filler

Question 41

Supraperiosteal treatments of midface

Answer 41

Cheek apex - zygomatic bone Lateral cheek - zygomatic arch - zygomatic bone & temporal bone Piriform fossa - maxilla

Question 42

Point of insertion of cannula in midface deep fat pad treatment

Answer 42

Vertical plane of lateral orbit

Question 43

Deep fat pad targets for treatment

Answer 43

deep medial and lateral cheek pad

Question 44

Superficial targets for treatment

Answer 44

Lateral fat pad - Pre auricular Nasiolabial fold

Question 45

Point of insertion for lateral superficial fat pad treatment

Answer 45

Vertical plane of anterior masseter

Question 46

Lateral cheek fat pad/preauricular treatment technique

Answer 46

Cannular fanning with mid-prime

Question 47

Layer of prezygomatic space

Answer 47

layer 4

Question 48

Movement of the facial fat pads

Answer 48

Deep - static Superficial - dynamic - use soft filler that moves with expression

Question 49

Pre-zygomatic space borders

Answer 49

posterior - preperiostel fat anterior - SOF ORL - superiorly zygomatic ligament - inferiorly