The center of the face is called the midface region. The midface encompasses the central part of the face, including the nose and cheekbones[1][5]. This region encompasses two main problem areas: the nose and cheekbones. What is considered to be beautiful in the midface region can also vary wildly based on the patient’s culture and perspective. For example, Asian patients tend to want a fuller central midfacial area in relation to their cheekbones out to the side, whereas Caucasian patients tend to want the opposite: more pronounced cheekbones when compared to the central midface region. The same unique and personal preferences are also at play when it comes to the nose. Although the ideal nose is one that harmonizes the face by tying together all the other surrounding facial features, most patients will have very specific desires for nasal fillers.
It is essential to take these unique preferences into account before proceeding with facial fillers, and that is why a comprehensive consultation is an essential part of the filler process. During a consultation, you should have an open line of communication with the patient in order to make sure they understand the patient’s exact goals. Patients should make an effort to understand all of the different filler treatments and techniques so that during the consultation they can have an informed viewpoint.
The nose in particular presents a unique challenge in filler placement. Filler is generally used to hide otherwise undesired features of the nose, or sculpt its overall shape. Because the nose is complex anatomically, it is especially critical to go to a facial expert when seeking out nasal injections, also referred to as “liquid rhinoplasty”. A comprehensive consultation, sometimes with photographic imaging and digital morphing, can be used to ensure that the patient and injector are aligned in the goals and expectations are set appropriately. It is even higher risk to have filler injections placed into the nose if a patient has had previous surgery to the nose, as this creates a situation where the anatomy, including blood supply, of the nose is less predictable.
- Injections over the temple should be kept deep to avoid intravascular injections in the superficial temporal artery.
- Injections along the lateral zygomatic arch may be kept deep along the bone and this a low risk area.
- When injecting near the infraorbital foramen as well as the nasolabial groove, a cannula can help decrease the risk of intravascular injections. This is due to the vessels in these areas often having variable depth and location.
- The midface anatomy includes multiple fat compartments, muscles, and ligaments that play crucial roles in facial aesthetics and aging[1][2].
- Understanding the vascular anatomy of the midface is crucial, which is critical for safe injections. The facial artery and its branches, including the angular artery, are key structures to consider[2].
- The superficial musculoaponeurotic system (SMAS) in midface anatomy is important for understanding facial aging and rejuvenation techniques[3][4].
- It is important to also understand the significance of the prezygomatic space, which is a safe target for volumization within the deeper plane of the midface[2].
Citations:
[1] https://plasticsurgerykey.com/midface-anatomy-aging-and-aesthetic-analysis-2/
[2] https://www.rejuvenationresource.com/articles/clinical-application-by-anatomic-region/rejuvenation-of-the-midface
[3] https://www.sciencedirect.com/science/article/pii/S0094129820309640
[4] https://link.springer.com/chapter/10.1007/978-1-4614-1007-2_1
[5] https://eyewiki.org/Malar_/_Midface_Descent