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Markup as the basis of philling of the middle third of the face. Cannula work

The key to success in contouring the middle third of the face is markup. The author considers the choice of correction zones, danger zones and access points with cannula technique.
The term ptosis in the field of aesthetic cosmetology is very common. But where exactly does ptosis begin – the root cause of all gravitational folds. This is a U-shaped deformation in the middle third of the face, formed by the nasolacrimal, palpebromolar and mid-cheek grooves, which is located in the middle third of the face. Problems such as dark circles and bags under the eyes, uneven cheeks, drooping cheekbones and lateral sections of the eyebrows are located in the middle third of the face, and they are involved in the formation of nasolabial folds, wrinkles, “puppets” and a violation of the clear contour of the face.

Facial aging is not only the aging of the skin as a “cover” mantle, including loss of elasticity, the formation of wrinkles, the appearance of pigment and vascular pathology, and neoplasms associated with aging. Facial aging is a process that affects all tissue levels and is realized due to a whole range of changes: gravitational shift of soft tissues, loss and redistribution of their volume, dystrophic changes, imbalance of the tone of facial muscles, decrease in skeletal support.

Ligaments – connective tissue cords extending from the facial fascia. Ligaments pass through the facial muscles of the face, deep and superficial subcutaneous fat and are attached at one end to the skin of the face, and the other to the bones of the facial skeleton. Undergoing gravitational changes, the ligaments lengthen and lose their elasticity, thereby increasing the distance between the ligaments in the tissues, which exacerbates the ptosis of the fat compartments, muscles of the face and dermis.

For the correct choice of a particular injection procedure and the compilation of a full correction algorithm, it is necessary:

conduct a clinical analysis of facial proportions using a medical caliper;
visually and by palpation to assess the condition of the skeleton of the facial part of the skull, dentition, soft tissues of the face, note the presence of muscular-fascial imbalance, wrinkles, skin tone.
This analysis allows you to identify the presence of a “true” or “false” nasolacrimal groove in the middle third of the face, to determine the severity of the U-shaped deformation.

With a “true” nasolacrimal groove, the tissues are tightly fused with the periosteum and there is no space for philling. Such a furrow is corrected by strengthening the tissues of the periorbital region with mesotherapy, bioreparation.

“False” nasolacrimal groove is the result of ptosis of soft tissues of the middle third of the face, weakening of the ligaments of this zone. Correction method – contour plastic. If the choice is made in favor of a “false” nasolacrimal fissure, it is necessary to adequately assess which drug and to what extent should be used.

We recommend the use of Soprano Touch 18 mg / ml in a volume of 0.3–0.5 ml on each side for contouring the nasolacrimal sulcus and palpebromal sulcus. To fill the mid-buccal sulcus – Soprano Basic 23 mg / ml in a volume of 0.5–1 ml on each side.

For adequate correction, it is necessary to understand the clear boundaries of the nasolacrimal and palpebromolar and mid-cheek grooves.

We draw a perpendicular along the mid-pupil line: all that is medial to the bridge of the nose is a nasolacrimal groove (red line); and all that is lateral to the outer corner of the eye is the palpebromolar groove (green). The continuation of the nasolacrimal sulcus is lateral to the mid-pupillary perpendicular to the outer corner of the eye and is the mid-cheek groove (yellow) (Fig. 4). Based on the foregoing, and access points for filling each furrow with a cannula will be different. Recommendations for the use of cannulas are associated with the anatomical features of the middle third of the face, which allows you to move freely in the desired layer and avoid unnecessary trauma with subsequent complications when the drug is administered near anatomically dangerous areas. The cannula we recommend in this area is 22G * 70 mm.

Before the introduction of the drug, markup should be carried out to detail the features of the anatomical structure of this area in the patient. During the marking, we mark the bone edge of the orbit, hernial packets and paint bags, if any, as well as the furrows and access points themselves. It is important to observe clear boundaries for the administration of a drug of one density or another and the depth of administration of each drug, since the skin of the periorbital zone is much thinner than on the cheek, and if the drug is injected with a density of 23 mg / ml into the nasolacrimal and palpebromolar grooves, contouring of the drug is possible.

A drug with a density of 18 mg / ml is injected into the area of ​​the nasolacrimal and palpebromal grooves under m. orbicularis oculi. A drug with a density of 23 mg / ml in the area of ​​the mid-cheek groove should not be introduced into the superficial fat pack (paint bag), as this can lead to long-term persistent edema. A drug with a density of 26 mg / ml in the zygomatic region is administered strictly supraperiostally.

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