Treating Aging Changes of Facial Anatomical Layers with Hyaluronic Acid Fillers

Figures & data

Table 1 Filler Procedure, Target Facial Layer Injected, and Type of HA Filler Used

HA Filler Procedure	Outcome	Layer	Type of Filler Used	Example
Skin Boosting	Enhancing skin quality	Dermis	Very Low viscosity; Low elasticity G′; Low cohesivity; Non or low crosslinked materials	Restylane vital, Juvederm volite, Teosyal RD1, Belotero Hydra
Smoothening	Fine wrinkle correction	Dermis, Superficial fat	Medium viscosity; Moderate elasticity G′; Low-medium cohesivity.	Juvederm Volite, Juvederm Volbella, Belotero soft, Restylane refine, Teosyal RHA1-2
Volumization	Replacing the volume loss associate with aging	Superficial fat, Deep Fat Layer	Low viscosity; Low-medium G′; Low-medium cohesivity	Juvederm Volift, Juvederm Voluma, Teosyal RD3-4, Belotero Balance, Belotero volume, Restylane Define, Restylane Volyme
Lifting	To give support for sagging facial layer associate with gravity	Deep Fat, Supraperiosteal, Retaining Ligaments	Low-medium viscosity; Medium-high elasticity (G′); Medium-high cohesivity.	Juvederm Voluma, Juvederm Volux, Teosyal RD 4, Teosyal Ultradeep, Belotero Volume, Belotero Intense, Restylane Define, Restylane
Contouring	Make a better face shape by taking light and shadow into consideration	Deep Fat, Supraperiosteal	Medium to high viscosity; High elasticity high G′; High cohesivity.	Juvederm Voluma, Juvederm Volux, Teosyal Ultradeep, Belotero Intense, Restylane

Table 2 Impact of HA Filler Injection Procedure for Different Facial Layers

Layer Injected	Injected Volume	Depth	Device	Outcome	Layer Elevated
Skin	Small	Very superficial	Mostly needle	Localised	0
Superficial fat	Small to medium	Superficial	Needle/cannula	Localised	1
Deep fat	Large	Deep	Needle/cannula	Diffuse	3
Supra periosteal	Large	Very deep	Mostly needle	Diffuse	4 except temple, lateral cheek/ jawline

Figure 1 Before and after pictures of a patient treated for skin quality fillers. Treatment description: Neck- Juvederm Volite, 1mL per side, in the most superficial layer of skin using a needle. (contributed by Catherine Ellen Porter).

Figure 2 Before and after pictures of a patient treated for skin quality fillers. Treatment description: Neck- Juvederm Volite, 2mL total, in the superficial subcutaneous layer using a needle; Face- Juvederm Volite, 1mL each side, in the superficial subcutaneous layer using a needle. (contributed by Ligia Colucci).

Figure 3 Treatment description: Lateral Cheekbone area- Juvederm Voluma, 0.1mL at 3 points each side, on periosteum with a needle; Temporal fossa: Juvederm Voluma, 0.5mL each side, on periosteum using a needle; Cheekbone projection: Juvederm Voluma, 0.2mL each side, on periosteum using a needle; Malar region- Juvederm Voluma, 0.5mL each side, in the deep malar fat pad, using a needle; Pre-auricular area- Juvederm Voluma, 0.5mL each side, in the subcutaneous layer using a cannula; Labiomental crease: Juvederm Voluma, 0.7mL each side, in the subcutaneous layer using a cannula; Chin/pogonion- Juvederm Volux, 0.3mL each side on the periosteum, using a needle; Posterior jawline//pre-auricular area- Juvederm Volux, 0.3mL each side in subcutaneous layer using a cannula; Medial to the angle of the jaw: Juvederm Volux, 0.4mL in the subcutaneous layer, cannula; Jawline- Juvederm Voluma, 0.5mL each side, in the subcutaneous layer of the pre-jowl sulcus and medial jawline using a cannula; Malar area- Juvederm Voluma, 0.5mL each side in deep malar fat pad using a cannula; Malar area: Juvederm Volift, 0.5mL each side, in SOOF layer using a cannula; Periorbital region- Juvederm Volbella, 0.5mL each side, in SOOF including tear trough using a cannula; Lips- Juvederm Volift, 0.5mL total, in the subcutaneous layer using a needle. (contributed by Ligia Colucci).

Figure 4 Treatment description: Lateral Cheekbones area: Juvederm Voluma 0.1mL in 3 points each side on periosteum with a needle. Pre-auricular area: Juvederm Voluma, 0.7mL each side, in the subcutaneous layer using a cannula; Malar area: Juvederm Voluma, 0.5mL each side, in deep malar fat pad using a cannula; Malar area: Juvederm Volift, 0.5mL each side, in SOOF using a cannula; Temporal fossa- Juvederm Voluma, 0.5mL each side, on periosteum using a needle; Labiomental crease- Juvederm Voluma, 0.7mL each side, in the subcutaneous layer using a cannula; Chin apex/pogonion- Juvederm Volux, 0.3mL each side, subcutaneous/intramuscular (mentalis muscle) plane using a needle; Medial to marionette lines- Juvederm Voluma, 0.5mL each side, in the subcutaneous layer using a cannula; Jawline: Juvederm Voluma, 1mL each side, in the subcutaneous layer of the pre-jowl sulcus and medial jawline using a cannula; Nasolabial folds- Juvederm Volift, 0.5mL each side, in the subcutaneous layer using a cannula. (contributed by Elian Elisabeth Anne Brenninkmeijer).

Figure 5 Treatment description: Lateral Cheekbones: Juvederm Voluma, 0.1mL in 3 points each side, on periosteum with a needle; Pre-auricular area: Juvederm Voluma, 0.7mL each side, in the subcutaneous layer using a cannula; Malar area- Juvederm Voluma, 0.5mL each side, in the deep malar fat pad, using a cannula; Malar area: Juvederm Volift 0.5mL each side, in SOOF layer, using a cannula; Temporal fossa- Juvederm Voluma, 0.5mL each side, on periosteum using a needle; Labiomental crease- Juvederm Voluma, 0.7mL each side, in the subcutaneous layer using a cannula; Chin apex/pogonion: Juvederm Volux, 0.3mL each side, subcutaneous/intramuscular (mentalis muscle) using a needle; Medial to marionette lines- Juvederm Voluma, 0.5mL each side, in the subcutaneous layer using a cannula; Jawline- Juvederm Voluma, 1mL each side, in the subcutaneous layer of the pre-jowl sulcus and medial jawline using a cannula; Nasolabial folds- Juvederm Volift, 0.5mL each side, in the subcutaneous layer using a cannula. (contributed by Elian Elisabeth Anne Brenninkmeijer).

Figure 6 Before and after pictures of a patient given filler treatment in various facial layers. Treatment description: Lateral and medial malar area- Juvederm Voluma, 0.2 and 0.3mL per side, on periosteum using a needle; Labiomental crease: Juvederm Voluma, 0.5mL each side, in the subcutaneous layer using cannula; Chin- Juvederm Volux, 1mL total, on periosteum using a needle; Angle of the jaw- Juvederm Volux, 0.3mL each side, on periosteum using a needle; Posterior jawline/pre-auricular area: Juvederm Volux, 0.3mL each side, in the subcutaneous layer using cannula; Medial to the angle of the jaw- Juvederm Volux, 0.4mL each side, in the subcutaneous layer using a cannula. (contributed by Catherine Ellen Porter).

Figure 7 Before and after pictures of a patient treated for lower face shaping and contouring. Treatment description: Labiomental crease- Juvederm Voluma, 0.7mL, each side, in the subcutaneous layer, using a cannula; Chin/pogonion- Juvederm Volux 0.3mL each side, on periosteum using a needle; Jawline- Juvederm Volux, 0.5mL each side, in the subcutaneous layer of the pre-jowl sulcus and medial jawline using a cannula; Angle of the jaw- Juvederm Volux, 0.5mL each side, in the subcutaneous layer using a cannula. (contributed by Jake Sloane).