This three part series is meant as a guide for beginner or intermediate injectors looking for new concepts or interested in advancing their techniques. These concepts apply for injectable fillers as well as with Botox/Dysport. I also invite my patients to review these topics in order that they can be knowledgeable about their treatments. These are concepts that I frequently reference when performing trainings. I perform my own injections of filler and botox in my Southlake and Fort Worth, Texas offices.
The Art of Injecting – Part 3: Draw Attention Upwards (Towards the Eyes)
Avoid the Nasolabial Trap
I blame “FDA approved marketing” for the seemingly incessant obsession over the nasolabial folds and here’s why. When filler companies first began getting FDA approval for fillers, the facial folds – most commonly nasolabial folds – were the first indications to gain approval. As a result, a flood of fillers were now considered safe for this indication, and subsequent FDA approvals allowed rapid influx of products for this same indication. Avoiding legal ramifications of promoting off-label uses of fillers, this FDA approved use of fillers were mass marketed directly to patients.
To this day, we continue to have patients that come in for correction of nasolabial folds as their primary concern. As I tell my patients, it is normal for a baby to have nasolabial folds. What isn’t present on a baby are the hollows above the nasolabial folds from volume loss in the cheeks and mid-face. Therefore, for natural correction, I strive to achieve correction of this volume loss to elevate the nasolabial folds with a tent-pole effect.
Volumize to Lift, not to Drop
Volume in the lower face should be used sparingly in areas that are gravity dependent and not adherent to bone. This includes areas like the lips and lower cheeks – which can hang lower with weighed down with filler. Areas along the bone can be filled in ways that provide support and use a cantilever-effect to lift areas that need lift.
Over-volumization of the lower face can lead to a monkey appearance if around the mouth or a masculine appearance if it causes squaring of the jaw line. Do not make this mistake! Lift, Don’t Drop!
How can I bring attention to the eyes?
This is my not-so-secret way of keeping things looking natural. I always ask myself this question while injecting, “What is distracting me from the eyes?” I then ask, “Will injecting the distraction make it less distracting or more distracting?”. If the answer is that it will make it more distracting, then you’re probably focusing your attention on the wrong area and may want to consider moving upward to the next closest region and ask that question again.
This could be its own 3 part series, but the point is always use safe injection techniques or a nice result is useless. Complications can ruin an otherwise nice result. Act fast if there is any evidence of vascular compromise and flush with large amounts of hyaluronidase. If there are issues or questions, feel free to reach out regarding this topic. That’s all I will say on that topic for now.
Well that wraps it up! I hope that this series was helpful for injectors out there. Feel free to let me know what you think or if there is anything you would like to know about the topic!
Jordan Rihani, MD
All original content, copyright 2018 Facial Plastic Surgery Institute, PLLC