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Injectable Fillers

Non-Surgical Facelift Using Fillers – A Plastic Surgeon’s Guide

A non-surgical facelift is a set of treatments that are a combination of minimally invasive non-surgical procedures that give the face a rejuvenated and youthful appearance. The ultimate impact of this treatment is a younger, sharper and refreshed face. Treatments that fall under the umbrella of non-surgical facelift include:

Plastic surgeons should take an aesthetic approach when performing a non-surgical facelift using fillers. The aim should be to give results similar to a surgical facelift while minimizing the downtime and invasiveness of the procedure. They should keep in mind to never inject a filler only in one part of the face since it looks disproportionate and unnatural to the rest of the face. Fillers should be injected in such a manner that the entire face looks volumized and younger.

What Are the Causes of Aging?

Aging is a natural process which everyone undergoes as they grow older. Aging brings about a variety of physical and psychological changes in human beings. As people grow older they become calmer, wiser and settle into a better way of life. But physically they lose out on those firm muscles and sharp jawlines and strong bones.

There are many factors that cause aging in the human body. These factors can be classified into

  1. Extrinsic Factors
  2. Intrinsic Factors

Extrinsic factors include natural circumstances, exposure to sunlight, pollution, smoking and even weight loss.

Intrinsic factors include the famous 5 D’s of Aging:

  • Deflation – loss of volume in the face
  • Disproportion – disproportionate changes to the facial muscles (some muscles may age faster than other resulting in a disproportionate face)
  • Descent – The depressors become more active than the elevators leading to an overall descent in the
  • Deterioration – The collagen fibrils deteriorate and there is a loss of elasticity and hydration of the
  • Dynamic Discord – Dynamic discord means that during the ageing process as the fat compartments in the face begin to atrophy it leads to changes in the muscles around The interplane between the muscles where the fat compartments are originally located moves causing dynamic discord.

Other intrinsic factors that lead to aging are volume loss and descent in fat pads, depressors becoming more active than elevators in muscles and decrease in bone density which affects the structure of the face.

All of these problems can be addressed by using fillers, toxins and thread lifts.

What Approach Should Plastic Surgeons Take for a Non-Surgical Facelift with Fillers?

Before performing a non-surgical facelift, a plastic surgeon should take into account:

  • Anatomical Considerations – A good surgeon will have an in-depth understanding of the facial anatomy and also how different ethnicities will have slightly different bone and muscle structures. Anatomical consideration is important because it defines the course of the treatment.
  • Treatment Protocol – A good plastic surgeon will thoroughly follow the treatment protocol laid down by the Medical Board. He/she will take the utmost precautions in their treatment to ensure 100% patient safety. All the medicines used in the treatment will be Board Approved only and the dosage will be determined based on the needs and goals of the patient.
  • MD Codes Correlation – The MD Codes was developed by Dr. de Maio in 2010. The MD Codes are a system which guides the use of injectables in medical aesthetics. MD Codes can be extremely helpful when moving forward with a non-surgical facelift.

My Tips For Injecting Fillers Perfectly

  • Perform needle aspiration before injecting fillers
  • Prime the needle before injecting
  • Inject slowly, never rush the fillers into the body
  • Keep communicating with the patient to note the level of discomfort or pain
  • Frequently check for skin color changes

Using Fillers for Deep Volumization

The surgeon should start assessing the areas that show the most notable signs of deficiency and volume loss. Deep volumization with fillers involves using a medium to high-G prime filler in a deep compartment targeted at areas of diminished ligamentous and soft-tissue support.

One of the common mistakes is targeting the nasojugal fold or nasolabial folds with fillers, but that gives a monkey-like look to the overall face. Hence, the approach should be similar to a surgical facelift which means go for a lateral midface volumization.

Fillers for Lateral Mid Face

In case of individuals showing a significant nasojugal fold or nasolabial fold, there will be a high deficiency in several areas. First, make an assessment of the lower eyelid vector. In individuals with a negative vector, the primary augmentation site will be the prezygomatic space.

An injection port 1.5 cm inferolateral to the lateral canthus is utilized. A pinch-and-pull technique with the non-injection hand facilitates cannula passage through the prezygomatic space capsule.

This capsule is analogous to the investment of SMAS on the posterior surface of the orbicularis oculi muscle. A palpable and often audible “pop” is noted when the cannula penetrates this capsule. Once in the prezygomatic space, the injector can move the cannula freely along the upper maxilla.

The prezygomatic space has roughly the shape of a Silastic cheek implant. The space extends superolateral up to the point of the lateral orbital thickening, which is the extension of the lateral canthal structures.

The injector can sweep the cannula within the space to feel the caudal boundary (zygomatic cutaneous ligaments) and the cephalic boundary (ORL). Volume additions of approximately 0.6mL with fillers or fat grafting volumes of approximately 1.4 to 1.5 mL are typical in this space.

Fillers for Anterior Midface

The technique for the effacement of tear troughs is vertical cannula injections fillers placed in a vertical stalagmite fashion via the deep pyriform or premaxillary spaces. These are accessed through a port roughly 1.5 cm inferolateral from the alar base in the nasolabial crease.

Once these steps are performed some of the patients do not need further fillers. But in case of some patients superficial fillers may be necessary to enhance the look and contour the face.

Using Fillers for Superficial Volumization

Lateral Midface

Due to the lateral limits of the prezygomatic space, volumization in the space does not address the lateral zygoma sweep. To address this, the injector can perform the DeMaio V1 injection which overlies the zygomaticotemporal suture.

A bolus injection in this location of approximately 0.25 to0.4mL will have a transmitted effect across the convexity of the cheek. Additionally, the DeMaio V2 injection is placed on the cephalic border of the main zygomatic ligament and should further enhance lateral cheek projection.

Anterior Midface

The primary targets are the superficial middle and medial fat compartments as described by Pessa et al. These are accessed through a port roughly 1.5 cm inferolateral from the alar base in the nasolabial crease.

The bounds of the superficial medial and middle compartments are readily apparent as resistance is felt when passing the cannula through the vascularized septae that divide them. The injector can fan broadly across these compartments to blend them, restoring volume and contour.

Other parts of the face where fillers may be injected as part of a non-surgical facelift:

  • The jawline
  • The chin
  • The cheeks
  • The temple
  • The tear trough
  • The lips
  • The nasolabial reshape
  • The marionette reshape

All of the above-mentioned areas are effectively areas where the doctor reshapes the features to look more youthful and firm.

Non-Surgical Facelift Using Fillers - A Plastic Surgeon’s Guide
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Non-Surgical Facelift Using Fillers - A Plastic Surgeon’s Guide
A non-surgical facelift is a set of treatments that are a combination of minimally invasive non-surgical procedures that give the face a rejuvenated and youthful appearance.
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July 2, 2020
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