Aesthetic Facial Anatomy Essentials for Injections

Ali Pirayesh, Dario Bertossi, Izolda Heydenrych, Ali Pirayesh, Dario Bertossi, Izolda Heydenrych

• Publisher: CRC Press
• Year: 2020
• ISBN:
  9781351378901
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

With the ever-increasing popularity of injectable toxins and fillers, all clinical practitioners in minimally invasive aesthetic procedures need to be experts in the anatomy of the face. This is a detailed and informative guide from international experts to all aspects of the facial anatomy of the presenting clinical patient - how it changes with age, how it differs in different patients, how it is layered, and what danger zones it may contain. An integral ebook contains videos demonstrating how injection can best be accomplished in each of the anatomical areas considered.

1

Forehead

Izolda Heydenrych, Fabio Ingallina, Thierry Besins,
Shannon Humphrey, Steven R. Cohen, and Ines Verner

Introduction

The forehead is an anatomic area with distinct con-tours and creases: contours indicate underlying bone and fat pads whilst creases predict underlying vasculature. An in-depth understanding of the location of neurovascular structures is vital when performing forehead injections. The most balanced enhancement and rejuvenation in the forehead is achieved by combining relaxing toxin injections and reshaping or volumizing filler treatment.

Boundaries

The boundaries of the forehead are the frontal hairline (superiorly), the eyebrows and nasal root (inferiorly), and laterally, the temporalis crest at the temporalis muscle insertion (Figure 1.1). In patients with hairline recession, the superior extent of the forehead is at the superior border of the paired frontalis muscles. The transition between the forehead and the temporal region is at the temporal crest where the fascial planes fuse to form the conjoined tendon (Figure 1.2).

Figure 1.1 The boundaries of the forehead are the frontal hairline (superiorly), the eyebrows and nasal root (inferiorly), and the temporal crest (laterally).

Figure 1.2 The temporal crest marks the lateral forehead boundary; a deep branch of the supraorbital nerve runs 1 cm medial to this line.

Aging

The hallmarks of a youthful forehead include a subtle convexity, smoothly outlined contours, lack of furrows, and even skin tone and texture. In the female patient, the ideal forehead should have a gentle convex curve 12°–14° off vertical. Ideal forehead height and brow shape count among the seven features of true facial beauty, but forehead shape and contour are extremely variable and compounded by ethnicity and gender. Although forehead height cannot be altered by injectables, the contour may be optimized by use of fillers, and both brow shape and position are supremely treatable with toxins and fillers.

Figure 1.3 shows the ideal female brow, which should be situated above the orbital rim and has the following characteristics:

Figure 1.3 The proportions of the ideal female brow.

In addition to intrinsic and actinic aging, there are changes in bone and soft tissue, with site-specific aging of facial fat pads leading to skeletonizing and accentuation of the brow muscles. Overall, widening of the orbital aperture, a more acute glabellar angle, and loss of bony support contribute to the formation of wrinkles (Figure 1.4).

1.The head of the brow should be in a vertical line with medial canthus.

2.The brow should raise at a 10°–20° angle.

3.The brow should peak above the lateral l...