Pertinent Midface Anatomy & Analysis for Volumizing Procedures

Purpose: To construct an anatomically inspired midfacial analysis facilitating safe, accurate and dynamic non-surgical rejuvenation. Emphasis is placed on determining injection target areas and adverse event zones.

Methods: Ten hemifacial fresh cadaver specimens were dissected in a layered fashion. Dimensional measurements between midfacial fat compartments, mimetic muscles and neurovascular bundles were used to develop a topographic analysis for clinical injections. The gliding pre-zygomatic space in the upper midface was anatomically isolated. A three-dimensional video rendering of the analysis was created.

Results: A longitudinal line running from the base of the alar crease to the medial edge of the Levator Anguli Oris muscle (LAO) [1.9 cm] lateral edge of the LAO [2.6 cm] and Zygomaticus Major muscle [4.6 cm] partitions the cheek into two aesthetic regions. A six-step facial analysis outlines three target zones, two adverse event zones and triangulates the point of maximum cheek projection. The lower adverse event zone yields an anatomical explanation to inadvertent jowling during anterior cheek injection. The upper adverse event zone localizes the palpebral branch of the infraorbital artery. The medial malar target area isolates quadrants for anterior cheek projection and tear trough effacement. The middle malar target area addresses lid-cheek blending and superficial compartment turgor. The lateral malar target area highlights lateral cheek projection and locates the pre-zygomatic space between the superficial and deep facial fat compartments.

Conclusions: This stepwise analysis illustrates target areas and adverse event zones to achieve midfacial support, contour and profile in the repose position while simultaneously molding a natural shape during animation. This reproducible method can be utilized both procedurally and in record keeping for midface volumization procedures.