Cheekbones

Either no anesthetic or only topical anesthesia is usually required for this procedure. Less product will be necessary if there is good bone projection at the malar level. Injecting over the malar eminence may be helpful in these cases. The best route for treating this area is transcutaneously. Outlining the entire area with eyeliner before injection may promote accurate filling and easy removal of the marking (Figs. 5.13 and 5.14).

Use of the frame technique will limit the area before the internal part is filled. Retrograde injection is usually preferable for a more uniform result along the frame, followed by a soft massage for smoothing any surface irregularity. For the internal part, the fan technique is undertaken from each edge of the drawing in order to promote a crossing of micro tunnels. Multilayer injections are conducted. The deep reticular dermis will be filled by starting more superficially with the needle almost parallel to the skin. Opening the angle of the needle to 30-45° will allow it to reach the subcutaneous and the muscular layers (Fig. 5.15). After filling all layers, a soft massage is conducted and a final analysis of the obtained projection is undertaken. Finally, if needed, the needle must be inserted at a 90° angle almost touching the periosteum on the most prominent parts of the malar bone for major projections. Drapes are applied to reduce edema and for correct maintenance of the position of the filler. After the edema has subsided, the final result may be evaluated (Fig. 5.16). The filling of the cheekbones should be subtle and increase slightly the midface width (Fig. 5.17).

Zygomatic Malar Enhancement
Fig. 5.13 A small triangle is demarcated at this level. Both the frame and the internal area should be filled

Fig. 5.14 When major projection is desired, the zygomatic arch level is also filled

Fig. 5.15 Injection is performed after an injection plan of the area to be treated has been drawn.

At this level, the malar prominence is enhanced

Fig. 5.16 The cheekbones were injected (a). With the improvement of the mid-third of the face, a youthful appearance may result (b)

Fig. 5.15 Injection is performed after an injection plan of the area to be treated has been drawn.

At this level, the malar prominence is enhanced

Hyaluronic Acid Filling Cheekbones

Fig. 5.17 The filling of the cheekbones must be subtle (a) and increase slightly the midface width (b)

Fig. 5.18 Skin demarcation for the injection: It is helpful to delimitate the area to be injected

Fig. 5.17 The filling of the cheekbones must be subtle (a) and increase slightly the midface width (b)

Cheekbones
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