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The Importance of Proper Injection Technique in Facial Rejuvenation

By

Lavanya Krishnan, MD    

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In order to understand the proper injection technique for cosmetic facial fillers, you must first educate yourself on the role fillers play in reversing the effects of aging. The mechanics of cosmetic fillers are very different from the mechanics of a neurotoxin injectable like botulinum toxin type A (Botox). Ultimately, the end goals of looking younger are the same, but the mechanics are different. Neurotoxins are meant to relax muscles, while cosmetic fillers do exactly what the name implies: “fill” areas that have lost volume due to age, excess sun exposure or a variety of other factors.

In general, fillers are considered a minimally invasive, low-risk procedure if performed by a board-certified dermatologist or plastic surgeon. Your doctor’s knowledge of facial anatomy, choice of filler, and depth of filler injections are all crucial to achieving safe, natural and long-lasting results.

Facial Anatomy

Your skin is made up of several layers, and every layer changes with age, time and gravity. The top layer, or the epidermis, is the layer we see; underneath your epidermis is the dermis, which is where molecules such as collagen and elastin are found. Collagen and elastin both provide youthfulness and strength to the skin. The next layer under the dermis is composed of fat, also known as adipose tissue; under that layer is bone.

The facial anatomy is also made up of lots of crucial anatomical blood vessels, arteries and nerves. To minimize the risk of inadvertently injecting into a blood vessel or artery, especially in the high-risk areas like around the eyes or mouth, I typically draw back on the plunger of the syringe to make sure no blood gathers in the syringe. If it does, that means I’m in contact with a blood vessel or artery and I’ll need to then reposition the needle prior to injecting the filler. Around the lips and eyes, these blood vessels branch into smaller vessels, which are close to the top layers of the skin. As a result, one typical side effect of filler injections, especially around the lips and eyes, can be temporary bruising.

Type of Fillers

The beauty of the cosmetic filler market is that there are multiple types of fillers that vary based on many factors, including the chemical makeup of the filler material and the viscosity. Your doctor’s knowledge of these factors is crucial in choosing the proper filler, as these conditions dictate what location and what depth is appropriate for each type of filler.

For example, if you’re looking for a filler for your cheeks or “smile lines,” a ”thicker” type of filler made of hyaluronic acid (HA), a substance naturally present in the human body, is a very popular choice; your doctor may go with Juvederm or Restylane Lyft. For those lines around your chin and nose, a filler made of calcium hydroxyapatite, like Radiesse, can be injected into the deeper layers adjacent to the bone. For extra volume around the eyes and to plump the lips, “thinner” HA fillers, like Restylane Silk, are typically recommended.

Depth of Injection

Knowing how deep to inject cosmetic fillers (e.g. top of the dermis, middle of the dermis, bottom of the dermis, or underneath the dermis) depends on the type of filler and where on the face the filler is being used. In general, the “thinner” the substance, the more superficially it’s meant to be injected, meaning it’s injected into the top layers of the skin. In comparison, “thicker” fillers can be injected deeper into the skin. Injecting a “thicker” filler into areas that are better suited for “thinner” filler types (such as around the eyes) can cause long-term nodules or visible bumps in these areas, among other things.

Ultimately, choosing the right filler should be done on a case-by-case basis, and is not necessarily a one-size-fits-all kind of procedure. It’s also extremely important to choose a board-certified dermatologist or plastic surgeon, rather than a general practice physician or someone who has gone through a weekend-long training course in fillers. Check the physician’s website or Healthgrades to learn their background and certifications to make sure you choose someone who is well-trained and experienced in using the right types of filler(s) in the right area(s) for your desired results.



THIS CONTENT DOES NOT PROVIDE MEDICAL ADVICE. This content is provided for informational purposes and reflects the opinions of the author. It is not a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of a qualified healthcare professional regarding your health. If you think you may have a medical emergency, contact your doctor immediately or call 911.


Lavanya Krishnan, MD

Lavanya Krishnan, MD, is a board-certified cosmetic and general dermatologist currently practicing in San Francisco.
View her Healthgrades profile >

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Publish Date: Mar 17, 2016

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