What is the recommended approach for lateral lifting with dermal fillers, such as hyaluronic acid (HA) fillers like Juvederm (hyaluronic acid) Voluma?

Lateral Lifting with Dermal Fillers: Recommended Approach

For lateral facial lifting, hyaluronic acid (HA) fillers should be administered using a 22G x 2 inches (~5 cm) cannula for safety, particularly in areas near the eyes, with small amounts (0.2-0.5 mL per quadrant) injected in a retrograde fashion above the orbicularis oculi muscle. 1

Anatomical Considerations for Lateral Lifting

• When performing lateral lifting with HA fillers like Juvederm Voluma, understanding the facial anatomy is crucial to achieve optimal results while minimizing risks
• Target areas typically include:
  • Lateral cheek/zygomatic arch region
  • Temporal hollows
  • Lateral jawline

Recommended Injection Techniques

Cannula vs. Needle Selection

• Cannula approach (preferred for safety):
  • Use a 22G x 2 inches (~5 cm) cannula for areas near the eyes 1
  • Use a 25G cannula with only two entry points for other facial areas 1
• Needle approach (when precision is needed):
  • Use small gauge needles (27-30G) for more precise placement 1
  • Inject in a retrograde fashion for better distribution and safety 1

Injection Depth and Placement

• Injection depth should be above the orbicularis oculi muscle for vessel safety 1
• Inject 0.2-0.5 mL per quadrant/treatment area 1
• For lateral lifting effect:
  • Place filler on periosteum or deep subcutaneous plane
  • Create strategic support points that provide lift through vector forces

Filler Selection for Lateral Lifting

• Hyaluronic acid fillers are the most commonly used and recommended:

  • Provide immediate volumizing effects 2
  • Allow for correction if needed (reversible with hyaluronidase) 3
  • Offer hydrating properties beyond mere volume 3
  • Higher G' (elastic modulus) fillers like Voluma provide better lifting capacity 4

• Robust structural HA fillers (like VYC-25L) offer:

  • Enhanced projection and lift capacity
  • Significant moldability immediately after injection
  • High levels of tissue integration
  • Duration of clinical effects typically lasting at least 24 months 4

Safety Considerations

• Patient warning: Inform patients about potential bruising and swelling, which is common when treating periorbital areas 1
• Vascular complications: Use cannulas in high-risk areas to minimize risk of vascular occlusion 5
• Injection volume: Less product is typically required with higher G' fillers compared to other fillers with similar indications 4
• Treatment sessions: Consider splitting treatment over two or more sessions when using robust structural fillers 4

Combination Approaches

• Synergistic treatments: Combining HA fillers with autologous platelet concentrates (APCs) may provide enhanced rejuvenation effects 1

  • An RCT showed that combining PRP and HA (50:50 mix) provided significant improvement in facial appearance and skin elasticity compared to either treatment alone 1
  • This combination offers both immediate volumizing (from HA) and regenerative benefits (from APCs)

• Post-laser application: If combining with laser treatments, perform laser treatment first, followed by filler injection, as APCs applied prior to laser therapy can result in cell damage 1

Pitfalls to Avoid

• Overcorrection: The most frequent complication with HA fillers 2
• Injection plane errors: Placing filler too superficially can create visible lumps
• Inadequate volume: Using insufficient product will not achieve the desired lifting effect
• Ignoring facial asymmetry: Always assess and address pre-existing asymmetry before injection

By following these guidelines for lateral lifting with dermal fillers, clinicians can achieve effective facial rejuvenation with minimal risk of complications while providing patients with natural-looking results.