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. 2011 Dec;4(12):32-6.

Avoiding malar edema during midface/cheek augmentation with dermal fillers

David K Funt  1
Affiliations

Avoiding malar edema during midface/cheek augmentation with dermal fillers

David K Funt. J Clin Aesthet Dermatol. 2011 Dec.

Abstract

As dermal fillers have evolved, volume restoration and contour enhancement have become the objective of advanced injectors. The value of injections of dermal fillers into the midface is well documented in the literature. However, the midface, particularly the infraorbital hollow, is the facial area most prone to adverse events from filler treatment. Malar edema is a particularly significant and long-lasting untoward event that is frequently reported. This article reviews the anatomic basis for malar edema, relates it to filler injection technique, and presents the author's preferred method of injection to help ensure avoidance of this adverse event.

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Conflict of interest statement

DISCLOSURE:Dr. Funt has received consulting fees for his work with Merz Aesthetics and serves as one of the company's medical advisors. He is also part of the national speakers bureau of Allergan Corporation and receives honoraria for educational activities. Financial support for preparation of this manuscript was provided in part by Merz Aesthetics (San Mateo, California).

Figures

Figure 1
Figure 1
Volume loss in the aging face
Figure 2
Figure 2
First injection is placed medial to the infraorbital nerve, entering perpendicular to the skin one cm beneath the inferior orbital rim. The needle is then “walked” medially toward the medial canthus, depositing 0.05 mL aliquots.
Figure 3
Figure 3
The second injection is lateral to the infraorbital nerve.
Figure 4
Figure 4
The third injection is at the malar eminence.
Figure 5A and 5B
Figure 5A and 5B
A 39-year-old woman received hydroxylapatite in her tear trough and infraorbital rim. Malar edema could be observed three weeks post injection (A). The patient was treated with 20 units of Vitrase, which led to resolution (B).
Figure 6A and 6B
Figure 6A and 6B
A 44-year-old woman received a total of 1.3mL of calcium hydroxylapatite in her midface (0.65mL per side), with malar edema evident five weeks post-treatment (A). A 40-year-old woman received a total of 2.6 mL of calcium hydroxylapatite (1.3mL per side), with malar edema evident at three weeks post-treatment (B).
Figure 7
Figure 7
Correction of tear trough and infraorbital hollow using calcium hydroxylapatite.
Figure 7
Figure 7
Correction of tear trough and infraorbital hollow using calcium hydroxylapatite.
See this image and copyright information in PMC

References

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    1. Graivier MH, Bass LS, Busso M, Jasin ME, Narins RS, Tzikas TL. Calcium hydroxylapatite (Radiesse) for correction of the mid- and lower face: consensus recommendations. Plast Reconstr Surg. 2007;120(Suppl):55S–66S. - PubMed
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