Filler injection



I will now introduce you to my model, Anna. Anna is clearly young, and accordingly, she will have minimal indication for treatment. Her request to me, in fact, is that she only wants very little treatment because she has a limited budget, but also because she wants to remain looking natural, and this is not an infrequent request from our patients. When I assessed her, my idea is to try and give her the most impact with the least amount of product and the least amount of budget. If I look at her face shape, I can see that she has a nice oval shape with beautiful cheekbones and a nice chin. Our idea therefore is to create maximum impact with limited treatment.


Upper third assessment

When we look at Anna’s eyes, we are aware that she has some obvious darkening and hollowing below the eyes. This gives her a tired appearance. If I tilt her head down and she looks up, we can see the extent of this hollowness and darkness. Accordingly, we can see a little bit of filling in the area would significantly improve this, and perhaps make her look less tired. She already has very good lateral cheekbone projection, so she only really requires direct treatment of her tear trough.


Injection site markings and treatment

We will treat Anna’s tear trough with a direct approach: I have decanted some Juvederm Volbella into a 0.3 ml syringe with a 32 gauge needle. I am treating at the base of the tear trough just lateral to the mid-pupillary line, so I am happy to use a needle in this region. I need to go deep, and my needle is touching the bone here just below the orbital rim. I will use a small amount of product, (0.15 ml) and after injecting, I will just apply some gentle pressure up further medially into the tear trough, and then wipe. If we notice her following her treatment, we can see an immediate improvement in her right treated eye, compared to her left untreated eye. We can see that she appears less dark, and we are also aware when we zoom in that the lid-cheek junction on the treated eye appears higher compared to the untreated eye. We can see that a very small amount of treatment has improved her under eye hollowness. If she required more treatment, this could certainly be done at a follow up stage.


We will now treat her on her left side. Anna’s infraorbital hollow is very medial and very mild, and accordingly I prefer to use a needle, as the amount of product I need is limited, and I want precision. The swab marks the location of her infraorbital foramen, and because I will be injecting very lateral to this, I feel comfortable using a needle in this region. You will notice that I inject laterally and go down to bone. I am using my decanted needle on the other side, and I will go ahead and inject 0.15 ml of Juvederm Voluma into the region. Having injected it laterally, I can then take the bolus I have formed and just push it slightly so it goes up the tear trough. We then give it a wipe and a gentle mould and massage.


Treatment outcome

We can see Anna now at the conclusion of her treatment. We treated her lip to increase the fullness, keeping the definition maintained. We also treated her under her eye to improve the dark eye circle appearance. As we zoom into the lip, we will notice that the shape has been preserved beautifully, and yet she has now a greater balance in her lower third, with the lips being more dominant. Therefore, we have decreased the dominance of the chin. We can see that, in the side profile, the projection of the chin is natural and remains with Rickett’s line. We can also see, when we zoom out, that she has got very normal animation on the smile and pout, and she looks more refreshed and more attractive. Remember, we have only used 0.5 ml of Juvederm Volbella for her entire treatment. To really appreciate the improvement, let’s have a look at Anna’s photos from before and after treatment. As we look at these photos, we can see that, despite using very little product in her infraorbital region, there has been quite a significant improvement in her under eye hollow. This is because she already had significant lateral cheekbone support, and also a full anterior cheek. If we move down to her lower face, we can see the rather significant impact of treating the lips in a younger patient. There is a decreased distance between the base of the nose to the Cupid’s bow, and it has also significantly reduce the dominance of the chin. The lips have increased the attractiveness of her face, and overall, very limited treatment has had a significant impact.