Received: 3 December 2022 | Accepted: 28 June 2023

DOI: 10.1002/wjo2.126

REVIEW ARTICLE

Facial fillers: Relevant anatomy, injection techniques, and

complications

Nicholas W. Clark | Debbie R. Pan | Dane M. Barrett

Duke University Department of Head and

Neck Surgery and Communication Sciences, Abstract
Durham, North Carolina, USA
Objective: The aim of this review article is to discuss the currently available facial
Correspondence fillers, their differences and indications, relevant anatomy, injection techniques, and
Dane M. Barrett, Department of Head and avoidance and management of complications.
Neck Surgery and Communication Sciences,
Duke South Yellow Zone 4000, DUMC Data Sources: Clinical experience and scientific papers.
Box 3805, Durham, NC 27710, USA. Conclusions: Reversal of facial aging via filler injection has been around since the
Email: [email protected]
late 1800s with the initial use of detrimental products. Today, many safe and
Funding information effective products exist and can be tailored to the individual patient's desired effect.
None
With the evolution of both products and injection techniques, the rate of
complications with facial filler use is low. Nonetheless, providers offering facial
filler injections should have detailed knowledge of facial anatomy, including facial
planes and soft tissue compartments. Multiple injection techniques exist. Different
techniques should be used, depending on the anatomic target. Providers should also
know how to avoid and manage complications.

KEYWORDS
cosmetic, facial, filler, injection, plastic surgery

Key Points
Facial filler is a widely popular procedure today. Various products and injection
techniques can be tailored to each individual patient to achieve ideal results. A
detailed knowledge of facial anatomy is required to properly treat patients and to
manage complications.

I NTR O D U C TI O N features such as the nasolabial folds and jowls. This leads to the
characteristic “inverted triangle” appearance associated with
Key hallmarks of facial aging include loss of facial volume and aging.
descent of facial structures. Volume loss occurs within the Facial fillers are used to counteract age‐related facial volume
subcutaneous fat compartments of the face, leading to a deflated loss as well as to reduce the appearance of fine lines and wrinkles
appearance. Weakening of facial retaining ligaments, thinning of associated with aging. Facial filler injection is the second most
the epidermis, and dermal atrophy with loss of collagen results in common nonsurgical cosmetic procedure in the United States and
descent of facial fat compartments. This can accentuate facial accounts for 3.4 million procedures annually. 1 Facial filler

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any
medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
© 2023 The Authors. World Journal of Otorhinolaryngology ‐ Head and Neck Surgery published by John Wiley & Sons Ltd on behalf of Chinese Medical Association.

World J Otorhinolaryngol Head Neck Surg. 2023;1–9. wileyonlinelibrary.com/journal/wjo2 | 1

2 | FACIAL FILLERS

injections are popular in large part due to their ease of Upper face
administration and minimal recovery time. Nonetheless, filler
injections are not without risk. Injection techniques and knowl- In the upper face, there are five forehead and temporal fat
edge of facial anatomy are vital for safe administration and compartments. Starting medially, the central compartment abuts
avoidance of complications. The ideal filler is biocompatible, the middle compartment on either side. The lateral compartments are
immunologically inert, retains volume as injected, lasts many contiguous with the temporal cheek fat which extends to the cervical
years but is easily reversible, looks and feels natural, and is fat.3 The orbital fat compartments are made up of three distinct
economical in use as well as storage. Few fillers meet all of these compartments: superior, inferior, and lateral. The superiormost
criteria. Therefore, filler selection depends on a combination of compartment lies around the superior orbit from the medial canthus
patient and injector‐centric factors. In this article, we review the to the lateral canthus.3 The inferior fat compartment is similar in that
available fillers as well as the indications for use, relevant it also extends from medial canthus to lateral canthus.3 The lateral
anatomy, and injection techniques. orbital fat compartment is contained between the temporal septum
and superior cheek septum and this fat pad is adherent to the
zygomaticus major muscle.3
DISCUSSION

Anatomy Midface

Detailed knowledge of facial anatomy is essential to treat patients The sub‐SMAS region of the midface is divided into upper and lower
safely and properly. The superficial musculoaponeurotic system regions, demarcated by the malar equator which divides the cheek in
(SMAS) is an anatomic structure through which important facial half horizontally. The upper region includes the suborbicularis oculi
vessels and nerves travel. Surek suggests thinking of facial and preperiosteal fat as well as the prezygomatic space. Injections in
anatomy as a 2‐tiered cake sitting on a platter (the facial the tear trough target the prezygomatic space. The angular artery in
skeleton).2 The middle layer of icing of the cake is the SMAS, the this area has been reported to be approximately 17 mm from midline
lower layer is the sub‐SMAS and associated structures (deep fat, and 13 mm inferior to the medial canthus. However, the angular
potential spaces, and preperiosteal layer), and the upper layer is artery can be aberrant in up to 30% of patients.2,4 The lower region
2
the supra‐SMAS and associated structures (subcutaneous layer). of the midface includes deep medial cheek fat. Deep medial cheek fat
The supra‐SMAS and sub‐SMAS layers are the most common lies deep to muscles that elevate the lip. This fat compartment can
targets for injection. To inject facial fillers correctly, it is soften the nasolabial fold prominence, and is typically accessed
paramount to understand the appropriate injection depth. Knowl- within 15 mm of the alar base.2 The angular artery in this region is
edge of facial fat compartments is also important when performing located laterally and superficially to the deep medial cheek fat
facial filler injections. Facial fat compartments are discussed below compartment and is within 5 mm of the nasolabial fold.2,4 The
and displayed in Figure 1. location of the angular artery is shown in Figure 2.

FIGURE 1 Facial fat compartments.

CLARK ET AL. | 3

TABLE 1 Filler length of action.

Filler length of action Time

Temporary Up to 6 months

Long lasting 6 months to 2 years

Semipermanent 2–5 Years

Permanent Greater than 5 years

Types of facial filler

Reversal of facial aging via the injection of facial fillers was first
trialed in the late 1800s. Paraffin, created from beech wood tar, is the
first described cosmetic facial filler.5 Although the concept of
reversing age‐related facial volume loss was sound, complications
F I G U R E 2 Landmarks for course of angular artery. Angular artery and side effects were so negative in the public eye that historians
can be found 13 mm from medial canthus and 17 mm from midline
attributed paraffin injections to slowing advancements in the
(A). Angular artery can be found within 5 mm of the nasolabial
cosmetic field for the first half of the 20th century. Silicone liquid
fold (B).
injection was popularized in the 1960s. However, it was banned for
use as a cosmetic injectable by the Food and Drug Administration
The supra‐SMAS region of the midface is comprised of multiple (FDA) in 1979 due to foreign body granuloma reaction, migration,
fat compartments (nasolabial, medial and middle superficial, and fistula formation, and even death.5 Today, injectable silicone is
lateral temporal cheek compartments) through which the orbital available for treatment of retinal detachment, but is considered illegal
retaining ligament passes superiorly and the zygomaticocutaneous for cosmetic use in some states.5 Despite setbacks with some filler
ligaments pass inferiorly. Injection between these two ligaments can materials, newer and safer products are now currently available.
2
disrupt lymphatics and subsequently cause iatrogenic malar mounds. These products are categorized by length of action, intended use,
Therefore, careful attention to midface anatomy is necessary. The advantages, and disadvantages in Tables 1 and 2.
cheek fat compartments include the medial, middle, and lateral Hyaluronic acid (HA) gel is the most popular facial filler.6 HA is
temporal cheek fat.3 The medial cheek fat is located lateral to the available in various forms with differing viscoelastic properties.
nasolabial fat and superior to the jowl fat.3 The middle cheek fat lies Restylane (Galderma) was the first FDA‐approved HA filler in 2003.7
3
anterior and superficial to the parotid gland. The lateral temporal HA is a naturally occurring substance in the body. It, therefore, has a
cheek fat is superficial to the parotid gland and connects to the very low immunogenic reaction and may be stored at room
3
cervical subcutaneous fat. temperature.7 When used as a facial filler, HA acts to stabilize,
lubricate, hydrate, and increase the viscoelastic properties of the
extracellular matrix.8 The viscoelastic properties vary depending on
Lower face crosslinking of the gel and substrate used to make the gel. These
properties are detailed most relevantly by the G′ (elastic modulus),
This region contains the retroorbicularis oris fat pad, a common which incorporates the sum of multiple factors which determine the
target for volumization. The sub‐SMAS region of the perioral face strength of the gel (including HA concentration and degree of
contains the facial artery. Facial artery branches include the chemical crosslinking).9 Swelling factor refers to the gel's ability to
superior and inferior labial arteries. In most patients, these uptake water from its surroundings after injection. As a general
arteries remain sub‐SMAS. Therefore, in this region, injections principle, as G′ increases, swelling factor decreases.9 As G′ increases,
2
should remain in the supra‐SMAS plane. The sub‐SMAS region of the product has greater resistance to compressive forces and
the jawline contains the mandibular osteocutaneous retaining therefore provides more correction. Lower G′ values are injected in
ligament and the platysma mandibular ligament. These ligaments more superficial planes with fewer degrees of correction needed.
are the injection boundaries used when addressing the prejowl Higher G′ values are indicated for deeper plane injections with more
area. The supra‐SMAS region of the jawline is made up of superior degrees of correction needed.9 Resistant HA (RHA) fillers are a newly
and inferior jowl compartments separated by the platysma FDA‐approved type of HA filler. RHA is crosslinked using technology
mandibular ligament. The jowl fat compartment underlies the that reduces degradation of HA chains during production.10 This
nasolabial fat compartment. The jowl fat compartment is a leads to a product with preserved natural HA polymer. The preserved
distinct entity which is adherent to the depressor anguli oris HA polymer results in fewer covalent bonds for stabilization,
muscle. 3 culminating in a product that is less rigidly crosslinked.10 These
 4
|

TABLE 2 Summary of facial fillers.

Filler Trade name Length of action Purpose Advantages Disadvantages

Hyaluronic acid (HA) Multiple including: Restylane Temporary Wide range of indications Available in different G′ Temporary, may require repeat
(Galderma), Juvederm including fine wrinkles to formulas which remain injections to maintain
(Allergan), Belotero deep wrinkles, nasolabial easy to inject, reversible desired effect
(Merz), Revanesse folds, periocular and with hyaluronidase
(Prollenium), RHA perioral lines, malar and lip
(Teoxane) augmentation

Collagen Human: CosmoDerm and Temporary Fine wrinkles up to deep Naturally occurring material Requires double skin testing (if
CosmoPlast (Allergan); wrinkles with 20+ year history of nonhuman derived) before
Bovine: Zyderm safe use injection, chance of allergic
(Allergan); Porcine: reaction. Most require
Evolence (Ortho refrigerated storage
Dermatologies)

Poly‐L‐lactic acid (PLLA) Sculptra (Sanofi‐aventis) Long lasting Stimulates collagen production, Can last up to 2 years. FDA‐ Requires time to see effects and
higher viscosity, moderate approved for facial repeated injections initially,
to severe rhytids, facial adipose loss associated not recommended for
volumization with HIV/AIDS periocular or perioral
injection

Calcium hydroxyapatite (CaH) Radiesse (Bioform) Semipermanent Stimulates collagen production. FDA‐approved for facial Highly viscous and predisposed
Moderate to severe adipose loss associated to nodule formation, not
wrinkles, nasolabial folds, with HIV/AIDS recommended for fine lines,
marionette lines, prejowl lips, or periocular injection
sulcus, facial volumization

Autologous Fat Not applicable Permanent (varies) Wide range of facial filler Autologous, relatively easy to Typically needs repeat injections
applications harvest, may serve as some fat is resorbed
regenerative capacity
given presence of
multipotent stem cells

Polymethylmethacrylate Artefil (Suneva) Permanent Medium to deep wrinkles, Can last up to 5 years Contains bovine collagen, needs
(PMMA) Aquamid (Contura) nasolabial folds, facial acne skin testing. Can take
scars months to see final effects,
not recommended for
perioral or periocular
injection
FACIAL FILLERS
CLARK ET AL. | 5

properties allow RHA gels to respect and accompany facial dynamics Injection techniques
while maintaining resiliency.10
Calcium hydroxyapatite (CaH) is a semi‐permanent filler made up Before any injection, the patient's skin should be cleaned and sterilized.
of small spheres suspended in a carboxymethylcellulose carrier. CaH This is commonly done with alcohol. Topical anesthetic or nerve blocks
stimulates collagen synthesis through an inflammatory mediated may be used depending on the provider and patient preference. Many
mechanism whereby collagen replaces the injectate over the course filler products are available with lidocaine premixed. Injections can be
11
of 3 months while maintaining the volume initially injected. CaH is performed with either a needle or cannula. Injection performed with
thicker and has a higher elastic modulus than HA. CaH tends to last needle has higher risk of vascular occlusion compared to cannula but
longer than HA.8,11 other factors such as experience play a role in vascular occlusion rates.16
Poly‐L‐lactic acid (PLLA) is a biodegradable inactive material made Needle injection allows faster acquisition of desired injection depth in the
from corn starch. PLLA is comprised of small particles (40–63 µm) which tissue with a higher risk of vascular injury. Cannula requires a large bore
cause an inflammatory response and subsequent fibroblast activation.12,13 needle or similar skin incision to introduce the cannula but carries a lower
The particles are slowly degraded over time and replaced with collagen. risk of vascular occlusion.
13
The effects from PLLA injection can be seen for up to 2 years. Linear threading technique is performed by injecting filler as the
Collagen, a temporary facial filler, is available in human, bovine, needle is either advanced or withdrawn within the tissue. This
or porcine‐derived formulas. Nonhuman‐derived formulas require technique is commonly employed in lips and the nasolabial fold
skin testing, as allergic reactions can occur.13 The FDA approved regions.7,13 Serial puncture technique involves small aliquot of filler
bovine collagen as the first cosmetic injectable filler in 1981.5,7 to be delivered to an area via multiple separate punctures. This
Collagen has a short duration of effect, typically 3–6 months, and technique is ideal for depositing filler in the superficial levels of the
requires refrigerated storage.7,13 Polymethylmethacrylate (PMMA) is dermis. It is commonly used in the glabellar region to address fine
a synthetic permanent filler made of microspheres suspended in wrinkles in a bolus fashion.7
bovine collagen. The microspheres in PMMA promote collagen Cross‐hatching and fanning techniques are two techniques
production in the body. PMMA effects can last up to 5 years. Fillers employed to distribute filler over larger areas.7 Fanning is the
such as HA, CaH, and PLLA are all FDA‐approved and each promotes process of making multiple linear passes along the same plane over
production of the body's own collagen.12 an area without withdrawing the needle or cannula from the tissue.
Autologous fat, an avascular‐free tissue graft, can also be used This technique can be useful for the deep malar region and nasolabial
for facial fillers. Autologous fat was first described for cosmetic use in fold.13 Cross‐hatching is the process of injecting filler in a grid‐like
the late 1800s and early 1900s. Although widely used today, it did pattern. Cross‐hatching is commonly employed around the oral
not gain wide popularity until high vacuum suction was introduced in commissure.13 Figure 3 shows examples of each injection technique.
1892.5 Fat is typically harvested from the abdomen or thigh with
liposuction cannula. Harvested fat is then treated either via
centrifuge or filtration before it is injected into the patient. Injection zones
Advantages of autologous fat include its biocompatibility, easy
harvesting, and ability to achieve a natural appearance. Disadvan- Different injection techniques should be employed in different areas
tages of autologous fat include variable length of effects due to loss based on the anatomic location. These areas are discussed below and
of injected fat.12 Various factors play a role in long‐term retention of graphically depicted in Figure 4.
adipose tissue such as patient age, technique of harvesting,
processing, and injection of adipose tissue.14 Gerth and colleagues
showed fat processed via filtration had significantly higher long‐term Temporal region
mean retention compared to centrifuged fat (31.8% vs. 41.2%) but
retention was quite variable.14 Gerth and colleagues showed that In the temporal region, the superficial temporal artery and middle
those younger than 55 years old and those who did not undergo temporal vein travel in the fat pad between superficial and deep
concurrent rhytidectomy both had significantly higher fat retention at temporal fascia.17 Multiple injection techniques can be used in this
14
follow‐up. Adipose tissue has been shown to contain multipotent area based on injector preference. Linear threading injection to avoid
stem cell populations.15 Therefore, autologous fat grafts may serve vasculature can be employed. In this area, cannula technique is
some regenerative effects when used as a facial filler. recommended to reduce the risk of vascular injury as well as

FIGURE 3 Filler injection techniques. (A) Linear threading, (B) depot/serial puncture, (C) fanning, (D) cross‐hatching.
6 | FACIAL FILLERS

medially.18 Injection in this area can be performed either with serial

punctures, with larger volumes of filler in a supraperiosteal plane, or with
a fanning technique in a more superficial but sub‐SMAS plane.

Tear trough

The angular artery and infraorbital artery are at risk in this region.
Injection can be accomplished via needle or cannula injection. The
most common technique is retrograde linear threading.20 The ideal
injection depth is deep to the orbicularis oculi muscle and superficial
to the periosteum. In a review by Rao et al.20 the authors could not
definitively determine the safest technique when comparing use of
needle versus cannula.

F I G U R E 4 Anatomic zones and techniques for filler injection. Nasolabial fold

Temporal region (A), glabellar and brow region (B), orbital and cheek
region (C), nasolabial fold (D), prejowl sulcus and mandibular line (E).
The facial artery closely follows the nasolabial fold. Injections in this
region should use a linear threading technique or fanning injection
inadvertent deep injection preperiosteally.18 One useful technique is techniques. Use of cannula should be considered in this region to
to place a single depot of filler at the depth of the hollow in the sub‐ lessen vascular injury risk.18
SMAS plane just deep to the superficial layer of the deep temporal
fascia. This fascial layer is a natural glide plane that allows the injector
to massage the filler within the hollow and to smooth out any Prejowl sulcus and mandibular line
irregularities. A single depot site at the depth of the hollow avoids
injection near the superficial temporal artery, sentinel vein, and The submental artery and facial artery are the two main vessels in
perforating vessels. this region. The facial artery crosses over the mandible just anterior
to the masseter and can be palpated at the antegonial notch. The
submental artery branches off the facial artery and is typically
Brow region encountered in the paramedian chin.17 Multiple injection techniques
may be employed for the prejowl area. These techniques include
The supraorbital, supratrochlear, dorsal nasal, and angular arteries fanning or crosshatching in either deep dermal or dermal‐
anastomose in the glabellar region are relatively superficial. Thus, this subcutaneous depths. Avoidance of the facial artery is important
region incurs an increased risk of vascular injury. The supratrochlear during jawline injections. Depth of injection should be kept
artery is closely related to glabellar frown lines.17,19 Injection subdermal along the jawline.17 Chin injections should be placed deep
techniques directed medially in this area should consist of superficial, in the midline to avoid submental artery branches.17
intradermal serial punctures along the facial wrinkles as well as digital
pressure to occlude the supratrochlear and supraorbital arteries to
prevent backflow.18 Supraorbital injections are directed near the Complications of facial fillers
junction of the lateral and superior orbital fat compartments at the
tail of the lateral brow. A slow supraperiosteal bolus along the orbital Complications from injection of facial fillers are relatively rare but
rim in this location can be massaged upward to both support and lift can have devastating consequences. Systematic review of
the tail of the lateral brow. nonpermanent facial fillers by Oranges et al. 8 found the nose
and nasolabial fold areas to have the highest complication rates.
This is likely related to complex and dense vascular branching in
Cheek region these areas. Helpful techniques to avoid complications in this
area include aspiration before injection as well as serial injections
The infraorbital foramen can be approximated by visualizing a vertical into the periosteal layer.8 Trinh and Gupta6 performed a
plane along the medial limbus that is one fingerbreadth below the orbital systematic review of adverse events related to HA injection.
rim.18 Injections should be administered lateral to the infraorbital They found that higher injection volume, delayed hyaluronidase
foramen. Injections medial to the foramen should be avoided. If filler is administration, and use of fanlike injection techniques all
needed in this area, it should be injected laterally and massaged contributed to adverse events.6 One specific complication,
CLARK ET AL. | 7

named the Tyndall effect, results in a bluish discoloration of the hyaluronidase dosage based on anatomic location or by compli-
overlying skin. This is caused by very superficial injections of filler cation.23 To correct HA filler injection, they suggest small doses
which causes light to scatter differently over areas containing the in the lower lid (1.5 units) and larger doses in the nose or perioral
superficial injected material. 7,13 The Tyndall effect is most likely region (15–30 units). 23 In the event of vascular occlusion, high
to occur in areas of thin skin such as the lower eyelid. To avoid doses of up to 1500 units should be used.23 In the setting of
this complication in the tear trough area it is recommended to impending blindness, retrobulbar injection of 150–200 units is
avoid superficial injection, not overfill (typically no more than recommended in 2–4 mL of diluent.22
21
1 mL), and use a product suitable for this area. Protocols to prevent skin necrosis after vascular occlusion vary.
Associated complication rates based on needle vs cannula Common recommendations consist of warm compresses to the
technique have been studied in the literature. A retrospective cohort affected area, nitroglycerin paste to promote local vasodilation,
study of board‐certified dermatologists evaluated complications of administration of filler reversal agent (hyaluronidase), systemic
filler injected with needle or cannula. This study found 77.1% lower steroids to reduce swelling and inflammation, acetylsalicylic acid to
odds of vascular occlusion with cannula compared to needle reduce plate aggregation, and antibiotics to prevent infection.24
injection.16 This study also showed those with more than 5 years Some protocols even recommend hyperbaric oxygen therapy.24
of injecting experience had 70.7% lower odds of occlusion than those Complications and management of filler injections are summarized
with less experience.16 in Table 3.
One major advantage of HA use is its reversibility. Hyaluron-
idase dissolves HA and can be used to reverse HA injection.
Hyaluronidase effectively reduces edema and improves blood CONCLUSION
flow from vascular occlusion.22 Dosages of hyaluronidase vary
depending on the product used. Doses range from 50 to 150 units Facial filler injections are commonly utilized as volumizing agents
to remove nodules and up to 1500 units in divided injections for in cosmetic procedures to reduce the effects of aging. Over time,
17,23
intravascular injection. King and colleagues suggest selecting advancements have been made that enhance the safety profile

TABLE 3 Complications of filler injection and management strategies.

Complication Incidence25,26 Management

Mild/temporary

Local edema 0.26–0.44 Skin massage,8 hyaluronidase,8,27,28 ice packs,27–29 intralesional steroids,28 oral
steroids8,28,29

Injection site pain 0.20–0.38 Ice packs29

Ecchymosis 0.23–0.35 Ice packs,29 firm pressure,27 vascular lasers,27–29 topical arnica30

Erythema 0.19–0.33 Hyaluronidase,8,27 ice packs,27 topical steroids29

Tyndall effect 0.03–0.11 Hyaluronidase,27–29 minimal stab incision with evacuation of residual filler if persistent28

Skin paresthesia 0.01–0.35 Hyaluronidase,29 intralesional steroids29

Filler migration 0.01–0.17 Removal of filler material27

Nodules or granulomas 0.01–0.10 Skin massage,27,28 hyaluronidase,29 intralesional steroids +/− 5‐FU,27–29 oral steroids,27–29
oral antibiotics,28,29 minimal stab incision with evacuation,28 excision8,28,29

Local infection 0.01–0.03 Oral antibiotics,8,27–29 acyclovir if herpetic vesicles,8,28,29 avoid hyaluronidase until infection
cleared27

Severe/permanent

Vascular occlusion 0–0.02 Hyaluronidase,8,27 aspirin,8,27 skin massage,27 warm compresses,8,27 topical nitroglycerin
paste8,27

Skin necrosis 0–0.02 Antibacterial ointment,8,31 daily local wound care regimen with debridement,8,31 hyperbaric
oxygen8

Ophthalmoplegia Case reports Retrobulbar space injection of hyaluronidase and corticosteroids,8,32 oral steroids8,31

Decreased visual acuity or Case reports Ophthalmic arterial injection of hyaluronidase and urokinase,8,27,32 retrobulbar space
vision loss injection of corticosteroids and tobramycin,8,27,32 ocular massage,32 intravenous
mannitol,32 acetazolomide,32 anterior chamber paracentesis,8,31,32 hyperbaric oxygen8,31
8 | FACIAL FILLERS

and utility of different filler substances as well as injection 9. Fagien S, Bertucci V, von Grote E, Mashburn JH. Rheologic and
techniques. While individual expectations and provider experi- physicochemical properties used to differentiate injectable
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707e‐720e.
understanding of facial anatomy and evidence‐based techniques 10. Kaufman‐Janette J, Taylor SC, Cox SE, Weinkle SH, Smith S,
such as distribution, dose, and depth can reduce complication Kinney BM. Efficacy and safety of a new resilient hyaluronic acid
rates. Successful management of complications also relies on a dermal filler, in the correction of moderate‐to‐severe nasolabial
folds: a 64‐week, prospective, multicenter, controlled, randomized,
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1244‐1253.
A U T H O R C O N TR I B U T I O N S 11. Bass LS. Injectable filler techniques for facial rejuvenation, volumiza-
Nicholas Clark performed literature searches, compiled, and edited tion, and augmentation. Facial Plast Surg Clin North Am. 2015;23:
479‐488.
the manuscript, and created tables and figures. Debbie Pan was
12. Crowley JS, Kream E, Fabi S, Cohen SR. Facial rejuvenation with fat
involved with literature search, edited manuscript, and creation of
grafting and fillers. Aesthet Surg J. 2021;41:S31‐S38.
figures. Dane Barrett was involved with the editing, creation of the 13. Rohrich RJ, Nguyen AT, Kenkel JM. Lexicon for soft tissue implants.
manuscript, and creation of figures. Dermatol Surg. 2009;35(suppl 2):1605‐1611.
14. Gerth DJ, King B, Rabach L, Glasgold RA, Glasgold MJ. Long‐term
volumetric retention of autologous fat grafting processed with
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The authors have nothing to report. 15. Zuk PA, Zhu M, Mizuno H, et al. Multilineage cells from human
adipose tissue: implications for cell‐based therapies. Tissue Eng.
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The authors declare no conflict of interest.
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Dermatol. 2021;157:174‐180.
D A TA A V A I L A B I L I T Y S T A T E M E N T 17. Wollina U, Goldman A. Facial vascular danger zones for filler
The data is publicly available as this is the review article. Any injections. Dermatol Ther. 2020;33:e14285.
18. Scheuer 3rd JF, Sieber DA, Pezeshk RA, Gassman AA, Campbell CF,
deidentified data can be made available upon request to the
Rohrich RJ. Facial danger zones: techniques to maximize safety
corresponding author. during soft‐tissue filler injections. Plast Reconstr Surg. 2017;139:
1103‐1108.
ETHICS STATEME NT 19. Vural E, Batay F, Key JM. Glabellar frown lines as a reliable landmark
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20. Rao BK, Berger LE, Reilly C, Alamgir M, Galadari H. Tear trough filler
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