PRIME Journal Vol. 8 Issue 5

IMPROVEMENTAND REJUVENATIONOF THE FACIAL CONTOUR Proposinganewvertical classificationsystem, Lakhdar Belhaouari, Pierre Quinodoz, CamilleBelhaouari, and IgnacioGarrido describe their injection techniques for rejuvenating the facial contour ABSTRACT Facial contour slackening is usually the first sign of facial ageing. Improvement and rejuvenationofthefacialcontour, which may be performed by either surgical lifting or by filler injections, is a growing demand. This article describes the anatomical background of the facial contour, the description of ensuing slackening mechanisms in this area, with the proposal of an original scale to describe the sagging severity, and additionally, technical guidance for filler injection. T HE SYMMETRICAL SYMBOL OF BEAUTY AND YOUTH, THE OVAL of the face is more than just a detail. Loss of this ‘oval’ can be a distressing experience. Few people are insensitive to the passing of time, the first sign of which can be noticeable facial slackening. Improvement and rejuvenation of the facial contour is a daily request in our aesthetic clinics, either through surgical or non‑surgical means. Inorder to offer the best advice, a soundunderstanding of the anatomy andphysiology of the ageing process, mastery of the required techniques, and knowledge of the latest products are essential. As a result of our experience and to aid amelioration of the facial contour, an original classification of this zone of the face will be proposed. Relevant anatomical and physiological considerations Classically, the cervicofacial area is divided into the upper, middle, and lower face, with the upper part of the neck often included in the lower face. Here we present a different approach not using horizontal divisions, but vertical. We have divided the face into three vertical segments from medial to lateral: the proface, the mesoface, and the metaface ( Figure 1 ). This original method of segmentation accounts for the sliding planes of the face, movement dynamics and time-related changes ( Figure 2–3 ), especially useful for the mid and lower floor of the face. The mesoface The intermediate part of the face is the main subject of this article. Its subcutaneous tissue varies in thickness but is firmly attached to the covering skin. In contrast, it adheres little to the deeper layers that it covers. The mesoface is mobile and expressive and is thus susceptible to slackening, or ptosis, with time. In contrast, because the posterior metaface adheres to the deep layers that it covers (masseter), it does not have the same freedom to become flaccid over time. In our opinion, the mesoface should not be divided into the mid and lower thirds of the face since these two parts are linked. Age-related slackening occurs across the whole area, and thus for treatment purposes, changes to this zone should be considered over its total height ( Figure 3 ). In the upper part of themesoface, around themid-face, the primarymotor element is the orbicularis oculi muscle which mobilises and raises the superficial subcutaneous malar fat pad of the mid-face during movement, while the deep malar fat pad remains attached to the underlying supporting bone. Age-related sagging only occurs in this mobile part and creates the three main grooves of the mid-face: the palpebromalar groove with the tear trough, the midcheek groove, and the nasolabial fold ( Figure 3 ) 1 . In the lower part, the contour sagging only occurs around the mesoface, forming a ‘jowl’. By contrast, sagging does not occur in the proface (chin) or the metaface. This heterogeneity in the sagging disrupts the regularity of the jawline of the face, causing loss of definition of the contour. Once the contour is broken, the more youthful KEYWORDS Face contour, rejuvenation, fillers, hyaluronic acid LAKHDAR BELHAOUARI Plastic and aesthetic practitioner, Toulouse, France email: PEER-REVIEW | INJECTABLES | 36 September/October 2018 |