A Review of the Multilayering Technique of Injecting Dermal Fillers

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The multilayer injection technique for dermal fillers has emerged as a promising strategy in facial rejuvenation, aiming to restore volume, enhance contours, and achieve a more natural and youthful appearance by strategically placing fillers of varying rheology in multiple facial planes. This contrasts with more traditional, single-layer injection techniques. This scoping review aims to critically evaluate evidence around the feasibility, procedural approaches, outcomes, and complications associated with the multilayer approach. A review of the literature was conducted across multiple databases, including Medline, Web of Science, and Embase, for studies published between January 1, 2010, and June 4, 2024. The search included keywords related to dermal fillers, facial rejuvenation, and multilayer injection techniques. Experimental studies, including randomized control trials (RCTs), observational studies, retrospective studies, case series, and cadaver studies were considered eligible for review. The search yielded 6 studies that met the inclusion criteria: 2 cadaver studies with associated prospective studies and 4 retrospective reviews. The studies collectively involved 464 patients and 15 human cadavers. The cadaver studies focused on establishing the anatomical justification for the multilayer technique, while the clinical studies reported high patient and physician satisfaction with few complications. The multilayer injection technique is a promising approach to facial rejuvenation, offering natural-looking results with a sound anatomical basis and low risk of complications. However, the existing literature is limited by methodological shortcomings, including variations in study designs, lack of control groups, and reliance on subjective assessments. Further rigorous research is needed to validate the efficacy and safety of this technique in live patient settings.