Abstract
In recent years there has been a breakthrough in non-invasive techniques of facial rejuvenation. The greater understanding of the anatomical changes involved in the aging process was accompanied by rapid evolution in how to address these changes and the expansion of substances and technologies used in this approach. Of the arsenal of substances used for rejuvenation, the upper third of the face was before an almost exclusive territory of neuromodulators. Currently, fillers have stood out, especially those based onhyaluronic acid (HA), because they are safe and produce immediate and lasting – but reversible – results. The objective of this first article is to provide a brief literature review and update on the use of HA fillers in the rejuvenation of the upper third of the face, focusing on the forehead and glabella areas
Highlights
The upper third of the face comprises the area covering the hair line or the frontal muscle extension in bald patients, eyebrows and the nasal dorsum and temples.[1,2,3]ANATOMY Recent studies in fresh cadavers without fixation suggest that the facial subcutaneous fat is divided into compartments separated by fibrous septa, where the vessels irrigating the skin lie
The skin in this region is thick and inelastic and in the frontal region consists of five layers: skin; subcutaneous cellular tissue; galea aponeurotica; loose areolar tissue and periosteum2,6– identified by the mnemonic SCALP (Skin, Connective tissue, Aponeurosis, Loose areolar connective tissue, Pericranium).The vascular structures and nerves are mainly located in the fibrous septa connecting the subcutaneous cellular tissue with galea aponeurotica
Chart 1: Hyaluronic acid options according to cohesiveness, viscosity and indication: Volumizing forehead and glabella Superficial filling of frontal and glabellar lines Juvederm Voluma Juvederm Refine, Juvederm Ultra, Vollift or Fortelis Extra or Modelis (Intense or Volume Belotero)
Summary
The upper third of the face comprises the area covering the hair line or the frontal muscle extension in bald patients (upper limit), eyebrows and the nasal dorsum (lower limit) and temples (lateral limits).[1,2,3]. Volume reduction takes place due to bone reabsorption, and loss or thinning of fat compartments,[8] altering the youthful convexity of the forehead, which begins to show concavities in the mid third and sides Such changes deepen the frontal wrinkles and contribute to the poor positioning of eyebrows and eyelids, which, not having the appropriate height and projection anymore, lend a tiring or aged appearance to individuals.[3,9] Cosmetic dermatology specialists know that the isolated use of botulinum toxin in these cases might accentuate the eyebrow ptosis, as a result of the weakening of the frontal muscle.Volume replacement becomes necessary for rejuvenation of the upper third of the face, recovering the natural projection and repositioning eyebrows.[9]
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