Abstract
Consideration of facial muscle dynamics is underappreciated among clinicians who provide injectable filler treatment. Injectable fillers are customarily used to fill static wrinkles, folds, and localized areas of volume loss, whereas neuromodulators are used to address excessive muscle movement. However, a more comprehensive understanding of the role of muscle function in facial appearance, taking into account biomechanical concepts such as the balance of activity among synergistic and antagonistic muscle groups, is critical to restoring facial appearance to that of a typical youthful individual with facial esthetic treatments. Failure to fully understand the effects of loss of support (due to aging or congenital structural deficiency) on muscle stability and interaction can result in inadequate or inappropriate treatment, producing an unnatural appearance. This article outlines these concepts to provide an innovative framework for an understanding of the role of muscle movement on facial appearance and presents cases that illustrate how modulation of muscle movement with injectable fillers can address structural deficiencies, rebalance abnormal muscle activity, and restore facial appearance.Level of Evidence VThis journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Highlights
Theories of facial aging have largely focused on changes in skin, underlying fat, and bone that result in sagging and folds [1], while the role of muscle in aging has generally been neglected [2]
Long-term observations of patients with certain structural deficiencies treated only with injectable fillers suggest that fillers can be used to alter muscle movement in facial esthetic treatments and may provide another tool, in addition to neurotoxins, in the armamentarium of facial muscle modulation
The aim of this article is to introduce the concept of using injectable filler treatment to modulate facial muscle action and to present cases that illustrate the use of this approach
Summary
Theories of facial aging have largely focused on changes in skin, underlying fat, and bone that result in sagging and folds [1], while the role of muscle in aging has generally been neglected [2]. The complementary and distinct ways in which injectable fillers and neuromodulators have generally been used for rejuvenation and improvement of facial esthetics [3] illustrate how skin and fat are considered separately from muscle action. The aim of this article is to introduce the concept of using injectable filler treatment to modulate facial muscle action and to present cases that illustrate the use of this approach. Filler treatment can be used to address muscle imbalance that results from structural defects with or without volume loss, and cases without substantial volume loss were selected to illustrate this approach
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