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Facial anatomy and the safe delivery of injection therapies

Updated: Aug 2, 2023

The most obvious and superficial anatomical features to be considered for safe delivery of injectable therapies are the integrity of the skin and treating areas of active acne, infection or psoriatic skin may not be indicated. It would also be pertinent to assess the facial wrinkles such as the appearance of static or dynamic rhytides as it is not recommended to inject directly into them. Identifying static or dynamic rhytides such as the nasolabial fold and the glabella lines can highlight the course of the angular artery and supratrochlear artery respectively as they can often lie directly beneath these facial wrinkles.

Knowledge of facial anatomy and artery location is of paramount importance when injecting dermal filler due to complications and adverse events that may occur. When using filler injections, we are taught to inject deep onto the bone therefore the face needs to be landmarked and marked up to ascertain safe injection points over the cheekbone or angle of the jaw to avoid the parotid gland or the facial arteries and nerves. The other consideration when using a cannula is to inject to the depth of the superficial musculo-aponeurotic system. Knowledge of the facial fat pads and how they atrophy with age is also important and how replacing lost volume in the fat pads can give the patient the desired effect.

When delivering botulinum toxin injection, we are targeting muscles therefore these anatomical features need to be assessed with dynamic movement and palpated to ascertain the best place to inject. Caution needs to be applied when injecting over and around the eye as injecting too low over the eyebrow or lateral to the pupil can cause brow and lid ptosis. Knowledge of neural anatomy when delivering facial injections is also recommended.

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