The Middle third of the Face is the area that is primarily subjected to gravitational ptosis and is involved in the formation of problems in neighboring areas of the face (ptosis, deformation of the shape of the face, dislocation and swelling of fat packs, changes in the homogeneity of soft structures).

Timely correction with the help of biodegradable implants (hyaluronic acid fillers, Radiesse) allows to optimally correct age-related changes, prevent them and obtain a positive clinical and aesthetic result. There are several techniques for contouring: using a needle, a blunt cannula, or a combination of both. At the same time, it should be noted that cannula techniques are an effective and safer method with minimal tissue trauma, a shorter rehabilitation period, and a lower risk of complications.

One of the most important starting points of the injection session is ADEQUATE CLINICAL ANALYSIS OF THE PATIENT and THEIR ANATOMICAL FACIAL STRUCTURES, taking into account the age, sex, skin type and its morphology. All this allows to choose the right tactics for conducting the injection procedure and allows to predict the result of aesthetic correction.

The second step is MARKING BEFORE THE CONTOURING INJECTIONS. Marking relatively safe injection points, for the convenience of working with areas of intended correction, allows to correctly and optimally inject a product into the places of retraction, taking into account the anatomical and age-related features of the middle third of the face.

The use of a cannula in most of the volumetric modeling of the middle part of the face allows to work near anatomically dangerous areas, and reduces the risk of hematomas.

Volumetric modeling of the middle third of the face, using vectors, is the most rewarding of the lifting procedures. Compensates for lost facial volumes and restores deformed facial contours.

As we already mentioned and emphasized during our “Full face” workshop in Madrid (in March 2021), with any volumetric modeling, vector lifting and even with any “simplest” injection procedure on the face, it is CRUCIAL to consider:

• Condition and shape of bone structures
• Topography of blood vessels
• Localization of the anatomical spaces of the face
• Knowledge of facial muscles and their functions and connections
• Localization and assignment of false and true ligaments
• Knowledge of the initial location of deep and superficial fat compartments and accounting for their gravitational dislocation

Next, the differential mobility and mechanical constraints OF EACH LAYER OF THE MIDFACE must be taken into account. Multilayer treatment algorithm is purposed for adapting the treatment strategy to patient specificities.

Marking of the middle face

Beuth marking

Marking according to Beuth (Fig. 1) allows to localize the fat packages of the middle third of the face.

From the lateral edge of the eyes we Draw vertical lines down. We connect the center of the vermilion border of the lip with diagonal lines to the outer corners of the eyes. From the medial canthus of the eyes, we draw lines that intersect the two above lines. Draw a horizontal line through the base of the nose.

McGregor point

1. Draw a line from the corner of the mouth to the outer edge of the eyebrow.
2. We draw the second line from the tragus of the ear to the nose.
3. Intersection of lines – McGregor point.

McGregor’s point – a connective tissue complex, which is the intersection point of the masticatory and zygomatic ligaments.

This anatomical formation is round in shape and 1-3 cm in diameter (depending on the size of the patient’s face). It is located in the thickness of the subcutaneous fat, immediately behind the attachment of the large zygomatic muscle to the bone. This point is a reference point for the location of the permanent vessel of the perforator, and with age, due to ligament sprain, it shifts medially down by 0.5-1 cm.

Hinderer markup for cheekbone correction

1. We draw the first line from the tragus of the ear to the wing of the nose.
2. The second – from the corner of the mouth to the lateral bone edge of the orbit. The correction zone will be located in the upper-outer quadrant.

Landau marking

1. We draw a line from the tragus of the ear to the corner of the mouth;
2. The second line – from the tragus to the outer canthus of the eye;
3. Third – from the lateral canthus to the corner of the mouth.
4. Then, we divide the line drawn from the tragus of the ear to the corner of the mouth into two equal parts. We connect this point with the opposite vertex of the triangle.
5. We draw a line along the most protruding part of the cheekbone parallel to the base of the triangle.
6. The intersection of lines 5 and 4 is one of the injection points.
7. Also, the injection points are the intersection of a line drawn along the zygomatic bone with the lines of the triangle.

Cannula access point

The distance from the lateral canthus of the eye to the middle of the tragus is divided into three equal segments, the border between the upper and two lower thirds is the access point.

I hope you learned a lot of new things today. In the next part of the blog I will talk about my favorite injection techniques into the middle third of the face and products.

If you are interested in individual or group workshops with me, please contact the Top Dermal team.