The Tower Technique: A Novel Technique for the Injection of Hyaluronic Acid Fillers
November 2011 | Volume 10 | Issue 11 | Original Article | 1277 | Copyright © 2011
A number of injection techniques have been described for the placement of hyaluronic acid fillers. Such techniques include, but are not limited to, linear threading, depot, fanning, and layering. The tower technique for hyaluronic acid filler injection is a novel variation of the depot and layering techniques. With this technique, the hyaluronic acid is deposited via a perpendicular approach to the deep tissue plane with a gradual tapering of product deposition as the needle is withdrawn. A series of towers or struts are thus created. These towers serve as support structures for the overlying soft tissue, thereby restoring the face to a more youthful appearance. The anatomic areas most amenable to this technique include the lateral brow, the nasolabial folds, the marionette lines, the prejowl sulcus, and the mental region. A detailed description of the tower technique for facial volume restoration with hyaluronic acid fillers is provided. Further prospective studies are needed to compare the efficacy, safety, and longevity of this technique to other commonly used techniques for the injection of hyaluronic acid fillers.
J Drugs Dermatol. 2011;10(11):1277-1280.
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Numerous techniques exist for injecting facial fillers. The specific technique used depends on a number of variables, including the type of filler, the anatomic location for the filler, and the preferences/experiences of the injector.
Hyaluronic acid fillers are used in various facial anatomic locations to smooth contour irregularities and augment facial features. The techniques used to inject hyaluronic acid fillers are numerous and include linear threading, cross-hatching, fanning, layering, depot injections, and the serial puncture technique.1 Another technique, the “tower-technique,” is a valuable addition to the aforementioned injection techniques. The concept of the tower technique is to create a tapering vertical tower of filler material that serves as a scaffold for the overlying soft-tissue structures (Figure 1). Whereas hyaluronic acid fillers are traditionally placed in the deep dermis and superficial subcutaneous fat, the tower technique aims to create a deep base of support that extends through the entire subcutis.
The tower technique has advantages over other techniques in certain anatomic areas, as the technique aims to fill the desired area by reintroducing the lost structural support. This technique can be used to correct the nasolabial folds and the marionette lines. The tower technique can also be used to revolumize the chin and the prejowl sulcus. Additionally, volumization of the lateral brow can be achieved with the hyaluronic acid towers.
The tower technique is appropriate for hyaluronic acid fillers. Fillers such as calcium hydroxylapatite and poly-l-lactic-acid, which require deeper anatomic placement or injection in a uniform plane, are not amenable to this technique.
Anatomy and Age-Related Changes
The nasolabial fold is defined by a series of muscles, fat compartments, and fibrous septae. The contributing muscles include the orbicularis oris, the levator anguli oris, the levator labii superioris, the zygomaticus major, and the zygomaticus minor. The superficial nasolabial fat compartment is the most medial of the cheek fat compartments. The compartment is bounded superiorly by the orbicularis retaining ligament. The suborbicularis oculi fat (SOOF) serves as the superior lateral and deep boundary. The deeper medial cheek fat surrounds the levator anguli oris. It is bounded laterally by the zygomaticus major and the buccal fat pad. Septal barriers contribute to the delineation of these fat compartments and serve as the origin of the retaining ligaments that provide support for the facial soft tissue.2
The appearance of the nasolabial fold with advancing age is due to a number of factors. The aging face needs to be viewed as a compartmentalized but inter-related three-dimensional structure. The nasolabial folds appear where thick superficial fat transitions to thinner superficial fat. However, loss of volume—