INTRODUCTION
Minimally invasive injectable aesthetic treatments are extremely popular. Data from an American Society of Plastic Surgeons survey shows neurotoxin and dermal fillers have continued to dramatically increase in popularity over the years. In 2014, over 13 million people had these procedures performed. An understanding of anatomy optimizes results and decreases complications. In addition to vascular and nerve structures, retaining ligaments and fat compartments are relevant for aesthetic surgeons when performing tissue augmentation. Retaining ligaments are important in attaching superficial fascia and dermis to underlying structures. They are fairly consistent anatomically and closely follow the branches of the facial nerve. However, these retaining ligaments have been inconsistently named by various investigators, leading to confusion. In addition, there are conflicting schools of thought on definition of true versus false ligaments including Furnas,1 Stuzin,2 Knize,3 Moss,4 Mendelson,4 and Muzaffar.5 The most widely used definition of true retaining ligaments, or osteocutaneous ligaments, originate from the periosteum and insert into the dermis.1,2 Currently accepted osteocutaneous ligaments include the zygomatic (McGregor’s patch), orbital, and mandibular ligaments. False ligaments originate from the fascia and also inserts into the dermis, such as the parotid cutaneous and masseteric ligaments.2 Retaining ligaments divide the fascial planes into distinct fat compartments. In relation to aging, true osteocutaneous ligaments are thought to maintain relatively fixed and resist gravitational descent, manifesting as grooves such as Lambros’s finding that the lid-cheek junction remains stable in position with time.6,7 Other ligaments do undergo descent and along with theory of volumetric loss as causes of facial aging, compartment specific augmentation is a technique for rejuvenation.
Aesthetic results obtained by using dermal fillers and neuromodulating agents can be extremely dramatic. However, there have been significant complications reported, including skin slough secondary to vascular compromise; neuropraxia; and blindness.8-16 In order to avoid complications and minimize risk, it is important for physicians to have a thorough understanding of the anatomy of these critical areas and an appreciation for potential complications that can result. While multiple types of complications have been reported, the major medical risks that can be avoided by being aware of regional anatomic structures, include vascular insults and injury to motor and sensory nerves.9,10,13
The physical act of injection can cause injury secondary to physical trauma to tissues from the needle or cannula. Injury can also result from compression caused by the filler substance on surrounding tissues and neurovascular structures. Inflammation or allergic reaction of tissues secondary to injected substances can also occur. Infection as a result of the injection introducing bacteria into tissues is also a potential risk. However, the most significant complication is embolization, which results in tissue ischemia. This can result in
Aesthetic results obtained by using dermal fillers and neuromodulating agents can be extremely dramatic. However, there have been significant complications reported, including skin slough secondary to vascular compromise; neuropraxia; and blindness.8-16 In order to avoid complications and minimize risk, it is important for physicians to have a thorough understanding of the anatomy of these critical areas and an appreciation for potential complications that can result. While multiple types of complications have been reported, the major medical risks that can be avoided by being aware of regional anatomic structures, include vascular insults and injury to motor and sensory nerves.9,10,13
The physical act of injection can cause injury secondary to physical trauma to tissues from the needle or cannula. Injury can also result from compression caused by the filler substance on surrounding tissues and neurovascular structures. Inflammation or allergic reaction of tissues secondary to injected substances can also occur. Infection as a result of the injection introducing bacteria into tissues is also a potential risk. However, the most significant complication is embolization, which results in tissue ischemia. This can result in
