exact application location. We observed and documented the indication and precise penetration depth, using staining evidence surrounding anatomical structures.
In both cases, the process was gradual. Pressure, volume, and depth parameters were empirically assumed and applied to the entire area of half a face. The applications were then visually inspected and meticulously characterized using a precise dissection technique. The settings were recalibrated and consequently applied to the second half of the face. There was a noticeable and accurate penetration into the target area. The second application was initially only carried out using Pintasol blue to observe a specific penetration setting. Afterward, however, all three colors were further applied as on the other face side. The second face side was then visually inspected and meticulously characterized using a precise dissection technique for the previous observation. A hyaluronic acid mixture (marked in red) was used to characterize the structures in the middle subcutaneous area: medial cheek area, perioral, and periocular.
A green-colored NaCl mixture was introduced to observe submandibular and submental fat body penetration. The procedure mimicked different energy settings of volume and pressure created to be used as chemical lipolysis.
Injections of the contrast materials were performed using a commercial jet-injection device (Enerjet 2.0, PerfAction Technologies, Rehovot, Israel). The device operates on compressed air and ejects a powerful stream of liquid (liquid jet) under control of the device software. The injection pressure can be set between 2 to 4 bars; the injection volume is ranged from between 50 to 150μl. The maximum jet velocity is 150 m/ sec and allows for easy and fast skin penetration at the entry point of ø200 micron. The dispersion zone has an average diameter of 10 mm, according to the device manufacturer.
RESULTS
Fascial and periosteal structures were targeted to test the distribution effectiveness of solutions, which would ultimately initiate lifting. A mixture of 20% glucose, NaCl, lidocaine, and blue color marking was used as a tightening and lifting solution. The following served as target structures: superficial temporal fascia, the mandible zygomatic arch, the mandible, the SMAS in the lateral cheek area, and the retinacula cutis (zygomatic, buccal, mandibular).
Moderate energy was used (35–50%). There is a clear external marking of the Enerjet application (A). However, the glucose- NaCl mixture did not penetrate down to the temporal fascia, the SMAS or the zygomatic arch (B). In contrast, the same mixture did show a high penetrance into the fat bodies located in the submandibular and submental region (C). Both mixtures (glucose-hyaluron) applied low energy applications showing dermal and subdermal penetration, deep facial structures remain unaffected. At high energy levels (pressure 100%, volume 100μl), deep regions were perforated with the blue colored glucose-NaCl mixture. There was explicit penetration to the temporal fascia, to the periosteal structures, and the cheek fat structurally bonding retinacula. A more intensive
Moderate energy was used (35–50%). There is a clear external marking of the Enerjet application (A). However, the glucose- NaCl mixture did not penetrate down to the temporal fascia, the SMAS or the zygomatic arch (B). In contrast, the same mixture did show a high penetrance into the fat bodies located in the submandibular and submental region (C). Both mixtures (glucose-hyaluron) applied low energy applications showing dermal and subdermal penetration, deep facial structures remain unaffected. At high energy levels (pressure 100%, volume 100μl), deep regions were perforated with the blue colored glucose-NaCl mixture. There was explicit penetration to the temporal fascia, to the periosteal structures, and the cheek fat structurally bonding retinacula. A more intensive
