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Injection Anatomy

Many different categories of human anatomy have been described, most of which relate to the instrument being used and the ensuing treatment or therapy (ex. surgical anatomy, radiological anatomy, etc.).  

Injection anatomy, not previously described, is centered on the fact that a syringe and needle are to be utilized, rather than a scalpel.  Where the tip of the needle resides (from which the product will flow) once under the skin is crucial.  Injecting under the skin involves encountering vital structures.  Knowledge of injection anatomy therefore pertains to the depth of injection as it relates to the location of the tip of the needle. Injection anatomy can be defined as the study of regional anatomy as it relates to surface landmarks and the underlying depth of targeted tissue and vital structures.  Although a myriad of vascular patterns exist in two dimensions, there is relative consistency in the depth (3rd dimension) at which vessels pass through the tissues in specific geographical regions of the face.   Appreciating the depth location of the tip of the needle, although not infallible, should guide treatment into “safer” lower risk zones for specific facial regions.  The clinician’s ability to delineate these facial anatomical zones at the time of treatment is limited to visual and palpable topographical assessment.  To this end, five bony and 2 soft tissue landmarks must be discerned which will divide the face into specific treatment regions according to depth.

Injection Rhinoplasty

Injection rhinoplasty has become one of the most frequently performed cosmetic procedures throughout Asia and refers to the non surgical technique of enhancing or beautifying the nose using injectable fillers delivered through a sharp needle or cannula. It is a satisfying technique for both patient and physician, relatively painless and the results are visible immediately, without the patients having to endure a protracted period of swelling, bruising and recovery. It is also cost effective as significant improvements can be seen with a single syringe of filler. Patients readily accept that they have to return on a regular basis for touch-ups as it is a quick convenient procedure and there is minimal downtime involved. Some of these patients may have an intention to eventually have surgery, using the injection technique as a stepping stone to evaluate the suitability of their new look.  In many cases the injection technique is so convenient and the results more than adequate that they may decide to avoid surgical intervention completely.

The technique is also growing in popularity amongst aesthetic physicians in the west who treat Asian patients or find it convenient to smoothen out or correct minor contour irregularities in Caucasian patients without having to resort to surgery.

With greater knowledge of the underlying nasal anatomy and the development of a variety of new fillers with different degees of cohesivity, injection rhinoplasty techniques have improved considerably over the last 15 years. It is now possible to elevate the dorsum, blending it artistically with the medial eyebrow (the orbitonasal line), project the tip forward or tilt it upwards, lower the columella, narrow the nostrils and even change the basal support of the nose by volumising the premaxilla and the sides of the pyriform aperture thus profoundly changing the shape and projection of the nose. These more cohesive and stable fillers can be placed where a cartilage graft may have been required and can more closely mimic the result of a surgical rhinoplasty.

Unfortunately injection rhinoplasty is also a technique that has found favour with beauticians and other unlicensed practitioners sometimes causing severe complications. Even amongst well trained physicians complications can occur, the most devastatating being vascular occlusions leading to skin necrosis and in some cases, blindness. The best way to minimise these complications is to understand the anatomy of the areas being injected and to practise safe injection technique.

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