Anatomy of the Facial Danger Zones

Maximizing Safety During Soft-tissue Filler Injections

Jack F. Scheuer III, M.D.; David A. Sieber, M.D.; Ronnie A. Pezeshk, M.D.; Carey F. Campbell, M.D.; Andrew A. Gassman, M.D.; Rod J. Rohrich, M.D.

Disclosures

Plast Reconstr Surg. 2017;139(1):50e-58e. 

In This Article

Abstract and Introduction

Abstract

With limited downtime and immediate results, facial filler injections are becoming an ever more popular alternative to surgical rejuvenation of the face. The results, and the complications, can be impressive. To maximize safety during injections, the authors have outlined general injection principles followed by pertinent anatomy within six different facial danger zones. Bearing in mind the depth and the location of the vasculature within each zone, practitioners can tailor their injection techniques to prevent vessel injury and avoid cannulation.

Introduction

Fillers have become a popular alternative to surgical rejuvenation of the face. Nearly 8.9 million nonsurgical procedures were performed in 2014, with 1.9 million of these being filler injections.[1] Although the results can be impressive, the complications can be even more so. Sequelae can range from slight bruising to blindness and stroke. Wide varieties of "experts" perform injections and have just as variable credentials. Compounding this with inconsistent training among practitioners, differing skill levels, and a variety of techniques, a need arises to distinguish safe practices from those that put patients at risk.

In this article, we describe general principles maximizing safety during facial filler injections, progressing to specific facial zones and pertinent anatomy. To illustrate relevant structures, a male cadaver head was procured from the University of Texas Southwestern Willed Body Program and lightly embalmed. Intraarterial and intravenous latex injections were performed.

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