Forehead Area
Anatomical Boundaries: The superior forehead margin is located at the hairline, and the lateral border is formed by the temporal crest, where the frontalis and temporalis muscles fuse.
Forehead Height by Ethnicity: The forehead height tends to be shorter in South American and Asian patients, while it is higher in Caucasians and Africans.
Aging Effects:The forehead surface increases due to hairline recession, widening of the orbital rims, and the descent of the eyebrows as part of the aging process.
Muscle Considerations for Neuromodulator Treatments: Key muscles for neuromodulator treatment in this area include the frontalis, corrugator, and procerus muscles, targeting the forehead and glabella.
Vascular Considerations: The supratrochlear and supraorbital vessels are the main vessels in this area, and depth awareness is crucial to avoid complications like blindness from inadvertent intravascular filler injection.
Nerve Considerations: The deep branch of the supraorbital nerve runs 1 cm medial to the temporal crest. Injections in this region should avoid sharp needles to minimize pain and prevent nerve damage.
Injection Safety: Injections near the temporal vein must be carried out with caution to avoid inadvertent injection and the risk of embolism.
Temporal Region
Anatomical Boundaries: The temporal region extends from the temporal crest to the zygomatic arch, with the orbital margin as the anterior limit and the hairline as the posterior limit.
Temporal Hollowing and Aging: Temporal hollowing is uncommon in African skulls due to the thick temporal bone. The aging process causes the lateral orbital margin to widen and leads to bone resorption, resulting in a hollowed, aged appearance.
Vascular Considerations: The temporal artery runs through the temporal fossa, and its anastomosis with other vessels presents a potential danger zone for blindness after filler injection. The temporal area also contains important veins, including the middle temporal vein, which is dangerous if mistakenly injected and can result in embolism.
Injection Safety: Injections in the temporal area should be either very deep or very superficial. Knowledge of the middle temporal vein’s course, located 1-2 cm above the zygomatic arch, is essential to avoid complications.
Glabella Area
Anatomical Boundaries: The glabella is the area between the eyebrows, above the nose bridge, and below the forehead.
Muscle Considerations for Neuromodulator Treatments: Key muscles in this area include the corrugator supercilii, which creates frown lines, and the procerus, responsible for horizontal lines across the nose bridge.
Vascular Considerations: The supratrochlear and supraorbital arteries are critical vessels in this region. Intravascular injection can cause serious complications like tissue necrosis or blindness.
Injection Safety: Careful needle placement is necessary to avoid vessels, using either a superficial or deep approach.
Periorbital Area (Eye Area)
Anatomical Boundaries: The periorbital area includes the upper and lower eyelids, extending to the lateral canthus (outer corner of the eyes).
Aging Effects: Skin laxity leads to drooping of the upper eyelids and puffiness of the lower eyelids, while wrinkles, commonly known as crow’s feet, form around the outer eyes due to muscle activity.
Muscle Considerations for Neuromodulator Treatments: The orbicularis oculi muscle, responsible for blinking and squinting, is a key target for treating crow’s feet with neuromodulators.
Vascular Considerations: The infraorbital artery and vein in the lower lid and the lacrimal artery near the lateral canthus are significant vessels in this region. Filler complications can result in bruising or blindness.
Injection Safety: Superficial injections should be carefully placed to avoid the thin skin and vessels in this area.
Nose Area (Rhinoplasty & Non-Surgical Rhinoplasty)
Anatomical Boundaries: The nose area includes the bridge, nasal tip, and alae (nostril wings).
Aging Effects: Cartilage weakening and bone resorption cause changes in the nasal structure, leading to nasal tip drooping and other alterations.
Muscle Considerations for Neuromodulator Treatments: The nasalis muscle, which compresses the nostrils, can be treated with neuromodulators to reduce nasal flare.
Vascular Considerations: The dorsal nasal artery and angular artery are critical vessels in the nose area. Intravascular injections here carry a high risk of blindness and tissue necrosis.
Injection Safety: Thorough knowledge of the vascular anatomy is essential to safely perform non-surgical rhinoplasty.
Cheek Area (Midface)
Anatomical Boundaries: The cheek area extends from the lower eyelids to the nasolabial folds and zygomatic arch.
Aging Effects: Volume loss in the midface leads to sagging, flattening, and deepening of the nasolabial folds. Skin laxity also contributes to jowl formation.
Muscle Considerations for Neuromodulator and Filler Treatments: The zygomaticus major and minor muscles elevate the upper lip and corners of the mouth, while the levator labii superioris muscle helps lift the upper lip.
Vascular Considerations: The infraorbital and facial arteries are important vessels in this area. Deep injections should be carefully placed to avoid vascular injury.
Injection Safety: Filler placement should be deep, close to the bone, to minimize the risk of injuring superficial vessels.
Nasolabial Fold Area
Anatomical Boundaries: The nasolabial fold runs from the sides of the nose to the corners of the mouth.
Aging Effects: Deepening of the folds occurs due to volume loss in the cheeks and midface, along with skin laxity.
Vascular Considerations: The facial artery runs along the nasolabial fold, posing a risk of complications such as necrosis if injected incorrectly.
Injection Safety: Superficial filler placement is crucial to avoid injuring the facial artery, and deep injections should be performed with care.
Lip Area (Perioral Region)
Anatomical Boundaries: The lip area includes the upper and lower lips, extending into the surrounding perioral region.
Aging Effects: Volume loss in the lips leads to thinning and flattening of the cupid’s bow, while perioral lines (smoker’s lines) form around the lips.
Muscle Considerations for Neuromodulator and Filler Treatments: The orbicularis oris muscle controls lip movement, while the depressor anguli oris pulls the corners of the mouth downward.
Vascular Considerations: The superior and inferior labial arteries supply the lips. Intravascular injection can lead to tissue loss and other complications.
Injection Safety: Filler should be placed with precision to avoid vessel injury, enhancing the lip shape without risking necrosis.
Chin Area
Anatomical Boundaries: The chin area extends from the lower lip to the jawline.
Aging Effects: Bone resorption and skin laxity lead to chin retrusion and loss of chin definition, along with sagging and the formation of a “witch’s chin.”
Muscle Considerations for Neuromodulator and Filler Treatments: The mentalis muscle controls chin movement and is a target for reducing chin wrinkling.
Vascular Considerations: The submental and mental arteries supply the chin area, and deep injections must avoid these vessels.
Injection Safety: Filler should be placed either deep or superficial to prevent injury to the mental artery, and neuromodulator injections should be applied cautiously.
Jawline Area
Anatomical Boundaries: The jawline extends from the chin to the angle of the mandible.
Aging Effects: Loss of jawline definition results from bone resorption and skin laxity, contributing to jowling.
Muscle Considerations for Neuromodulator and Filler Treatments: The masseter muscle, responsible for chewing, can be treated with neuromodulators to slim the jawline.
Vascular Considerations: The facial artery and vein run along the jawline, and care should be taken to avoid these vessels during treatment.
Injection Safety: Filler placement should be done with care to enhance jawline definition, while avoiding key vessels, and masseter muscle treatments should target the muscle belly.
Further Reading:
- 📖 “Aesthetic Facial Anatomy Essentials for Injections” by Ali Pirayesh, Dario Bertossi, and Izolda Heydenrych
- 📖 “Facial Danger Zones: Avoiding Nerve Injury in Facial Aesthetic Surgery” by Brooke R. Seckel