3D Topographical Surface Changes in Response to Compartmental Volumization of the Medial Cheek; Defining a Malar "Augmentation Zone".

Background: Given the widespread use of facial fillers and recent identification of distinct facial fat compartments, a better understanding of 3D surface changes in response to volume augmentation is needed. Advances in 3D imaging technology now afford an opportunity to elucidate these morphological changes for the first time. Methods: A cadaver study was undertaken in which volumization of the deep medial cheek (DMC) compartment was performed at intervals up to 4cc (n=4). 3D photographs were taken following each injection in order to analyze the topographical surface changes which we define as the 'zone of augmentation' (ZOA). Perimeter, diameter, and projection were studied. The arcus marginalis of the inferior orbit consistently represented a fixed boundary of the ZOA, and additional cadavers underwent similar volumization following surgical release of this portion of the arcus marginalis (n=4). Repeat 3D computer analysis was performed comparing the ZOA with and without arcus marginalis release. Results: Volumization of the DMC led to unique topographical changes of the malar region defined by distinct boundaries. Interestingly, the cephalic border of the ZOA was consistently noted to be at the level of the arcus marginalis in all specimens. When surgical release of the arcus marginalis was performed, the cephalic border of the ZOA was no longer restricted. Conclusions: Utilizing advances in 3D photography and computer analysis, we demonstrate characteristic surface anatomy changes in response to volume augmentation of facial compartments. This novel concept of the "zone of augmentation" can be applied to volumization of other distinct facial regions. (C)2016American Society of Plastic Surgeons

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