Cannulation and injection of the muscles of facial expression: a cadaver study

Facial fat grafting typically places autologous fat in the subcutaneous plane directly under the surfaces that are deemed to need volume augmentation. Because this plane is relatively avascular, there can be variable loss of the fat graft. Placing the fat into a rich muscular vascular plexus may increase graft retention.

To explore the feasibility of engrafting the muscles of facial expression in the plane and direction of their fibers using a percutaneous approach.

Three muscles--corrugator, zygomaticus major, and depressor anguli oris--were chosen for this study. More than 50 thawed frozen cadaver heads were studied. A blunt-tipped cannula, designed to find and follow the muscle within its enveloping fascia, was introduced through an access port created through the skin using an awl. One to 2 mL of blue gel was injected per muscle from a 3-mL syringe. Immediately after injection, the muscle was dissected to determine placement of the blue gel.

Accurately targeting the muscles of facial expression for autologous fat grafting using a percutaneous approach is feasible.

With practice, the muscles of facial expression can be reliably cannulated percutaneously, permitting restoration of volumetric losses.