Why we should be avoiding periorificial mimetic muscles when injecting tissue fillers

Area of Science:

• Dermatology
• Plastic Surgery
• Aesthetic Medicine

Background:

• Facial fillers are widely used with generally good safety profiles.
• However, severe complications such as intravascular injection and late nodularity can occur.
• Injection depth is a critical factor in mitigating these risks.

Purpose of the Study:

• To investigate the implications of injecting facial fillers into the facial muscular layer.
• To identify potential adverse reactions associated with muscular layer injections.

Main Methods:

• A comprehensive literature review was conducted.
• Searched available databases for studies on facial filler injections into or around facial muscles.
• Focused on identifying links between injection site and adverse events.

Main Results:

• Literature indicates a higher incidence of adverse reactions when fillers are injected into the mimetic musculature.
• The periorbital and perioral regions' musculature are particularly implicated.
• These injections are associated with product clumping, displacement, and late-onset swelling or nodularity.

Conclusions:

• Injecting fillers into the perioral and perioral mimetic muscular layers increases risks of complications.
• These risks include product clumping, displacement, late nodularity, and swelling.
• Muscular layer injections, especially into sphincteric muscles, should be avoided to minimize adverse outcomes and intravascular injection risks.