Dr. Mario Goisis – Anatomy for safe injections: A cadaveric and clinical study

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Investigating planes of insertion in Micrograft, hyaluronic acids, calcium hidroxylapatite, PRP, threads, desossicolic acid and micro knife treatments:
Background: The aim of the study is to analyze the facial layers in which the product is released in the most common practices in aesthetic medicine, such as volume augmentation by means of hyaluronic acid, calcium hydroxylapatite, PRP, micro/nanograft, volume reduction by dessicolic acid and ptosis correction by threads. The role of resection of ligaments by micro knife is also discussed.
Materials and methods: 40 cadavers head have been treated using several techniques imitating procedure on common practice in aesthetic medicine to properly restore age related volume loss. During the simulated procedures different materials have been used: hyaluronic acid, calcium hydroxylapatite, human fat harvested from cadavers, threads and saline solution simulating PRP and dessocolic acid. Different colors have been used for the different materials in order to identify them at the dissection.
The injection of hyaluronic acid has been executed using both 27 gauges blunt cannulas and 30 gauges sharp needles. Calcium hydroxylapatite has been injected using both 27 gauges blunt cannulas and 28 gauges sharp needles. Micrograft has been injected using 22 gauges blunt cannulas and 21 gauges sharp needles, while nanograft using both 22 gauges blunt cannulas and 25 gauges sharp needles.
The colored saline used to imitate PRP has been injected using 22 gauges blunt cannulas and 30 gauges sharp needles.
The threads has been placed using 18 gauge needle to insert them under the skin.
After the injections and threads placements all cadavers head have been dissected creating 5 anatomical layers: 1-skin, 2-superficial fat compartments, 3-SMAS, 4-deep fat compartments and masticatory muscle , 5 –bone. Colored materials has been searched along the layers.
Results.
Hyaluronic acid has been placed in layer 2 for 93% of the volume injected, calcium hydroxilapatite has been injected in 92% of the cases in the layer 4, Micrograft has been injected for 93% in the layer 3, nanograft for the 83% in layer 2 e 17% in layer 3; PRP has been injected for 89% in layer 2; threads have been placed for 92% along layer 2, Dessocolic acid has been injected for 92% in layer 2, the legaments were resected in the layers 2 and 3 in 96% of cases.
Conclusion: Cadaver dissection offers various insights over injections in aesthetic medicine, focusing the relationships between anatomical structures and injectables. The analysis of facial layers offers opportunity to optimize facial injection in order to have better aesthetic results.