Anatomical Basis for Malar Augmentation Injection With the Zygomatic Ligamentous System.

Background: The malar augmentation injection has gained popularity in recent years, but the exact location of each injection site has not been clearly identified.
Objective: To discover ideal injection sites by comprehensively considering the distributions of ligaments, muscles, and vessels.
Materials and Methods: Eighteen cadaver heads were dissected to investigate the zygomatic ligamentous system and to measure the position of muscles. Sixty-six cadaver heads were subjected to computed tomographic scanning and three-dimensional vessel reconstruction. Radiological evaluation of the fillers was performed before and after experimental injection in one hemiface and dissected to confirm safe delivery. Five patients were enrolled in a prospective clinical study. 2D and 3D photographs were taken before and after the injections for comparison.
Results: Site 1 was defined along the zygomatic arch, except the first 1/4 length and the midline of the arch. Site 2 was on the body of the zygoma, superior to the level of the infraorbital foramen and medial to the jugale. Site 3 was defined in the anteromedial midface approximately 30 mm below the lateral canthus.
Conclusion: Injections at these 3 sites can be performed within the range of the ligaments to achieve effective lifting effects and minimize potential complications.
(Copyright © 2022 by the American Society for Dermatologic Surgery, Inc. Published by Wolters Kluwer Health, Inc. All rights reserved.)