Injection techniques for midface volumization using soft tissue hyaluronic acid fillers designed for dynamic facial movement

Volume loss of the face occurs over time; thus, volume enhancement of the midface can counteract the effects of aging. Hyaluronic acid (HA) fillers are often used for facial revolumization for a more youthful appearance due to their favorable outcomes and safety profiles. A patient-centric approach, in which dynamic facial expressions are considered, is needed for optimal aesthetic results. In addition, injectors must be familiar with midface anatomy, how it is affected by the aging process, and must also consider the rheological and physical properties of fillers, including their stretch and dynamic strength. In this article, optimal injection techniques are described for a new range of HA-based fillers for midface revolumization using a needle, cannula, or both. The layering technique involves product placement in both the deep and superficial fat compartments to achieve natural-looking outcomes at rest and during motion. The Resilient Hyaluronic Acid (RHA^®) line of fillers was designed to maintain their durability and integrity while adapting to the dynamic movements of the face. RHA 2 is applicable for superficial placement, whereas the balanced stretch and dynamic strength of RHA 3 render it more versatile. The novel rheological properties of RHA 4, with the highest dynamic strength and sufficient stretch, allow it to be injected superficially and into deep facial compartments. Depending on patient characteristics, the appropriate RHA filler can be chosen to reach the goal of a natural, younger appearance and avoid overfilling.