Injection Techniques for Filler Procedures With Illustration: Narrative Review

This narrative review explores the various injection techniques utilized in facial filler procedures, emphasizing their applications, benefits, and potential complications. The increasing demand for total facial contouring and rejuvenation has led to a rise in the use of volumizing fillers and the integration of these procedures with other treatments such as toxins, threads, lasers, radiofrequency, and ultrasound. Achieving satisfactory results necessitates a comprehensive understanding of facial anatomy and the effects of aging on skin tissue. Key injection techniques discussed include retrograde and anterograde injections, linear and serial threading, serial puncture, fanning, cross-hatching, bolus, towering, sandwich, tenting, and specialized methods like fern leaf and duck walk injections. Each technique offers unique advantages, such as the retrograde technique's ability to minimize vascular complications and the dual plane technique's effectiveness in achieving optimal volumization and contouring by layering different types of fillers at varying depths. The dual-plane injection technique, in particular, is highlighted for its ability to provide natural and lasting results by combining firm fillers in deep layers with softer fillers superficially, minimizing surface irregularities and filler migration. The review also underscores the importance of preprocedure planning, including the marking of injection points to ensure precision, especially in patients with facial asymmetry. This comprehensive review aims to equip practitioners with the knowledge to select and master appropriate injection techniques, tailored to the specific needs of different facial areas, thereby enhancing treatment outcomes and patient satisfaction while minimizing risks.