title: Three-Dimensional Changes in the Midface Following Malar Calcium Hydroxyapatite Injection in a Cadaver Model.
abstract: BACKGROUND
  Three-dimensional (3D) changes in the midface following malar calcium hydroxyapatite (CaHa) injection have not been systematically analyzed.
  
  
  OBJECTIVE
  The authors analyzed 3D volume changes in midface and naso-labial fold (NLF) volume, as well as lateral movement in the NLF/naso-labial crease (NLC) junction following malar injection of CaHa in a cadaver model.
  
  
  METHODS
  A single surgeon injected CaHa in the supraperiosteal plane. Sequential images were obtained with the VECTRA 3D system pre- and post-1.5- and 3-cc CaHa injections. All measurements were performed by a single examiner. Injection location was verified anatomically.
  
  
  RESULTS
  Injections were performed in 16 fresh cadaver hemi-faces. Maximal increases in projection were centered on the malar injection site, with associated decreases in projection and volume in the infero-medial locations. Relative mean increases in volume of 3.16 cc and 4.94 cc were observed following the 1.5-cc and 3-cc injections, respectively. There was a relative decrease in the volume of the NLF of -0.3 cc and -0.4 cc following the 1.5- and 3-cc injections, respectively. Injection of CaHa was associated with lateral movements of the NLF-NLC junction at the level of the nasal sill, philtral columns, and oral commissure, measuring 2.7, 2.5, and 1.9 mm and 2.8, 2.9, and 2.4 mm following the 1.5- and 3-cc injections, respectively. Anatomical dissection verified the location in the supraperiosteal space and within the middle malar fat pad.
  
  
  CONCLUSIONS
  Following malar CaHa injection, 3D photographic analysis showed a measureable lifting effect with recruitment of ptotic tissue and lateral movement of the NLF-NLC junction in a cadaver model.
authors.affiliation: From the Department of Plastic Surgery, University Hospital Case Medical Center, Cleveland, Ohio, USA.
authors.forename: James R
authors.initials: JR
authors.lastname: Gatherwright
authors.affiliation: From the Department of Plastic Surgery, University Hospital Case Medical Center, Cleveland, Ohio, USA.
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Brown
authors.affiliation: From the Department of Plastic Surgery, University Hospital Case Medical Center, Cleveland, Ohio, USA.
authors.forename: Kristopher M
authors.initials: KM
authors.lastname: Katira
authors.affiliation: From the Department of Plastic Surgery, University Hospital Case Medical Center, Cleveland, Ohio, USA.
authors.forename: David J
authors.initials: DJ
authors.lastname: Rowe
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D003357:Cosmetic Techniques; D000067548:Dermal Fillers / Q000008:administration & dosage*; D017886:Durapatite / Q000008:administration & dosage*; D004954:Esthetics; D005145:Face / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D007271:Injections, Intradermal; D008297:Male; D010781:Photography; D012060:Rejuvenation; D015595:Skin Aging
chemical_list: D000067548:Dermal Fillers; D017886:Durapatite