How to best utilize the line of ligaments and the surface volume coefficient in facial soft tissue filler injections

Gabriela Casabona, Francesco P. Bernardini, Brent Skippen, Gianna Rosamilia, Hassan Hamade, Konstantin Frank, David L. Freytag, Jonathan Sykes, Emy C. Onishi, Sebastian Cotofana

Research output: Contribution to journalArticlepeer-review

14 Scopus citations


Background: Recent advances in facial anatomy have increased our understanding of facial aging and where to best position facial soft tissue fillers. Aim: Aim of this study was to investigate a novel injection protocol which makes use of concepts like the line of ligaments or the surface - volume coefficient. Materials and Methods: A total of 306 Caucasian patients (270 females, mean age 45.1 ± 11.4 years; 36 males, mean age 45.9 ± 11.6 years) were retrospectively investigated after the injection following a standardized protocol. This protocol comprised a total of six boluses and one retrograde fanning injections in the infraorbital area utilizing a 22G and a 25G blunt-tip cannula, respectively. Medial midfacial distances were measured using skin surface landmarks and compared after the injection of the partial and the total algorithm. Results: Distances between the dermal location of the lateral SOOF and the dermal location of the mandibular ligament increased by 0.17 ± 0.11 mm with P <.001, to the corner of the mouth by 0.20 ± 0.09 mm with P <.001 and to the nasal ala by 0.20 ± 0.11 mm with P <.001. The repositioning of the facial soft tissues resulted also in a decrease of the height of the lower eyelid by 0.49 ± 0.13 mm with P <.001. Conclusion: The results revealed that utilizing these novel anatomic concepts, a mean amount of 0.32 cc high G-prime soft tissue filler injected in the lateral SOOF can change midfacial distances by an average of 0.19 mm.

Original languageEnglish (US)
JournalJournal of Cosmetic Dermatology
StateAccepted/In press - Jan 1 2019


  • infraorbital hollow
  • line of ligaments
  • soft tissue filler
  • sub-orbicularis oculi fat
  • surface volume coefficient

ASJC Scopus subject areas

  • Dermatology


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