Anatomical Basis for Malar Augmentation Injection With the Zygomatic Ligamentous System

The malar augmentation injection has gained popularity in recent years, but the exact location of each injection site has not been clearly identified.To discover ideal injection sites by comprehensively considering the distributions of ligaments, muscles, and vessels.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.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.Injections at these 3 sites can be performed within the range of the ligaments to achieve effective lifting effects and minimize potential complications.