Authors: Dr. Gabriel Siquier, MD, Dr. Natalia Mikhaylova, MD, Ph.D
As more men seek corrections of volume-related changes to the face using noninvasive dermal fillers, it has become increasingly imperative to understand the male facial anatomy and perform volumetric remodeling techniques to prevent feminization of the male face. Hyaluronic Acid fillers that demonstrate high volumetric lifting capacity, such as Apriline® Forte and Apriline® Normal are excellent products that can be used to achieve both overall volume replacement and enhancement of lost facial contour in male patients.
Forehead and Eyebrows. Volume loss of the frontal eminence causes ptosis of the upper third of the face. To preserve and restore these facial features, the high viscosity HA filler Apriline® Forte is administered to the frontal area with a needle. Small boluses of 0.1 to 0.2 ml are made at each injection point followed by massage of the area [1]. Administration of the product in these small boluses helps to create support for the soft tissues and ensures a lifting effect of the upper third of the face. For further improvement of the contour of the forehead, Apriline® Forte may also be used 2 to 4 mm above the entire length of the eyebrow. To prevent adverse events, these injections should be done with a noninvasive, 25G cannula using subdermal or preperiosteal fanning or linear threading technique. Small amounts of product should be used. 
Treatment of the eyebrow area itself should be done using a cannula with retrograde injection technique. The cannula is inserted near the head of the eyebrow and is then repositioned and advanced toward the tail [2]. The result is a uniform distribution of the product along the entire length of the eyebrow. Each eyebrow may require between 0.3 to 1.0 ml of product.
Middle Face Features. One third of men experience atrophy and redistribution of deep and superficial fat compartments of the face, resulting in a tired and depressed look. To restore lost bony support and atrophy of the fat compartments, Apriline® Forte can be used to the deep zygomatic area in small amounts. Apriline® Normal may be used for superficial volume correction. To achieve the desired effect, 1 to 3 ml of this combination of products may be administered to each cheek, depending on the severity of the volume deficiency.
The product is injected in the zygomatic region and medial part of the cheek to replenish volume loss in the middle third of the face and to provide a lifting effect. Once the area of maximum volume deficit is located, the procedure can be performed. A 25G cannula is used due to the proximity of the infraorbital neurovascular tract. The insertion point is 5 mm above the middle of the nasolabial folds. Retrograde fanning injection technique is used to deposit the product up to the mid-pupillary line. Injections should be done at the depth of 4 to 6 mm.
Further correction laterally is obtained by using a medial zygomatic insertion point located along the lower edge of the zygomatic arch in between the mid-pupillary line and a line drawn inferiorly from the lateral canthus. To better locate the insertion point of this injection, two marking lines can be drawn: The first one extends inferiorly from the lateral canthus to the oral commissure. The second extends from the inferior edge of the nasal ala laterally to the tragus. The intersection of these two lines is the optimal injection site for deep medial cheek fat pad restoration. The amount of filler administrated at this point ranges from 0.2 to 0.5 ml.
Perioral Region. Revolumizing the perioral area requires replacement of lost subcutaneous fat. Apriline® Normal is administered to patients with medium skin thickness and Apriline® Forte is best for the very thick skin. Injections of 0.5 to 1 ml are done at the level of the deep dermis or subdermally from each side using a fanning injection technique along the oral commissure, then repositioned laterally towards areas of depression with progressive placement of the product.
Deep nasolabial folds are not easily corrected by fillers alone. Botulinum toxin should be administered to hyperdynamic musculature in conjunction with the use of dermal fillers. Once elimination of hyperdynamic musculature has been achieved, nasolabial folds can be corrected using a flexible cannula inserted near the upper part of the fold. Apriline® Forte is the product that is best suited for this area and may be administered in the amount of 0.5 to 1.0 ml for each side using a linear retrograde or fanning injection technique.
Inferior Jaw Line. To create a distinctive contour of the mandibular line, a stiffer filler such as Apriline® Forte is injected with a cannula. The insertion point is at the base of the angle of the lower jaw. One marking vector is directed towards the lower edge of the jawline and another towards the mandibular ramus. A noninvasive, flexible cannula is inserted vertically into the skin and then repositioned parallel to the bone and advanced medially to the outer border of the jowl. Filler is injected via linear retrograde technique. Product is continuously administered as the cannula moves posteriorly.
Instead of withdrawing the cannula from the insertion point following this injection, it is turned along the mandibular ramus and pointed towards the earlobe. Roughly 0.6 ml of product will be used per side, per vector and 0.4 ml of product per injection to the mandibular ramus.
The upper part of the mandibular angle can also be emphasized with dermal filler. Bolus injections of product are administered preperiosteally at the prominence of the mandibular angle using a needle. This injection is done with the patient in a sitting position. The administered quantity should be between 0.3 to 0.5 ml of product per side.
To achieve a lifting effect and replenish a deficit of tissue volume in the chin, high viscosity filler is symmetrically injected with a needle to both sides of the chin at 1 to 1.5 cm distance from the medial facial line. To increase the chin region volume laterally, injections are done superior to the mental tubercle. Filler is injected very slowly (0.1 ml injected while counting to ten) in an amount of 0.5 to 1.0 ml on each side. Two further injections can be done to the lower corner of mandible at 1 cm distance from the medial facial line to lengthen the face or visually expand the chin. The insertion point is at the lower jaw corner directly inferior to the corner of the mouth. The quantity of product normally needed for a chin augmentation can vary between 1 to 3 ml of HA filler.
In summary, to address male patients needs, one should understand various products and methods available. One option is to choose extremely safe with long-lasting results APRILINE® (Suisselle, Switzerland) HA filler products, based on biosynthetic HA modified in accordance with A.P.R.I. Technology. APRILINE® fillers are monophasic, homogeneous, sterile apyrogenic gels with high plasticity, and a 23 mg/ml concentration of HA.
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Gabriel Siquier,
MD, aesthetic physician, founder of Dameto Clinics International, specialized in aesthetic treatments, peelings, hair restoration and skin improvement. He gives masterclass workshops and congresses worldwide.
Natalia, Mikhaylova
M. D., PhD, dermatologist, cosmetologist, member of the American Academy
of Dermatology (AAD) and the American Society for Laser Medicine and Surgery (ASMLS),
certified trainer for SINCLAIR PHARMA (Great Britain), SuissElle (Switzerland), Academic Adviser
for Martinex Training and Methodology Centre, Academic Adviser for Laboratory TOSKANI Ltd,
Chief Physician of Reforma clinics, President of the National Society of Mesotherapy.
