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The basic criteria for fillers require that they do not cause severe foreign body reactions and remain for a certain period of time without being absorbed by the body too quickly. Due to these characteristics, it has become possible to construct beautiful faces, but at the same time, concerns about various side effects have been raised. While using fillers, we have constantly deliberated on the safe and efficient use of such a fine tool for patients.

Among the many questions considered, the most concerning were about the organization of vasculature and its physiology within a live body, rather than in a cadaver or an anatomical illustration. This is important as we want to avoid vascular accidents associated with filler procedures. Although the anatomical illustrations or cadaver studies have provided us with a great insight we failed to completely resolve these questions. After much thought, we have proposed utilizing MRI scans and CT angiography obtained from live bodies. With the help of many doctors, we have had the opportunity to test this approach and have summarized the results in this book. One surprising discovery is that organization of blood vessels within our body is not only very complicated, but also in many cases different from what is portrayed in illustrations.

1. We demonstrate the vasculature and depth of actual blood vessels based on imaging acquired from live bodies. 
Firstly, we demonstrate a novel approach, which is the use of MRI and CT scans of live bodies. This method provides an upgraded treatment scheme leading to improved treatment results as doctors an visualize the precise depth and location of blood vessels in relation to bones, muscles and skin. This is especially useful in areas at risk for vascular accidents. 
2. We explain filler procedures in detail. 
Secondly, we provide detailed explanations on how to use cannulas and needles. Readers can obtain more information on how to achieve satisfactory and safe results in the danger zones. 
3. We recommend appropriate fillers for each area according to filler characteristics. 
Thirdly, in order to provide instruction on the appropriate filler selection for each area, we considered various questions and investigated the characteristics of fillers. As a result, clinicians may wisely select appropriate fillers for each area using this research. We look forward to additional research and theses on the characteristics of fillers and the way they change after being injected into the body. 
4. We added the results of the filler dissolution tests 
Fourthly, we added experimental results for filler dissolution as well as newly proven research.

Table of contents
Part 1 Filler Types and Choosing Fillers

1. Types of Fillers· ········································· 4
2. Characteristics of Each Filler· ························ 6
1. Characteristics of HA Fillers······························· 7
1) Physical Characteristics of HA Fillers· ····················· 7
(1) Cross-linking········································· 11
(2) Cross-linking Ratio· ···································· 11
(3) Gel Hardness· ········································ 14
(4) HA Degradation········································ 14
(5) Viscoelasticity ········································· 15
(6) Filler Concentration and the Relative Degree of Hydration·········· 16
(7) Filler Injection and Anti-Oxidant Substances··················· 17
(8) Fillers that Harden after Injection· ·························· 19
(9) Spread of Fillers ······································· 21
(10) Cohesiveness ········································ 22
2) HA Filler from Physician’s Perspective· ···················· 25
3) Summary of Characteristics of Fillers· ····················· 27
2. Characteristics of Calcium Fillers·························· 35
3. Characteristics of Fillers Composed of Polycaprolactone (PCL)·· 39
3. Categorization of the Filler Market ················· 43
4. Filler Selection ········································· 44
1. Standards for Filler Selection · ···························· 44
2. Filler Selection and Safety ································ 46

Part 2 Basic Introduction

1. Design Method ········································ 52
1. Designing the Whole and Parts ··························· 52
2. Design Considering Facial Expressions ··················· 53
3. Tricks for Safe Procedures ······························· 54
2. Filler Administration with Cannulas · ················ 57
1. Puncturing Method for Cannula Insertion ·················· 59
2. Method of Using Cannula Depending on the Depth ········ 60
3. Cannula Advancement and Separation of Tissue ·········· 63
3. Basic Method of Using a Needle · ··················· 65
1. Method of Using a Needle ······························· 65
2. Considerations of Bevel Location in Procedures ·········· 67
3. Post Dermal Subcision Injection Method ·················· 68
4. Perpendicular Pulling Injection Method ··················· 69
5. Perpendicular Injection of a Large Bolus ·················· 70
4. No Bleeding Technique ······························· 71
5. Molding ················································· 76
1. What is Molding? · ······································· 76
2. Molding Method for Each Facial Area ····················· 84
1) Molding Under Eyes (the Smile Line) · ···················· 84
2) Under Eye Guider ······································ 85
3) Nasolabial Folds and Cheeks ···························· 86
4) Massage after Injection ································· 86
6. Dissolution Test · ······································· 88
1. How to Use Hyaluronidase · ······························ 88
2. An Experiment for Melting HA Fillers ······················ 90

Part 3 Basic Anatomy

1. The Vasculature · ······································· 107
1. The Facial Artery & Vein · ································ 107
2. Variations in the Facial Artery · ··························· 109
3. The Supratrochlear Artery (STA) &
Supraorbital Artery (SOA) ································ 109
4. Superficial Temporal Artery (SfTA) · ······················· 110
5. The External Carotid Artery & Internal Carotid Artery ······ 111
6. Palpation of the Artery · ·································· 112
7. Visual Inspection of Veins ································ 113
2. Nerves · ·················································· 114
1. CN V (Trigeminal Nerve) - Sensory · ······················ 114
2. CN VII (Facial Nerve) - Motor ····························· 116
3. Fat Compartments ···································· 118
1. Superficial Fat · ·········································· 118
2. Deep Fat · ··············································· 119
4. Muscles · ················································· 120
1. Muscles around the Eyes · ······························· 120
2. Muscles around the Mouth · ······························ 120
3. Muscles of the Nose · ···································· 121
5. The SMAS & Retaining Ligaments · ················· 122
1. The SMAS (Superficial Musculo-Aponeurotic System) · ····· 122
2. The Retaining Ligaments ································· 125
1) True Retaining Ligaments · ······························ 125
2) False Retaining Ligaments ······························· 126

Part 4 Filler Treatment for Each Facial Area

Upper Face
1. Forehead ··············································· 130
2. Glabella ················································ 148
3. Temples · ··············································· 160
Mid Face
4 Nose ···················································· 178
5. Nasolabial Folds ······································· 190
6. Cheek (Upper Cheek and Lower Cheek) ··········· 210
7. Dark Circles · ·········································· 230
8. Lower Eyelid Pretarsal Augmentation · ············ 248
9. Sunken Eyes ··········································· 254
Lower Face
10. Chin ···················································· 260
11. Marionette Line · ······································ 268
12. Lips · ···················································· 274

Part 5 Filler Complications

1. Filler Complications and Interventions ············ 284
1. Bruising and Hematoma ·································· 285
2. Erythema ················································ 286
3. Edema · ················································· 287
4. Neovascularization ······································ 288
5. PIH ····················································· 288
6. Nodule · ················································· 288
7. Infection ················································· 290
8. Skin Necrosis (Blood Vessel Complications) ··············· 291
2. Mechanism and Treatment of Skin Necrosis ······ 294
1. Predisposing Factors of Skin Necrosis ···················· 294
2. Factors Affecting the Extent of Skin Necrosis ·············· 295
3. Symptoms of Skin Necrosis · ····························· 295
4. Treatment of Skin Necrosis ······························· 297
5. Notes for Preventing Necrosis during Procedures · ········ 301
6. Tips for Early Discovery and Treatment of Necrosis · ······ 303
7. Factors Affecting the Prognosis of Skin Necrosis ·········· 303
3. Other Blood Vessel Complications · ················ 304
1. Blindness and Cerebral Infarct · ·························· 304
2. Pulmonary Embolism ····································· 306

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