Ocular Complication in Facial Aesthetic Laser and Light Treatments: A Comprehensive Review.

BACKGROUND: The increasing popularity of laser- and light-based esthetic treatments for facial rejuvenation has raised concerns regarding ocular safety. Although these procedures are generally considered safe and effective, there is a growing body of evidence highlighting the potential for ocular complications. This review aims to systematically analyze the types and mechanisms of ocular injuries associated with such treatments, as well as to evaluate preventive measures and management strategies. METHODS: A comprehensive literature search was conducted using databases including MEDLINE, PubMed and Ovid for relevant studies published on clinical trials, diagnosis and treatment. Some papers were further reviewed using a double-blinding approach, varying sample sizes, control usage, randomization usage and objective endpoint measurements. All studies were classified according to the Oxford Centre for evidence-based medicine evidence hierarchy. RESULT: Our review identified several types of ocular complications associated with facial laser or light treatments, including but not limited to conjunctival burns, corneal damage, retinal phototoxicity, and transient vision disturbances. The incidence of these complications varies significantly depending on the type of laser or light source employed, treatment parameters, and the anatomical proximity of the eyes to the treatment area. Factors such as inadequate protective measures, patient movement during the procedure, and the operator's experience were found to contribute to the risk of ocular injury. Strategies such as the use of appropriate eye protection, careful patient positioning, and thorough pre-treatment assessments were highlighted as essential preventive measures. CONCLUSION: Ocular complications, though rare, represent a significant risk in facial esthetic laser and light treatments. This review underscores the importance of awareness among practitioners regarding the potential ocular hazards and the implementation of robust safety protocols. Future research is needed to establish standardized guidelines to minimize risks and enhance patient safety in esthetic dermatological practices. Continued education and improved protective strategies will be essential in safeguarding ocular health as the field of esthetic treatments continues to evolve. This comprehensive review serves as an essential resource for practitioners, informing them of ocular risks, management options, and the need for vigilance to mitigate complications in clinical practice.

Poly-d,l-lactic Acid (PDLLA) Application in Dermatology: A Literature Review.

Poly-d,l-lactic acid (PDLLA) is a biodegradable and biocompatible polymer that has garnered significant attention in dermatology due to its unique properties and versatile applications. This literature review offers a comprehensive analysis of PDLLA's roles in various dermatological conditions and wound-healing applications. PDLLA demonstrates significant benefits in enhancing skin elasticity and firmness, reducing wrinkles, and promoting tissue regeneration and scar remodeling. Its biodegradable properties render it highly suitable for soft tissue augmentation, including facial and breast reconstruction. We discuss the critical importance of understanding PDLLA's physical and chemical characteristics to optimize its performance and safety, with a focus on how nano- and micro-particulate systems can improve delivery and stability. While potential complications, such as granuloma formation and non-inflammatory nodules, are highlighted, effective monitoring and early intervention strategies are essential. PDLLA's applications extend beyond dermatology into orthopedics and drug delivery, owing to its superior mechanical stability and biocompatibility. This review underscores the need for ongoing research to fully elucidate the mechanisms of PDLLA and to maximize its therapeutic potential across diverse medical fields.

Noninvasive high-intensity focused ultrasound for skin brightening efficacy using a topical agent containing glutathione and hyaluronic acid.

BACKGROUND: High-intensity focused ultrasound (HIFU) is well-documented for skin rejuvenation, lifting, and tightening. However, its synergistic effects with topical agents, enhanced by HIFU-induced vibration and heat, remain underexplored. OBJECTIVE: To evaluate clinical and photographic outcomes of HIFU combined with a topical agent versus the topical agent alone. METHOD: This non-randomized controlled trial involved 20 female volunteers (ages 30-55) divided into two groups. Group A (n = 10) received two HIFU sessions combined with a topical agent containing glutathione and hyaluronic acid. Group B (n = 10) received the topical agent alone. Outcomes were assessed using digital photography, patient satisfaction surveys, and the A-One Smart™ system for fine wrinkles, hyperpigmentation, and hydration. Skin brightening was evaluated with the Global Esthetic Improvement Scale (GAIS). RESULTS: Group A showed significant reductions in fine wrinkles (6.25 ± 2.00 mm to 3.10 ± 1.62 mm), improved hyperpigmentation (3.50 ± 0.80 to 2.10 ± 1.05), and increased hydration (28 ± 10 to 55 ± 11) (all p < 0.05). Over two-thirds of Group A reported significant improvements, with no complications. Group B showed minimal, non-significant changes (p > 0.05), with only 30% reporting noticeable improvements. CONCLUSION: Combining HIFU with a topical agent significantly enhances skin quality and brightness without adverse effects.

Biodegradable polymers and platelet-rich plasma causing visual impairment: a literature review.

BACKGROUND: Dermal fillers are widely used for facial rejuvenation and esthetic enhancement, offering temporary solutions for aging and volume loss. Despite their general safety, a rare but severe complication associated with these fillers is visual impairment, including blindness. This underscores the need for a thorough understanding of risks associated with various filler materials. Historical cases of blindness following filler injections date back to 1963, with increasing reports linked to the expansion of the cosmetic filler industry. While hyaluronic acid (HA) and autologous fat have been extensively studied, other fillers such as calcium hydroxylapatite and poly-l-lactic acid (PLLA) are less understood. OBJECTIVE: This systematic review aims to address gaps in the literature by providing a comprehensive overview of visual impairment caused by fillers other than HA and autologous fat. We systematically examine the prevalence, causes, clinical features, and treatment outcomes associated with these less common fillers. MATERIALS AND METHODS: A comprehensive literature search was conducted across databases including PubMed, Scopus, and Google Scholar using terms related to visual impairment and dermal fillers. Studies published between 2014 and 2021, including observational studies and case reports, were included. Studies were selected based on predefined inclusion and exclusion criteria, and a PRISMA flow diagram was used to illustrate the study selection process. RESULTS: The review identifies and summarizes cases of visual impairment associated with calcium hydroxylapatite, poly-d,l-lactic acid (PDLLA), and PLLA fillers. Key findings reveal that visual impairment following these fillers is rare but can occur suddenly or within a few days of the procedure. Cases of delayed onset up to two weeks are also noted, emphasizing the need for extended post-procedure monitoring. DISCUSSION: The review highlights unique insights into the risks associated with non-HA fillers, such as the heightened risk in the periorbital region and other facial areas. It explores mechanisms of complications, including retrograde flow of emboli leading to retinal ischemia. The discussion also covers emergency protocols and preventative measures, providing valuable guidance for managing and mitigating risks. CONCLUSIONS: Visual impairment caused by fillers other than HA and autologous fat, while rare, represents a serious complication that requires careful attention. This review contributes new perspectives on the differential risks of various fillers, symptom onset variability, and anatomical risk factors. Emphasizing the importance of proper patient selection, technique, and monitoring, it calls for further research to better understand and prevent these complications, ultimately aiming for safer and more effective use of soft-tissue fillers.

Energy-Based Device Management of Nodular Reaction Following Poly-D, L-Lactic Acid Injection for Tear Trough Rejuvenation.

BACKGROUND: Poly-D,L-lactic acid (PDLLA) is used for tear trough rejuvenation but can cause complications like nodular reactions. This report describes using a radiofrequency device to manage these nodules. CASE PRESENTATION: A 42-year-old woman developed firm, non-inflammatory nodules 3 weeks after receiving PDLLA (Juvelook) injections in the tear trough area. The nodules were firm and not associated with erythema or tenderness. INTERVENTION: The monopolar radiofrequency device was used directly on the nodules with 150 shots at an energy level 115 J, 28.75 J/cm². The treatment resulted in complete resolution of the nodules within 24 hours. RESULTS: The radiofrequency treatment effectively resolved the nodular reaction without recurrence, highlighting the device's compatibility with the unique structure of Juvelook's PDLLA. CONCLUSION: Radiofrequency therapy is effective for managing nodular reactions following PDLLA injections. Further research is needed to optimise protocols and improve the safety of biostimulator treatments in cosmetic procedures.

Volumizing and Cogged Threads for Nose Augmentation.

BACKGROUND: Nose augmentation using nonsurgical methods, including volumizing and cogged threads, has gained popularity due to its minimally invasive nature, shorter recovery times, and reduced risks compared to traditional rhinoplasty. However, there is limited literature on the use of these techniques in the Asian population. AIMS: This study aims to present two successful cases of nose augmentation using volumizing and cogged threads, providing evidence of their effectiveness and demonstrating the insertion techniques through a supplementary video. PATIENTS/METHODS: Two female patients (aged 26 and 33) underwent nonsurgical nose augmentation. The first patient received volumizing threads to enhance nasal contour, while the second patient received cogged threads to refine the nasal tip and alar base. Both procedures were performed using polydioxanone (PDO) threads, with follow-ups conducted to assess the outcomes. RESULTS: Both patients exhibited significant improvement in nasal contour and projection, with outcomes maintained for up to 8 months post-procedure. The patients reported high satisfaction with the aesthetic results, and no complications were observed during the follow-up period. CONCLUSIONS: Volumizing and cogged threads offer a promising nonsurgical alternative for nose augmentation, particularly in patients seeking minimal invasiveness and natural-looking results. While the initial outcomes are positive, further research is needed to evaluate the long-term safety and effectiveness of these techniques, especially in the Asian demographic.

Poly-d,l-Lactic Acid Via Transdermal Microjet Drug Delivery for Treating Rosacea in Asian Patients.

BACKGROUND: Rosacea, a chronic inflammatory skin condition, is marked by enduring redness, visible blood vessels, and inflammatory eruptions in facial areas. Managing rosacea remains a persistent challenge for dermatologists, especially in cases unresponsive to conventional treatments. Injectable poly-d,l-lactic acid (PDLLA) has shown promise in treating erythema and telangiectasia associated with rosacea in addition to age-related concerns. Employing Mirajet, a laser-induced microjet system, for administering PDLLA is a novel and promising treatment for rosacea. AIMS: We aimed to evaluate the efficacy and safety of injectable PDLLA delivered via a needle-free microjet system for managing rosacea. METHODS: Four Korean women with persistent and refractory rosacea received five monthly sessions of PDLLA needle-free injections. Clinical assessments were conducted using the Clinician's Erythema Assessment and Patient's Self-Assessment (PSA) at baseline, 4 weeks post-treatment, and 22 weeks post-final treatment. Adverse events were monitored throughout the study period. RESULTS: At 4 weeks post-treatment, both Clinician's Erythema Assessment and PSA scores indicated significant improvements in erythema that were sustained up to the 22-week follow-up. Patients reported high satisfaction with resolution of redness and improved skin texture. Mild swelling, redness, and petechiae were observed post-treatment but resolved spontaneously. No product-related adverse events were noted during the study period. CONCLUSION: Injectable PDLLA delivered via laser-induced microjet injection demonstrated promising efficacy in improving rosacea symptoms and skin quality for up to 22 weeks without significant adverse effects. Larger randomized controlled trials are needed to confirm these findings and evaluate long-term safety and sustainability of outcomes.

Cosmeceuticals in photoaging: A review.

BACKGROUND: Photoaging is a process of the architecture of normal skin damaged by ultraviolet radiation. Topical cosmeceuticals have been used to treat this condition. The authors aimed to understand the mechanism and level of evidence of different commonly used cosmeceuticals used to treat photodamaged skin. OBJECTIVE: A range of commonly used topical cosmeceuticals (botanicals, peptides, and hydroquinone) has been used in cosmetic medicine for many years to treat photodamaged skin. This review article compares their efficacy and level of evidence. MATERIAL AND METHODS: This study was a systematic review to evaluate the efficacy of different topical cosmeceuticals. Keywords including "Photoaging," "Azelaic acid," "Soy," "Green Tea," "Chamomile," "Ginkgo," "Tea Tree Oil," "Resveratrol," "Cucumber," "Ginseng," "Centella asiatica," "Licorice Root," "Aloe Vera," "Peptides," "Argireline," "Hydroquinone," were typed on OVID, PUBMED, MEDLINE for relevant studies published on photoaging treatment. RESULTS: Most of the evidence behind cosmeceuticals is of high-quality ranging from Level I to Level II. In particular, the evidence base behind peptides is the strongest with most studies achieving Level Ib status in the evidence hierarchy. CONCLUSION: Topical cosmeceuticals like botanicals, peptides and hydroquinone can effectively treat photodamaged skin.

Anatomical Guidelines and Technical Tips for Neck Aesthetics with Botulinum Toxin.

Botulinum toxin can be used for various purposes to enhance neck aesthetics, addressing concerns such as platysmal bands, optimizing the cervicomental angle, preventing worsening of horizontal neckline and decolletage lines during aging, submandibular gland hypertrophy, and hypertrophied superior trapezius muscle. Understanding the anatomy of muscles such as the trapezius, platysma, and submandibular gland is crucial for achieving desirable outcomes with botulinum toxin administration. Techniques for injecting botulinum toxin into these muscles are discussed, emphasizing safety and efficacy. Specific injection points and methods are detailed for treating platysmal bands, optimizing the cervicomental angle, addressing submandibular gland hypertrophy, and managing hypertrophied superior trapezius muscle. Careful consideration of anatomical landmarks and potential complications is essential for successful botulinum toxin injections in these areas.

Anatomical perspectives of brow-lifting using threads: Clinical cases with techniques.

INTRODUCTION: Tailoring surgical interventions to target age-related transformations is paramount. Many candidates seeking blepharoplasty commonly exhibit eyebrow ptosis, underscoring the necessity for surgeons to possess a comprehensive understanding of techniques for brow and forehead rejuvenation. METHODS: Various surgical techniques are available for eyebrow and forehead enhancement, contrasting the standardized approaches in upper and lower blepharoplasty. Thread lifting has gained popularity for forehead lifting, although a more precise term would be eyebrow lifting. The thread lifting methods using V and I techniques with floating-type threads (Secret Line, Hyundai Meditech., Inc., Wonju-si, Republic of Korea) are used. RESULTS: The natural aging process often causes the forehead and eyebrows to sag under the influence of gravity, leading to the appearance of heavy eyelids. Elevating the eyebrows can mitigate droopiness, enhance vision clarity, and rejuvenate the facial aesthetic. While non-surgical methods like Botulinum Toxin A can weaken muscles and potentially aid in brow elevation, their visible effects may be somewhat constrained. DISCUSSION: Surgical methods encompass endoscopic forehead lift, eyebrow lift techniques, and scalp excision-based forehead reduction surgery, each with specific advantages and drawbacks. Thread lifting bridges the gap between surgical and non-surgical modalities. Forehead areas often lack subcutaneous fat, requiring precise anatomical understanding for effective thread lifting. Cannula usage with partial tunneling ensures efficacy even in patients with strong adhesions. Presented cases showcase successful eyebrow lifting using cog threads, illustrating immediate and gradual post-procedure changes. CONCLUSION: Eyebrow thread lifting demands periodic procedures, offering subtler improvements than surgery. Anatomical knowledge is crucial, and the technique presents discomfort. Effects last about 6 months, requiring re-treatment as effects regress. Thread lifting, a middle ground between surgical and non-surgical methods, can rejuvenate brows with less downtime.

Reverse and antegrade vector thread lifting techniques: Correcting nasolabial and marionette lines.

BACKGROUND: This study evaluates the efficacy of reverse and antegrade thread lifting vectors in conjunction with thread selection for correcting nasolabial folds and marionette lines, aiming to enhance treatment precision and effectiveness. METHODS: Three female patients aged 43, 48, and 53, presenting with primary concerns regarding nasolabial folds, underwent distinct treatment regimens utilizing various types of threads and vectors. Additionally, video demonstrations were recorded to showcase the procedural techniques employed in each case. RESULTS: The outcomes of the thread lifting procedures demonstrated significant improvements in the correction of the nasolabial fold and marionette line. CONCLUSION: Innovative thread insertion techniques involve entry points above the zygomatic arch and threading toward the temple hairline for lateral face lifting. These utilize barbs to pull skin and underlying tissues. The reversal technique involves inserting threads in a criss-cross pattern, forming a fibrous structure that may prolong the duration of results. Various thread combinations, considering factors such as composition, thickness, and barb size, provide customized procedures. This research introduces clinical applications, including temple area hairline lifting for nasolabial fold and marionette line correction, reverse vectors targeting nasolabial folds and marionette lines, and antegrade approaches from the lateral side.

Review of the Adverse Effects Associated with Dermal Filler Treatments: Part I Nodules, Granuloma, and Migration.

The increase in the use of filler treatments within minimally invasive cosmetic surgery has correspondingly escalated the variety and frequency of associated side effects. Initially, unregulated procedures led to primary side effects such as infections, foreign body reactions, and granuloma formation. However, severe vascular complications like skin and tissue necrosis and blindness have emerged as recognized risks. Side effects from filler treatments can range from mild to life-threatening, including edema, pain, tenderness, numbness, bleeding, bruising, hematoma, redness, erythema, pigmentation, allergic reactions, itching, pruritus, the Tyndall effect, asymmetry, irregularity, migration, skin and soft tissue infections, nodules, granulomas, and vascular compromise. These side effects are categorized into early and delayed types. Many complications, particularly those related to vascular abnormalities, are frequently linked to procedural issues, emphasizing the importance of understanding filler properties, injection techniques, and facial anatomy. Preventing side effects is ideal, but early detection and treatment are crucial. Recognizing potential side effects based on their timing and understanding appropriate preemptive treatment methods is essential. This discussion addresses non-vascular side effects, highlighting their onset, symptoms, and management strategies. The comprehensive understanding and careful management of these side effects are vital for minimizing complications and ensuring patient safety in filler treatments.

Polynucleotides in Aesthetic Medicine: A Review of Current Practices and Perceived Effectiveness.

Polynucleotides, complex molecules composed of nucleotides, have gained attention in aesthetic medicine for their potential to regulate gene expression and promote tissue regeneration. This review aims to provide an overview of the current practices and perceived effectiveness of polynucleotides in aesthetic medicine. A comprehensive search of the literature was conducted using keywords related to polynucleotides, cosmetic application, and aesthetic application. Studies were selected based on their relevance to aesthetic medicine and the inclusion of human subjects. The review found that polynucleotides have been used to improve skin texture, reduce wrinkle depth, and enhance facial appearance. The studies reported varying degrees of efficacy and safety, with some studies demonstrating significant improvements in skin elasticity and hydration. However, others reported limited or no benefits. The review also highlighted the need for further research to establish the optimal use and efficacy of polynucleotides in aesthetic medicine. While the existing literature suggests that polynucleotides may have potential benefits in aesthetic medicine, more research is needed to fully understand their mechanisms of action and optimal use. Clinicians should be aware of the current limitations and potential risks associated with the use of polynucleotides in aesthetic medicine.

The condition of hair follicles produced by different punching methods during FUE surgery.

BACKGROUND: Achieving successful outcomes in hair transplant surgery involves various critical factors, including donor area harvesting, graft survival, and minimizing post-operative complications. This study investigates the differences in grafts obtained using the rotary and oscillatory punch methods during follicular unit extraction (FUE) surgery. METHODS: The study involved 15 patients undergoing FUE. Four 4 × 6 cm2 areas in two rows were selected for each patient, with each row utilizing a different punch method (rotary or oscillatory). The grafts were extracted and examined under a microscope, classified into single, double single, double, and triple categories. The total yield rate and average number of hairs per graft were measured and compared. RESULTS: The average number of hair follicles per graft was 2.029 for the rotary method and 2.084 for the oscillatory method, indicating no statistically significant difference. However, the total yield rate was 88.3% for the rotary group and 90.5% for the oscillatory group, with the difference being statistically significant. In selected cases with soft scalps or deeper punch requirements, the oscillatory method showed significantly better results, with an average of 2.078 hairs per graft compared to 1.836 for the rotary method. The total yield rate in these cases was 91% for oscillatory and 86% for rotary. CONCLUSION: While the overall differences between rotary and oscillatory punches are minimal, the oscillatory punch is significantly more effective in cases with soft scalps or deeper punch requirements. Adhering to a structured guideline before extraction can help reduce the transection rate and increase the number of hairs per graft.

Rheological Characteristics of Hyaluronic Acid Fillers as Viscoelastic Substances.

Hyaluronic acid (HA) fillers are widely used in esthetic medicine and are categorized into biphasic and monophasic types based on their manufacturing processes. To evaluate the quality of these fillers, it is essential to understand their rheological properties, which reflect their viscoelastic nature. Rheology, the study of material deformation and flow, reveals how fillers behave under stress, combining properties of solids and liquids. This study explores the fundamental principles of elasticity and viscosity, rooted in Hooke's law of elasticity and Newton's law of viscosity, to explain the complex behavior of viscoelastic substances like HA fillers. The distinction between biphasic and monophasic fillers lies in their chemical cross-linking processes, which impact their molecular weight, structure, and ultimately, their clinical performance. Biphasic fillers with minimal cross-linking rely on natural molecular entanglements, exhibiting lower modification efficiency and greater elasticity. Conversely, monophasic fillers, which undergo extensive chemical cross-linking, demonstrate higher modification efficiency, firmer texture, and enhanced resistance to enzymatic degradation. The study emphasizes the importance of thoroughly removing residual cross-linking agents to ensure filler safety. Understanding these rheological characteristics aids clinicians in selecting appropriate fillers based on injection sites, tissue conditions, and desired outcomes, balancing viscoelastic properties and safety for optimal esthetic results.

Adverse Effects Associated with Dermal Filler Treatments: Part II Vascular Complication.

Vascular complications arising from dermal filler treatments pose significant risks, including ischemia, tissue necrosis, and severe outcomes like blindness and pulmonary embolism. This study investigates the mechanisms of vascular complications, categorizing them into extravascular compression and intravascular emboli. Extravascular compression occurs when injected fillers compress adjacent blood vessels, leading to ischemia and potential necrosis, while intravascular emboli result from fillers entering blood vessels, causing blockages. The study emphasizes the importance of anatomical knowledge, careful injection techniques, and early intervention. Management strategies include the use of hyaluronidase to dissolve HA fillers, vasodilators to improve blood circulation, and hyperbaric oxygen therapy. The regions most susceptible to complications align with major arterial pathways, particularly the nasolabial folds and nasal region. The study also highlights the need for meticulous injection techniques, the use of cannulas over needles in high-risk areas, and the aspiration test to detect vessel penetration. Early detection and immediate intervention are crucial to mitigate adverse outcomes. Continuous education and training for practitioners, along with advancements in filler materials and injection methods, are essential for improving the safety of cosmetic procedures. This comprehensive understanding aids in preventing and managing vascular complications, ensuring better patient outcomes. The field of dermal filler treatments is advancing with new techniques and technologies, such as High-Resolution Ultrasound, Infrared Imaging, self-crossing hyaluronic acid filler, biodegradable microspheres, and microinjection.

Energy-based devices and hyaluronic acid filler, polymer filler, and threads: Cadaveric study.

INTRODUCTION: The objective of this experiment was to investigate the thermal effects on hyaluronic acid fillers, PCL fillers, and PDO threads when exposed to controlled heat. This study aims to provide insights into how these materials respond to thermal energy, which is crucial for safe and effective cosmetic procedures involving combined modalities. MATERIALS AND METHODS: Cadaveric tissue was utilized to simulate clinical conditions. Hyaluronic acid fillers were injected at approximately 1 mm and 5 mm thicknesses, with variations in G' value (high and low). PCL fillers were similarly injected in 1 mm and 5 mm thicknesses. PDO threads were also inserted. All materials were injected at a depth of 2 cm. A thermometer was used to measure heat penetration, and a multi-wavelength laser was applied to the tissue. The temperature was maintained at 60°C for 5 min to assess whether heat penetrated more than 3 cm in thickness. Observations were made regarding the heat distribution and any physical changes in the fillers and threads. RESULTS: In thick layers, heat accumulated above the PCL filler without penetrating deeper layers. In thin layers, heat penetration was observed. For the HA fillers, heat energy was not blocked, regardless of the G' value or thickness. For the threads, no significant heat blockage effect was observed. For all materials, no visual changes were detected in any of the materials due to temperature exposure. DISCUSSION: The findings suggest that the thickness and composition of fillers significantly influence heat penetration. Thick PCL fillers act as a thermal barrier, whereas thin PCL fillers allow deeper heat penetration. Hyaluronic acid fillers do not impede heat transfer, regardless of their physical properties. PDO threads do not exhibit any notable thermal resistance. These insights are essential for optimizing the safety and efficacy of combined filler and energy-based device treatments in esthetic medicine.

Safe Zones for Facial Fillers: Anatomical Study of SubSMAS Spaces in Asians.

The study "Spaces of the Face for Filler Procedures: Identification of subSMAS Spaces Based on Anatomical Study" explores the anatomy of facial spaces crucial for safe and effective filler injections. By delineating the subSMAS (sub-superficial musculoaponeurotic system) spaces, this research highlights how these virtual compartments, bordered by fat, muscles, fascia, and ligaments, facilitate independent muscle movement and reduce the risk of damaging critical structures. The thicker and more robust skin of East Asians necessitates deeper filler injections, emphasizing the significance of accurately identifying these spaces. A cadaver study with dyed gelatin validated the existence and characteristics of these subSMAS spaces, confirming their safety for filler procedures. Key spaces, such as the subgalea-frontalis, interfascial and temporalis, and prezygomatic spaces, were examined, illustrating safe zones for injections. The findings underscore the importance of anatomical knowledge for enhancing facial aesthetics while minimizing complications. This study serves as a guide for clinicians to perform precise and safe filler injections, providing a foundation for further research on the dynamic interactions of these spaces and long-term outcomes.