so at this point we are going to be injecting the jawline and what we're going to do is we're going to do two boluses along the periosteum near the gonial angle really the only vasculature that is important in this area is the facial the facial comes up through the antigonial notch which is right here so i'm going to identify where the facial artery is and then we're going to make sure that our injections are posterior to that so we're going to use the sterile ultrasound gel and we're going to go into the antigonial notch which i can feel right here and i'm just going to confirm the arteries and we can actually see them in b mode and i'm going to change it over to color and we'll there's the artery right there and it's so the artery is right here we need to inject posterior to that so in this injection again it's a very safe injection down to periosteum when you inject the angle of the mandible you're injecting onto periosteum but with the movement of the masseter it actually gets involved into the masseter muscle it spreads and that's okay it still it still gives a great improvement in the gonial angle as we get older we lose that corneal angle we lose that definition we lose the definition between the jaw and the neck and this gives us a little shadow between the jaw and the neck we're going to be injecting two boluses of 0.25 so half a cc per side you don't want to inject too much on a patient in their 50s or 60s because it does widen them a little bit but you do want to improve the definition so go ahead there's the artery and we identified it and now we're going to go down onto bone you could aspirate if you'd like britney likes to but in this position we can just inject straight down and we'll and we'll do it towards the gonial angle and we'll go a little anterior to that as well there's 0.25 you're going to do the whole okay and then we'll just go a little bit anterior to that so i think that jawlines particularly in men are extremely important i think the single most important uh feature of a man's face is it is his jawline in females is probably second or third i think the eye area is probably first in the female and then the cheeks and then the jawline being third in the male it's number one and it's pretty avascular there so now let's uh confirm the placement using our b mode and uh so let's go and take a look at britney's injection and there we go there we see a nice bolus on the periosteum we see a nice posterior enhancement from the bolus there we go and just a little posterior you see the other one too so nice job there's the two areas of bolus of the aha we're going to now do on the other side so there we go i'll take a picture of that all right nice job let's do the other side how did it feel pretty easy right yeah so i highly recommend incorporating jawline injections to your practice it's a fairly easy injection very low risk and it has significant changes in to to the patient's uh beauty so now let's look at the anti-corneal notch on this side i'm going to go into color doppler on this side and we can identify where the arteries are here there's the facial artery you see that brittany okay so it's midline so it's about right here so there's a facial artery but we're injecting back here so we have significant room for our injections this already here injection point here okay so now brittany let's clean her off and do it so what britney is going to do is she's going to feel the mandibular border and the gonial angle and the ascending ramus and she's just going to come off of the uh mandibular border about 0.5 to 1 centimeter she's going to aspirate for 10 seconds and then she's going to inject right down onto the mandible again whether it goes onto the periosteum or in the masseter what happens is actually you get reflux along the needle and it does become part of the masseter but that's okay it still leads to great improvements in the masseter i'm sorry in the mandible so that's about 0.25 she's going to go a little bit anterior and inject another 0.25 and we'll be done it's a very safe procedure particularly when you've checked for the facial artery using ultrasound so exasperating right now for 10 seconds no reflux and she's going to inject down the bone perfect job all right so we have great improvement there and now let's check it with ultrasound again patients love to see this you need to if you get an ultrasound you need to show your patients look the filler is exactly where i thought it was going to be it's perfect placement they have confidence when they leave that the filler there's one of the filler boluses and you see the filler bolus is actually a little bit in the masseter and that's okay because it reflux up the path of least resistance which is along the needle sometimes so there we go perfect placement some of it's along the mass the mandible and some of it's in the masseter but that's okay all right good job brittany there we go okay and you can tell it's uh h a because of that posterior enhancement that's what h a looks like very anechoic meaning black and then posterior enhancement is white that's behind it or deep to it okay so there are the two boluses right there next to each other that's a good picture hit the screen freeze for me okay so there they are there's the two boluses a little bit off of the periosteum that posterior enhancement and the anechoic aha product patient did great hardly felt the thing so in conclusion the clarius l20 hd was able to identify the arteries in the injection area and i could inject free from those arteries and have much confidence that i'm not going to be injecting within the artery the patient has more confidence and feels more secure that the injections are going to be exactly where you want them you can confirm placement afterwards using the clarius as well and you can document that and put it in the patient's chart so i don't think that there's a better way to inject some of these areas that we went through the temple the puriform and the mandible without using ultrasound if you if you're using ultrasound you can guarantee that you are going to be above or below the vessel and stay out of trouble and have better outcomes and better safety
