the next area of evaluation is the cheek and you can evaluate that in both a horizontal and vertical fashion which I will show you remember to keep the notch to the patient's right but when you're doing it in a vertical fashion keep the notch superiorly so the main structures of the cheek are going to be your infraorbital framan and artery your deep cheek fat your smaz and your superficial fat so let's make sure you're in the cheek reset and I want to show you some Anatomy here all right so the first thing you see right here is going to be your maxilla your bone your cheekbone this next area here that's going to be your smash layer so the smash layer is pretty distinctive it's going to be hyper aoic because it's full of a lot of collagen and then above that you're going to see your superficial fat pad notice that the Deep Fat which is right here is actually a lot darker and so there's differences between the deep fat and The Superficial fat as far as consistency the Deep Fat doesn't have as much fibrous tissue to it so it's going to be um more globular it's it doesn't have as much structure to it and it's going to be darker it's going to be hypo aoic but the fat that's superficial right here it's going to have a lot of fibrous tissue to it so it's going to be a little more echogenic so it's going to be hyper aoic so this proves that fat can be several different echogenicities and um so don't let that fool you so some fat could be dark and some fat could be light if you look along the bone here you see that this patient actually has some ha lying along the bone and in my opinion I think that the filler in the cheek should be placed deeply along the bone for uh best results and best longevity so let's look for the infraorbital framan so that's going to be a break in the bone so the typical infraorbital France going to be 8 mm um from the orbital Rim in the midline mid pupular line so we see it right over here I'm trying to move it into the middle of the screen it's going to be right here so you see that there's a small notch in the bone and that's where the artery and nerve come out so we can confirm this by using the Doppler the vascular so although it's not a strong signal it seems to be very consistent in this area so this is the infraorbital artery and that's it in the exact area where I told you that the framan was as well and you can actually see it coming out of the framan right there so that's the infraorbital artery coming out of the framan so let's look at it in a vertical fashion remember keep that Notch upward let's see if we can find that Notch right there see there we go so at this point this is the infraorbital artery I'm going to show you a little better view of it right right there and you can see that there's a break in the bone so here's the bone here here's the bone here and you see the artery coming through that framan and what's interesting to note is that the infraorbital framan H from Superior has a little roof on it and you can kind of see how this right here creates a roof and so that protects the framan when you're coming from lateral or superior but when you're coming from inferior which would be from um the right side of the screen you can actually get into the frame and very easily so the vertical position shows that roof a little bit better than the horizontal so again the anatomy here here's the bone the maxilla here is the smaz layer here is the Deep Fat area which is going to be a little bit darker than the superficial fat which is up here so what I'd like to show you now is the t- mode of the cheek and it's really cool it shows the the anatomy make sure that that Notch is p patient's right and as I described earlier I'm going to show you here is the t- mode over here so I showed you before what the smash looks like so the smash is going to be right here and I showed you what the deep fat and the subcutaneous fat look like so it's spot on just as I told you before without using AI good job clarus so that concludes the evaluation using t- mode of the cheek
