Q-TIER: A structured, anatomy-guided framework for advanced facial profiling with fillers
Keywords:
Aesthetics medicine, Face profiling, HA fillers, Inverted triangle of youth, Triangle of agingAbstract
Hyaluronic acid (HA) fillers dominate non-surgical facial rejuvenation, yet outcomes hinge on precise plane selection, product rheology, and injection strategy. The TIER framework (Face profiling framework based on inverted triangle of beauty) systematically sequences treatment from the upper to lower face: top foundation (forehead and temples), infraorbital core (under-eyes and cheeks), essential midface (nasolabial and piriform), and refining apex (chin and jawline). Here, we synthesize literature from 2019-2024 to defend TIER’s anatomical logic, safety, and efficacy, illustrating how its inverted-triangle lens aligns with facial thirds and optimizes aesthetic harmony.
References
1. Funt D, Pavicic T. Dermal fillers in aesthetics: an overview of adverse events and treatment approaches. Clin Cosmet Investig Dermatol. 2021;14:699-716.
doi: 10.2147/CCID.S290142
2. Gavard Molliard S, Albert S, Mondon K. Key rheological properties of hyaluronic acid fillers: from tissue integration to product degradation. Plast Aesthet Res. 2018;5:17.
doi: 10.20517/2347-9264.2018.10
3. Sito G, Manzoni F, Sommariva R. A new standardized protocol for the use of high- and low-molecular-weight hyaluronic acids in a combined treatment for facial rejuvenation. J Cosmet Dermatol. 2020;19(6):1378-85.
doi: 10.1111/jocd.13170
4. Urdiales-Gálvez F, Delgado-Márquez S, Martín-Sillero M, et al. Rate of vascular complications after facial filler injection: A systematic review and meta-analysis. Aesthet Surg J. 2022;42(8):899-915. doi: 10.1093/asj/sjac085
5. Fabi S, Yoelin S, Talarico S, et al. A Multicenter, Prospective, Open-Label Study of the Efficacy and Safety of a Hyaluronic Acid Gel for the Correction of Forehead Lines. Dermatol Surg. 2021;47(4):516-21.
doi: 10.1097/DSS.0000000000002932
6. Cotofana S, Gaete A, Lanz O, et al. The Anatomy of the Temple: A Combination of Sonography, Dissection, and Injection Studies. Dermatol Surg. 2021;47(1):65-71.
doi: 10.1097/DSS.0000000000002766
7. Hwang CJ. Periorbital rejuvenation with hyaluronic acid filler. J Cosmet Dermatol. 2020;19(11):2815-21.
doi: 10.1111/jocd.13693
8. De Maio M, Rzany B. Injectable Fillers in Aesthetic Medicine. 3rd ed. Springer; 2021.
doi: 10.1007/978-3-030-58079-8
9. Goodman GJ, Liew S, Callan P, et al. A Consensus on the Use of Hyaluronic Acid Fillers from the Cohesive Polydensified Matrix Range for Mid-face Contouring. J Clin Aesthet Dermatol. 2016;9(3):E1-E18.
10. Cotofana S, Schenck TL, Trevidic P, Rohrich RJ, Fagien S. Midface: clinical anatomy and regional approaches with injectable fillers. Plast Reconstr Surg. 2015;136(5 Suppl):219S–234S.
doi:10.1097/PRS.0000000000001848
11. Lambros V. Observations on periorbital and midface aging. Plast Reconstr Surg. 2007;120(5):1367-76. doi:10.1097/01.PRS.0000279348.09156.C3
12. Mendelson B, Wong CH. Changes in the facial skeleton with aging: implications and clinical applications in facial rejuvenation. Aesthet Plast Surg. 2012;36(4):753-60.
doi:10.1007/s00266-012-9904-3
13. Shaw RB Jr, Katzel EB, Koltz PF, Kahn DM, Puzas EJ, Langstein HN. Facial bone density: effects of aging and impact on facial rejuvenation. Aesthet Surg J. 2012;32(8):937-42.
doi:10.1177/1090820X12462865
14. Wong CH, Mendelson B. Newer understanding of specific anatomic targets in the aging face as applied to injectables. Plast Reconstr Surg. 2015;136(5 Suppl):44S–48S.
doi:10.1097/PRS.0000000000001752
15. Rzany B, Cartier H, Kestemont P, et al. Full-Face Rejuvenation Using a Range of Hyaluronic Acid Fillers: Efficacy, Safety, and Patient Satisfaction over 6 Months. Dermatol Surg. 2017;43 Suppl 1:S78-S89.
doi: 10.1097/DSS.0000000000001091
16. Beleznay K, Carruthers JD, Carruthers A. Delayed-Onset Nodules After Treatment With a Vycross Hyaluronic Acid Filler: A Case Series and Expert Opinion. Dermatol Surg. 2019;45(8):1084-92.
doi: 10.1097/DSS.0000000000001851
17. Monheit G, Beer K, Hardas B, et al. Safety and effectiveness of a new hyaluronic acid dermal filler in the treatment of moderate to severe facial wrinkles. J Drugs Dermatol. 2016;15(8):934-40.
18. Pierre S, Liew S, Bernardin A. Basics of dermal filler rheology. Dermatol Surg. 2015;41 Suppl 1:S120-6.
doi: 10.1097/DSS.0000000000000334
19. Raspaldo H, Chantrey J, van Eijk T, et al. A consensus-based approach to the use of a new family of fillers for facial rejuvenation. J Cosmet Dermatol. 2020;19(12):3211-24.
doi: 10.1111/jocd.13745
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