Why we should be avoiding periorificial mimetic muscles when injecting tissue fillers

J Cosmet Dermatol. 2020 Aug;19(8):1846-1850. doi: 10.1111/jocd.13531. Epub 2020 Jul 1.


Background: Tissue fillers are generally safe and well tolerated by patients. However, complications do occur and may be very severe, such as intravascular injection (with occasional residual tissue loss, visual and neurological sequelae) and late nodularity and swelling. Methods to lessen the likelihood of complications have been the subject of much recent literature. Depth of injection has been identified as a key safety consideration.

Patients/methods: The role of injection of facial filler into the muscular layer of the face is explored in this article. Literature was explored using available search facilities to study the role of injections in or around this layer in the production of significant adverse reactions.

Results: A body of literature seems to suggest that injection into mimetic musculature of the face especially the musculature in the periorbital and perioral regions is prone to adverse reactions.

Conclusions: Injection of agents into the perioral and periorbital mimetic muscular layer may produce, product clumping, displacement, and tendency to late nodularity and swelling. It also risks intravascular injection as compared to injection of other layers of the face. Injection into the mimetic muscles especially the sphincteric muscles should be avoided to minimize the risk of complications.

Keywords: COVID-19; Tissue fillers; mimetic muscles; orbicularis oculi; orbicularis oris.

Publication types

  • Review

MeSH terms

  • Cosmetic Techniques / adverse effects*
  • Dermal Fillers / administration & dosage
  • Dermal Fillers / adverse effects*
  • Edema / etiology
  • Edema / prevention & control*
  • Face
  • Facial Muscles / blood supply*
  • Humans
  • Injections, Subcutaneous / adverse effects
  • Injections, Subcutaneous / methods


  • Dermal Fillers