Galyna Khrushch belongs to Russia and is a board certified plastic surgeon, board certified maxillofacial surgeon, international member of the American Society of Plastic Surgeons, member of MOSBT, member of the OSEM, certifaited trainer of IPSEN, specialist in injection techniques of the company “Melis”, Melis, Member of Russian Association of Plastic and Reconstruction Surgery, Individual Membership Journal of clinical review and case reports

Introduction: The face of modern socially active person remains a region of interest because it is a trigger zone that reflects the most natural appearance of early signs of aging. Everywhere the increasing need to improve the quality of life determines the relevance and importance of procedures for facial rejuvenation, the key point of the application which is undoubtedly the region of the mid face.

Main part: Question injection correction of the middle third of the face, including the periorbital area, despite the large number of proposed injection methods of rejuvenation is still open. Largely this is due to the contradicting hypotheses development of age-related changes in this area in different time period. Soft tissue model of facial aging, according to which the leading factor of age-related changes is the effect of gravity on the skin, resulting in their stretching, have lost the dominant value. But this ignores the role of the underlying anatomical levels. There is essential value of detailed description and study of age-related changes of anatomical structures of the middle third. With the emergence of volumetric concept of aging based on the manifestations of atrophy and redistribution of fat compartments; the theory of the restraint of the ligaments, which involves ptosis as a result of stretching the fixing structures; the hypothesis of a dynamic age-related changes of tone and length of muscle (Le Louarn); and theory of age changes with the prevailing skeletotopy factor of involution facial area, it’s understanding what triggers any age manifestation that gives us a range extension for the successful correction, suggesting a complex effect on all the causal-effect components of this change. However, due to accumulation of clinical experience, the question arises: are all patients the same age category, which celebrates the age-related changes in the middle third we can offer the same correction algorithm?

Goal and objectives: Systematization and classification of changes of the middle third; development and implementation of complex correction algorithms that take into account the prevailing factor in the occurrence of this manifestation; the study of the optimal combination of treatments for their synergistic effects; injection rhinoplasty as part of a comprehensive program of beautification of the middle third; non surgical rhinoplasty with PDO threads the election to demonstrate how the concept of remodeling of the middle third depending on the degree of manifestation of age-related changes and of belonging to a morphotype; compliance with the principle of “layerwise” exposure to all levels of anatomical lesions of the middle third (skin, malar and deep fatty tissue, SMAS (OO muscle, zygomatic muscles, lLSAN and LLS), retaining ligament (ORL, zygomatic); clinical testing of new techniques to demonstrate well-proven quality and safe medicine for injectable correction hernial and malar “bags” use PDO threads with a view to strengthening orbital septum; for rejuvenation skin of the periorbital area.

Conclusions: The application of the concept of selective remodeling in comprehensive nonsurgical rejuvenation of the middle third is based on the assessment and differentiation of patients according to the morphotype of aging and degree of manifestation of age-related changes; medical rhinoplasty with threads and fillers as a part of beautification of the mid face targeted effect on the cause of manifestation according to the prevailing mechanism of change; preparation of the complex, layered, relevant gerontological medical and protector program correction; and demonstrate how innovative technologies use well-proven quality with the purpose of correctio of age changes of the middle third(clinical cases).