Key Points for Maximizing Filler Safety in the Infraorbital Region

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  Use low-G’ fillers and less hydrophilic fillers.

  
  
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  It it better to use hyaluronic acid fillers because they can be reversed with hyaluronidase. This is especially important in the tear trough.

  
  
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  Inject small amounts in a low-pressure manner, always doing so in a retrograde and anterograde manner.

  
  
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  Avoid direct, deep injections into the location of the infraorbital foramen (▶ Fig. 15.1 and ▶ Fig. 15.2 ). Best practice is to inject inferiorly and laterally to the location of the foramen.

  
  
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  The primary injection sites for blending follow the zygomatic arch and are along the malar eminence (▶ Fig. 15.3 ). Secondary injection sites are below the zygomatic arch, inframalar region, and the superficial fat compartments of the midface (Video 15.1).

  
  
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  Inject the lateral two-thirds of the tear trough from a lateral direction and stay in a deep (preperiosteal) plane (▶ Fig. 15.4 ).

  
  
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  Inject the medial one-third of the tear trough from an inferior direction, staying in a deep plane. Inject a low volume in a cross-hatching pattern (Video 15.1).