This chapter summarizes how to inject soft-tissue fillers into the infraorbital region. Patients often report hollowness in their lower eyelid consistent with a tear trough deformity. To blend the lid/cheek junction, we present techniques to safely augment the lower eyelid and cheek. The infraorbital nerve and artery are located within the infraorbital region, and detailed knowledge of the anatomy is key to prevent devastating complications such as blindness.
Key Points for Maximizing Filler Safety in the Infraorbital Region
Use low-G’ fillers and less hydrophilic fillers.
It it better to use hyaluronic acid fillers because they can be reversed with hyaluronidase. This is especially important in the tear trough.
Inject small amounts in a low-pressure manner, always doing so in a retrograde and anterograde manner.
Avoid direct, deep injections into the location of the infraorbital foramen (▶Fig. 15.1and ▶Fig. 15.2). Best practice is to inject inferiorly and laterally to the location of the foramen.
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).
Inject the lateral two-thirds of the tear trough from a lateral direction and stay in a deep (preperiosteal) plane (▶Fig. 15.4).
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).