15 Facial Danger Zone 6 – Infraorbital Region


15 Facial Danger Zone 6 – Infraorbital Region

Rod J. Rohrich and Raja Mohan


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. 15.1 and ▶ 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).

Fig. 15.1 Anatomy of the Periocular Region. The infraorbital artery and nerve emanate from the infraorbital foramen.
Fig. 15.2 Improper Injection Technique. Direct injections overlying the infraorbital foramen should not be performed. Furthermore, lateral injections should not deposit filler near the infraorbital foramen. One should be very cautious when filling the tear trough and not deposit filler near it. Intravascular injections can result in migration of emboli in a retrograde fashion to the ophthalmic artery.
Fig. 15.3 Tear Trough and Malar Eminence Injection Technique. When injecting from the tear trough laterally, the needle should be in a deep preperiosteal plane. Injections should not be performed adjacent to the infraorbital foramen. The malar and zygomatic eminence can be filled laterally by performing depot injections in a deep plane. The needle should be perpendicular to the skin surface for these volumizing injections.
Fig. 15.4 Tear Trough Injection Technique. When injecting the tear trough from below, the trajectory of the needle should be lateral to the location of the infraorbital foramen. The needle should be in a deep preperiosteal plane, and the needle can be fanned laterally to add more volume. Injections should not be performed near the infraorbital foramen.

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Jul 18, 2020 | Posted by in Dermatology | Comments Off on 15 Facial Danger Zone 6 – Infraorbital Region

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