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Review
. 2023 Feb 17:5:ojad016.
doi: 10.1093/asjof/ojad016. eCollection 2023.

Infraorbital Hollow Rejuvenation: Considerations, Complications, and the Contributions of Midface Volumization

Julie Woodward, Sue Ellen Cox, Kiyoko Kato, Fernando Urdiales-Galvez, Charles Boyd, Nazanin Ashourian
Review

Infraorbital Hollow Rejuvenation: Considerations, Complications, and the Contributions of Midface Volumization

Julie Woodward et al. Aesthet Surg J Open Forum. .

Abstract

Infraorbital hollows are one of the most common target areas for facial aesthetic treatment; however, they are often perceived to be challenging to treat due to the complex anatomy of the periorbital area, concurrent deformities, and risk of complications. Treatment options include surgical (eg, lower eyelid blepharoplasty with fat transposition or injections) and nonsurgical approaches (eg, fillers). Among these approaches, filler injections have become common practice because they are minimally invasive and provide long-term patient satisfaction. In particular, hyaluronic acid (HA) fillers have been shown to be safe and effective for infraorbital hollow rejuvenation. This review provides an overview of infraorbital hollows, including periorbital anatomy, etiology, clinical assessment, and overlapping deformities, such as malar mounds, festoons, and dark circles under the eyes. Patient and HA filler product selection, injection techniques, as well as potential adverse events, such as bruising/swelling, lower eyelid and malar edema, and vascular occlusions, are discussed. This review also highlights the importance of midfacial volumization to improve outcomes in the infraorbital region and in the overall aesthetic appearance. By selecting appropriate patients and attaining proficiency in periorbital anatomy and infraorbital hollow rejuvenation techniques, clinicians can safely and successfully perform HA filler injections that result in high patient satisfaction.

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Figures

Figure 1.
Figure 1.
Anatomy of the tear trough. The tear trough includes the medial third of the nasojugal groove, continues in an inferolateral manner, and may be discerned as the midcheek groove over time. The palpebromalar groove is located at the lid-cheek junction and is lateral to the tear trough region.
Figure 2.
Figure 2.
Periorbital anatomy of the infraorbital hollow. (A) Structures of the eyelid margin. (B) Periorbital muscles. (C) Superficial (left) and deep (right) fat compartments. (D) Schematic showing relative positioning of the muscles, fat, pads, prezygomatic space, and ligaments. The superficial (eg, infraorbital fat) and deep (eg, deep medial cheek fat) fat pads are separated by the orbicularis oculi muscle. The orbitomalar ligament or orbicularis-retaining ligament and the zygomaticocutaneous ligaments represent the superior and inferior borders of the prezygomatic space. (E) Periorbital ligaments.
Figure 3.
Figure 3.
Blood and lymphatic vessels in the periorbital area. (A) Periorbital blood vessels. Needle illustrates approximate injection location to minimize vascular complications: a, artery; v, vein. (B) Periorbital lymphatic vessels. Light green lines (middle and right) represent the superficial lymphatic system, which drains to the preauricular (laterally) and mandibular/submandibular lymph nodes (medially). The dark green line (left) represents the deep lymphatic system, which drains to preauricular lymph nodes within the parotid gland. Adapted with permission from Shoukath et al. The Creative Commons license does not apply to this content. Use of the material in any format is prohibited without written permission from the publisher, Wolters Kluwer Health, Inc. Please contact permissions@lww.com for further information.
Figure 4.
Figure 4.
Representative photographs of patients before and after filler treatment. (A) A 48-year-old female received 1.0 mL of VYC-15L in the tear troughs (0.5 mL on each side) and 1 mL of VYC-20L in the cheek (0.5 mL on each side). (B) The patient is shown at 1-month posttreatment. (C) A 41-year-old female received 1.0 mL of VYC-15L on each side to correct infraorbital hollowing. A needle was used in the middle and lateral region and a cannula was used in the medial region. The patient's photograph was taken (D) 1 month and (E) 18 months posttreatment. (F) A 47-year-old female received 0.6 mL of VYC-15L on each side to correct infraorbital hollowing in the first treatment session. Injections were performed in the submuscular plane with a cannula using a fanning technique. Using the same technique in the second treatment session, the patient received 0.75 mL VYC-15L in the left infraorbital hollow and 0.55 mL VYC-15L in the right infraorbital hollow. (G) The patient's photograph was taken 13 months after the second treatment session.
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