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Injecting the infraorbital hollows

Article-Injecting the infraorbital hollows

Thin skin, increased vascularity and a compromised lymphatic drainage system make injecting the infraorbital hollows challenging for even experienced injectors. But facial plastic surgeons practicing in Austin, Texas, suggest Juvéderm Voluma XC is a relatively safe and effective hyaluronic acid filler for the off-label use.

Edward D. Buckingham, M.D., and colleagues at the Buckingham Center for Facial Plastic Surgery reported their results in a retrospective observational study of 202 eyes (101 patients) treated with the Juvéderm Voluma XC (Allergan) to the tear trough, nasojugal fold and/or palpebromalar groove.

Providers who improperly fill the infraorbital hollows risk contour irregularities, asymmetries and Tyndall effect. While the FDA hasn’t yet approved a soft tissue filler for the periorbital complex, researchers are increasingly examining periorbital region volume rejuvenation. Most of the published studies report on Belotero or Restylane, according to study published in JAMA Facial Plastic Surgery.

Juvéderm Voluma XC is more stable and long-lasting than other products in the Juvéderm line, which makes it ideal for this indication and for using layered injection techniques, the authors write.

Patients were 21 to 85 years old and represented a mix of racial and ethnic backgrounds. Doctors injected an average 1 mL of filler initially. Eighteen patients needed more treatment within three months.

Overall, 12% of patients had treatment-related adverse events: 10% had post-treatment bruising; 2% contour irregularities; 3% swelling; 1% (one patient) Tyndall effect. Providers had to use hyaluronidase in three patients.

Researchers used validated patient-centric questionnaires, suggesting overall patient satisfaction with results was 71.1% and satisfaction with their decision to treat was 65.6%.

Study author Edward D. Buckingham, M.D., says in a JAMA Network audio interview posted April 5 that he tells patients prior to their injections that the most he’ll use is .5 cc for each lower eyelid, which may or may not lead to a full correction. And patients should expect they might need a touchup.

“As long as it’s improved and looks better, I think that’s a much better outcome to shoot for than trying to shoot for perfection, because you do end up with people that are overfilled,” Dr. Buckingham says in the audio.

He will treat to full correction, as long as it takes 5 ccs or less for each treatment.

Dr. Buckingham says he uses cannulas exclusively for filling — for safety, as well as minimizing short-term complications, such as bruising.