Fillers are the main injectable used to restore volume in this
area. Before starting, one should assess for excess festooning
or fat pad herniation in the infraorbital hollow, since fillers may
exacerbate the problem. Such patients may be more suitable
for surgical intervention.
“Thinner†fillers like Restylane®, Juvéderm® Ultra or Ultra
XC, and Prevelle® Silk work best in this area. As stated above,
Boletero® has less risk of causing the Tyndall effect.37 Polymethylmethacrylate
(PMMA), poly-L-lactic acid (PLLA), and calcium
hydroxyapatite (CaHa) are not desirable in this area because of
risk of superficial papules.
The filler should be placed in small aliquots along the tear
trough and blended laterally and inferiorly (Figure 3). Filler is
best injected below the orbicularis oculi along the orbital rim;
the orbital septum should not be penetrated. It is important to
correct the inferior extension of the tear trough as it extends
onto the medial cheek as well as laterally.
Temples
Wysong et al. noted that the temple is the location of the second
greatest loss of subcutaneous tissue (23%) in the aging male
face.21 Filler can be used to correct the concavity that forms at
the temples. In this area, the superficial temporal artery runs
along the superficial temporal fascia, while the temporal nerve
is found just deep the superficial fascia.38
Higher G’ HA fillers can be used like Perlane® (Galderma Inc.,
Lausanne, Switzerland) and Juvéderm® Ultra Plus and Ultra Plus
XC39 (all off label indications). Depots can be placed above the
superficial temporal fascia in a retrograde linear fashion and massaged
into place.
