Definitions of groove and hollowness of the infraorbital region and clinical treatment using soft-tissue filler

Abstract

Clarification is needed regarding the definitions and classification of groove and hollowness of the infraorbital region depending on the cause, anatomical characteristics, and appearance. Grooves in the infraorbital region can be classified as nasojugal grooves (or folds), tear trough deformities, and palpebromalar grooves; these can be differentiated based on anatomical characteristics. They are caused by the herniation of intraorbital fat, atrophy of the skin and subcutaneous fat, contraction of the orbital part of the orbicularis oculi muscle or squinting, and malar bone resorption. Safe and successful treatment requires an optimal choice of filler and treatment method. The choice between a cannula and needle depends on various factors; a needle is better for injections into a subdermal area in a relatively safe plane, while a cannula is recommended for avoiding vascular compromise when injecting filler into a deep fat layer and releasing fibrotic ligamentous structures. The injection of a soft-tissue filler into the subcutaneous fat tissue is recommended for treating mild indentations around the orbital rim and nasojugal region. Reducing the tethering effect of ligamentous structures by undermining using a cannula prior to the filler injection is recommended for treating relatively deep and fine indentations. The treatment of mild prolapse of the intraorbital septal fat or broad flattening of the infraorbital region can be improved by restoring the volume deficiency using a relatively firm filler.

Location of the infraorbital foramen with reference to soft tissue landmarks for regional nerve blocks during midface surgery

“…The observations made in the present study are consistent with previous reports regarding the location of the IOF. Levine and Allen (2018) suggested that the IOF is situated between the medial limbus and the mid-pupillary line, while Lee and Hong (2018) suggested that the IOF is situated on the same vertical plane as the medial pupil. The horizontal distance of the IOF from the midline has previously been reported to range from 24.4 to 30.3 mm (Agthong, Huanmanop, & Chentanez, 2005;Aziz et al, 2000;Chrcanovic et al, 2011;Ercikti et al, 2017;Gupta, 2008), and the mean value of #6 that we measured (27.2 mm) falls within this range.…”

Whole-Face Approach with Hyaluronic Acid Fillers

“…The treatment plan is guided by the severity and etiology of the deformation (the atrophy of the skin and the subcutaneous fat, the orbital oculi muscle contraction or herniation of orbital fat or bone resorption). 18 , 19 …”

“…The tear troughs are different as underlying causes vary. 18–21 Many techniques have evolved to address this cosmetic issue. 22 Low G’, G” and cohesivity HA fillers are safe to correct tear trough deformity.…”

Recommendations for the treatment of tear trough deformity with cross‐linked hyaluronic acid filler

“…The addition or restoration of volume is part of a general strategy for rejuvenation and enhancement. 16,17 In tear trough deformity, there are several factors that contribute to the eyeball having a sunken appearance and a shadow appearing on the lower eyelid, 9,16,[18][19][20][21] which we summarize in Table 1.…”