Infraorbital furrows and cavities: filler correction technique

Подглазничные борозды и впадины: техника коррекции филлерами

Filler injections – a convenient way to correct aesthetic defects in the infraorbital zone, such as the infraorbital sulcus and depression. Preparation for the procedure is minimal, as is the recovery period after the intervention.

However, in order to ensure a safe and aesthetically pleasing result of work in this delicate and unforgiving area of the doctor, it is necessary to choose the right type of filler and method of administration of the drug, depending on the cause of the formation and the severity of the imperfection. In the article estet-portal.com you will find information about correction of the infraorbital sulcus and cavity with HA fillers.

Major vessels and nerves of the infraorbital cavity and sulcus
Which fillers are used to correct the infraorbital cavity and sulcus
Points of injection and nuances of successful correction of the infraorbital zone of the filler Major vessels and nerves of the infraorbital cavity and sulcus To ensure the safety of the filler injection during the correction of the infraorbital sulcus and depression, it is necessary to first determine the paths of the main vessels and nerves, which are quite numerous in the infraorbital zone:

infraorbital nerve;

angular artery; facial vein;

For successful correction of the infraorbital cavity and sulcus, it is important to choose the optimal type of filler and insertion technique.
The infraorbital artery and nerve emerge from the infraorbital foramen about 0.6-1.0 cm below the orbital ridge along a line running vertically from the medial part of the pupil. The zygomaticofacial artery and nerve emerge from the foramen vertically on the outer edge of the lateral part of the orbital ridge, approximately 0.5-1.0 cm below the horizontal line drawn from the outer corner of the eye, and pass along the lower border of the infraorbital fat.

Lacrimal trough filling: a case report

The nasolacrimal groove is located between the palpebral and orbital parts of the orbicularis oculi muscle, and the location of the nasolacrimal cavity corresponds to the lower border of the orbicularis oculi muscle. Blue dotted line – nasolacrimal sulcus, red – nasopharynx; – orbital fat,

OF	OS – orbital septum, SOOF – infraorbital fat; PO – palpebral part of the orbicular muscle of the eye; LLSAN – muscle that lifts the upper lip and wing of the nose; MFP – painter fat pack; OOM –circular muscle of the eye. Fig. 1: nasolacrimal trough and nasopharynx

If the correction is performed with a needle, it will be relatively safe for the main vessels to insert the filler along the border of the orbital ridge. The drug is injected along the entire length of the roller into the subdermal and axillary planes using a linear drop technique.

Use extreme care. The position of the facial artery and vein, as well as the medial branch of the infraorbital artery under the nasopharynx, can be predicted. In order to avoid bleeding and bruising, it is not worth inserting the fillertoo deep into the nasopharyngeal sulcus using a needle.

Which fillers are used to correct the infraorbital cavity and sulcus

In general, fillers based on pure hyaluronic acid – safe and effective drugs for the correction of the infraorbital cavity and furrow. An additional advantage of this type of fillers –

the ability to dissolve hyaluronic acid with the help of the hyaluronidase enzyme

This is especially important when working in the infraorbital region, where irregularities often appear after contouring due to the exceptional thinness of the skin. Subdermal injections require a very soft HA gel

Pronounced nasolacrimal and nasolacrimal groove in a middle-aged patient.

PMG – palpebromalar furrow,

MCG

– mid-cheek sulcus, TTD

– nasolacrimal groove; NG

– nasobuccal sulcus.

Fig. 2: infraorbital sulci

The filler can be injected with a cannula or a needle.

The choice of instrument depends on a number of conditions. For example: needle is better suited for creating precise contours when the drug is injected subdermally over the orbicular muscle of the eye;

cannula is recommended to reduce the risk of vascular damage and serious bleeding when the filler is injected

into the deep fat layer under the orbicularis oculi muscle in order to compensate for volume.

Points of injection and nuances of successful correction of the infraorbital zone with HA fillers

and nasopharyngeal zone with a soft filler that is injected into the subcutaneous fat. If necessary, if the fat layer does not allow you to get optimal results, you can also inject the drug into the orbicular muscle of the eye.

Fig. 3: Reasons for the formation of a furrow or depression:

My default image

(A) normal state; (B) nasolacrimal sulcus formed due to atrophy of the skin and subcutaneous fat in the suborbital zone; (C) manifestation of the nasobuccal sulcus on the skin and subcutaneous adipose tissue; (

D) nasolacrimal sulcus formed due to contraction of the orbital part of the orbicular muscle of the eye or squinting; (F

) infraorbital cavity formed as a result of resorption of the zygomatic bone and soft tissue atrophy. To even out the skin surface, after filling the main depression of the sulcus, it will be necessary to inject a more dilute HA filler into the superficial subdermal space. Because the layers of skin and subcutaneous fat in the periorbital area are very thin, the skin must be stretched before insertion using the tenting technique (tenting)

If the indentation is relatively deep and thin, the tightening effect of the ligamentous structure can be reduced by cutting and releasing the dense fibrous connective tissue and squeezing the muscle attachment site with a cannula prior to filler insertion.

Important facial vessels to be taken into account when correcting sulci and depressions in the infraorbital area:

Aa – angular artery,

Av – angular vein,

ОО – orbicular muscle of the eye,

ZFa – zygomatic-facial artery,

IOa

– infraorbital artery, ITFa

– infraorbital trunk of the facial artery, Fv

– facial vein; Fa

– facial artery.

Fig. 4: infraorbital vessels

The safe entry point for the above manipulations is located at a distance of 1.5-2.0 cm from the orbital ridge on the middle vertical midline extending from the lateral edge of the cornea (Fig. 5B

). After the release of the connective tissue, the soft filler is injected into the freed intermuscular and axillary space. And after filling the main depth of the furrow, in order to even out the surface of the skin, the diluted HA filler is injected into the superficial subdermal plane.

Read also: Forehead anatomy for injectionists: important nuances of the structure and correction of the zone

In case of slight

descent of the infraorbital fat or wide flattening of this area (with or without a subtle depression), the infraorbital cavity and sulcus can be corrected by volume restoration. If there is a deep furrow around the orbital ridge, the fibrous junction must first be released before proceeding to the next step.

(A) injections around the orbital ridge in a linear drip technique;

(B) entry point for sulcus correction cannula;

IOF – infraorbital foramen.

Fig. 5: insertion technique and points of correction

The ideal

entry point of the volume replacement cannula is located 2 cm below the horizontal line of the outer canthus, on the vertical line of the lateral part of the inner border of the orbital rim (see Fig. 5C). As a rule, the filler is injected first into a deep plane, and then – subdermally to smooth the surface as described above.

The filler should be injected just below the infraorbital sulcus and cavity, including into the deep fat pack and infraorbital fat in the central part, as well as into the lateral part of the orbit.

However, the infraorbital fat is not located in the medial orbital area and therefore the filler should be injected under the muscle near the periosteum on the medial orbital area. It is very difficult to insert a filler between the muscle and the bone due to the tight connection of the axillary space with the periosteum in this area.