Effect of HA filler injection into the midface on the lower lid

Hyaluronic acid (HA) fillers are widely used to restore facial soft tissue volume. In particular, there is significant interest in improving infraorbital hollows; however, attempts to correct this area with HA filler alone often face challenges, including the Tyndall effect, unnatural contours, bulging, and migration. Additionally, midfacial skeletal deformities contribute significantly to infraorbital hollowness by sagging the soft tissue connected to the midface, which lengthens the lid-cheek junction (LCJ). To address this, we focused on restoring midfacial volume in patients seeking to improve infraorbital hollowness. One month later, changes in the LCJ, globe-to-orbital rim relationship, lower lid contours, and eyelash position were observed. HA filler was injected using a modified sequential autologous fat injection (SAFI) technique into the palpebromalar groove, malar eminence, tear trough, and mid-cheek furrow. In each area, 60% of the filler was injected below the orbital retaining ligament, 30% into the deep fat layer, and 10% into the superficial fat layer. We administered 3.0 ml on the left side and 4.0 ml on the right side. The V-shaped LCJ changed to a rounded shape, with LCJ measurements along the mid-pupillary line showing a significant reduction from 20.5 mm to 15.0 mm on the left and from 18.0 mm to 14.5 mm on the right. The lower lid contour transformed from rounded to linear, and the scleral contour decreased. The midface appeared smaller and narrower, and the negative vector rim relationships improved to a reversed negative vector relationship. Consequently, improvement of lower lid eversion and lifting of drooping eyelashes were observed. In conclusion, the filler injection method using the SAFI technique prioritizes correcting skeletal deformities, structurally supporting the lower lid, and yielding favorable results, as demonstrated in this study.