Background: Despite high demand for hyaluronic acid (HA) filler injection in the infraorbital area for infraorbital hollowing, there is currently limited data on its use in this region.  

Objectives: We aimed to contribute to the clinical and anatomic understanding of infraorbital HA injection via a prospective patient injection study in combination with a cadaveric analysis.  

Methods:  Patients were injected with Volbella XC into the tear trough region by a single experienced aesthetic plastic surgeon. Over a 12-week period, precise undereye volumetric measurements using 3D photogrammetry (VECTRA-M3) and patient reported outcomes (FACE-Q) were collected and analyzed relative to two pretreatment severity scales. Juvéderm Vycross and Restylane NASHA products were injected into the infraorbital and malar region in six cephalus specimens and evaluated with regards to the anatomic injection location with and without common clinical physical manipulations. 

Results: Eleven patients participated with a 100% retention rate. Infraorbital HA volume maintenance was 70-81% at 30 days and 50-70% at 90 days.Significant improvement was noted in the eyes, overall facial appearance, and cheekbones (p<0.05) with FACE-Q outcomes, irrespective of pretreatment severity. In the cadaver examination, we observed variability in the anatomic locations occupied by Juvéderm and Restylane products as well as in behavior after physical manipulation between gel types. 

Conclusions: Volbella XC effectively augments undereye volume to diminish infraorbital hollowing as measured over a 12-week period with significantly improved PROs. Enhanced knowledge of the behavior of Volbella XC and other HA fillers in this sensitive anatomic region will lead to improved patient outcomes.