Abstract

Objectives: This study aims to evaluate the efficacy of hyaluronic acid treatment in the middle face for correcting lower eyelid bags, focusing on restructuring the eyelid-cheek junction and reducing malar edema. Introduction: The protrusion of lower eyelid bags is a common concern in aesthetic consultations, often contributing to a fatigued, aged appearance. While surgical options exist, non-surgical approaches such as hyaluronic acid injections have gained popularity due to their less invasive nature. However, the infraorbital region remains challenging due to complications like malar edema. Materials / method: In this observational prospective study, patients were treated with a five-point injection technique using two cohesive polydensified matrix hyaluronic acid fillers, administered in a supraperiosteal plane on days 0 and 30. Follow-up assessments were conducted at 30, 60, and 180 days, with a subset followed up to 16 months. Outcome evaluation included standardized photography, VECTRA H2 imaging, and the Global Aesthetic Improvement Scale. Adverse events were monitored and treated according to clinical practice. Results: Twenty-six patients were treated. At 2 and 6 months post-treatment, 96.15% (25/26) reported satisfactory outcomes. In five patients (19.2%), results were maintained at 16 months. Adverse events included ecchymoses and hematomas resolving within two weeks. Mild edema was common but subsided gradually within 60 days without intervention. One patient (3.85%) developed persistent edema requiring hyaluronidase. All adverse events were mild and nonserious. Conclusion: Five-point supraperiosteal hyaluronic acid injections appear to be a safe, well-tolerated nonsurgical option for correcting lower eyelid bags, providing sustained aesthetic outcomes in most patients. Anatomically guided techniques and rheologically adapted fillers may help reduce complications and improve treatment precision. Further research, ideally through controlled studies with independent evaluation, is recommended to confirm these findings and refine the approach in broader patient populations.