Abstract

Objectives: To evaluate a novel, anatomy-based four-point multiplane hyaluronic acid (HA) filler injection technique for tear trough correction, with particular emphasis on high-resolution ultrasound assessment of filler localization, distribution, and safety. Introduction: To evaluate a novel, anatomy-based four-point multiplane hyaluronic acid (HA) filler injection technique for tear trough correction, with particular emphasis on high-resolution ultrasound assessment of filler localization, distribution, and safety. Materials / method: This pilot single-group pre- and post-intervention study enrolled five female volunteers aged 20–40 years with tear trough deformity suitable for HA filler correction. The technique targeted four planes: the premaxillary space, medial sub-orbicularis oculi fat (SOOF), subcutaneous plane, and subdermal plane. A 25G blunt cannula was inserted through a lateral entry point, delivering a total of 1.0 mL per side, including 0.5 mL in the deep plane and 0.5 mL in the superficial plane. Standardized photography, blinded dermatologist assessment, patient-reported Global Aesthetic Improvement Scale. Results: Tear trough appearance improved immediately after treatment and remained stable at 1 and 3 months. No serious complications occurred. Minor adverse events, including bruising and swelling, were transient and resolved without sequelae. No clinically detectable nodules or contour irregularities were observed throughout follow-up. High-resolution ultrasound consistently demonstrated well-defined, homogeneous hypoechoic filler deposits accurately localized within the intended anatomical planes, particularly the SOOF and premaxillary space, at all post-treatment time points. Conclusion: This novel four-point multiplane HA filler injection technique achieved sustained tear trough improvement with precise ultrasound-validated filler placement and a favorable safety profile. Serial ultrasound confirmed stable filler localization within the intended tissue planes, homogeneous distribution, and absence of sonographic abnormalities such as migration, irregular clumping, or nodule formation. These findings support the utility of ultrasound not only as a validation tool for anatomical accuracy but also as an objective method for safety monitoring in tear trough filler treatment.