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. Although surgical options exist, minimally invasive approaches such as hyaluronic acid injections have gained popularity. However, the infraorbital region remains challenging due to risks like malar edema. Materials / method: In this prospective observational study, patients were treated with a 5-point injection technique using 2 types of 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 for 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 posttreatment, 96.15% (25 of 26) reported satisfactory outcomes. In 5 (19.2%) patients, results were maintained at 16 months. Adverse events included ecchymoses and hematomas resolving within 2 weeks. Mild edema was common but subsided gradually within 60 days without intervention. One (3.85%) patient developed persistent edema requiring hyaluronidase. All adverse events were mild and nonserious. Conclusion: Five-point supraperiosteal hyaluronic acid injections seem 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 minimize complications and enhance precision. Further research, ideally through controlled studies with independent evaluation, is recommended to confirm these findings.