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Objectives: A technique to inject filler below the orbicularis oculi muscle over the entire contour of the inferior orbital margin is described in detail.

Introduction: Treatment of the tear trough deformity and, by extension, hollowing over the entire inferior orbital margin, is technically challenging and not devoid of risk. Injection as close to bone as possible has been proposed as helpful to achieve an even result. However, tissue septae may guide the filler inferiorly and be an impediment. A gliding plane for a cannula has been described under the orbicularis oculi muscle, with the exception of its insertion on the bone. We propose to inject with a 25 cannula, just under the orbicularis oculi muscle rather than as close to bone as possible.

Materials / method: Relevant publications on clinical anatomy were compared to before and after clinical photography. Representative film fragments were selected to demonstrate the advocated injection technique. Cadaver dissections after the injection of dyed filler with a 25G cannula were performed to study the filler deposits.

Results: Both in the treatment of the orbital part of the tear trough and of the entire inferior orbital margin contour, a 25G cannula can glide under the orbicularis oculi muscle and filler can be injected in a linear retrograde manner. Due to the muscle insertion medially, it is frequently necessary to inject superior and inferior to this line to fully correct the deformity. In four dissection courses, the participants were able to replicate the treatment with dyed filler in cadavers and to verify the position of the filler in the correct plane.

Conclusion: The use of a 25 G cannula for linear retrograde injection of filler just below the orbicularis oculi muscle is a reliable and reproducible method to fill a depression over the inferior orbital margin and to obtain a smooth result.

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