Juvederm Volbella, a hyaluronic acid (HA) filler formulated with Allergan’s proprietary Vycross technology, has emerged as a standout option for subtle aesthetic enhancements. In 2022, it gained FDA approval for the correction of infraorbital hollows, expanding its utility beyond lip augmentation and perioral wrinkles. This approval underscores its suitability for the delicate tear trough region, where precision and safety are paramount.

The demand for non-surgical under-eye rejuvenation continues to rise as patients seek to address the tired, shadowed appearance caused by infraorbital hollowing. For cosmetic medical professionals, mastering tear trough correction with Volbella offers an opportunity to meet this need effectively. This article provides a practical guide to its application, focusing on anatomical considerations, injection techniques, and safety protocols to achieve optimal outcomes. Let’s jump right in.

Anatomical Considerations for Tear Trough Injections

The tear trough presents a complex anatomical region requiring careful assessment. It is bordered superiorly by the orbital rim, medially by the tear trough ligament—a fibrous attachment between the orbicularis oculi muscle and bone—and inferiorly by the infraorbital foramen, where the infraorbital nerve and artery emerge. Sub-orbicularis oculi fat (SOOF) and deeper pre-periosteal fat compartments influence the degree of hollowing. Clinicians must distinguish true volume deficiency from pseudo-hollowing due to fat prolapse or skin laxity, as severe cases may warrant surgical intervention or denser fillers.

Vascular anatomy demands particular attention. The infraorbital artery, branching from the maxillary artery, typically exits 6–8 mm below the orbital rim, though its course varies. The angular artery, connecting to the facial artery near the nasal ala, lies superficially and may anastomose with periorbital vessels unpredictably. These structures elevate the risk of vascular occlusion or embolization, potentially leading to tissue necrosis or visual impairment. The periocular skin, often less than 1 mm thick with minimal subcutaneous fat, amplifies visibility of filler placement. Palpating the orbital rim or employing Doppler ultrasound, when available, enhances precision in mapping these critical landmarks.

Why Juvederm Volbella? Suitability for Tear Trough Correction

Volbella’s properties make it well-suited for tear trough correction. Its 15 mg/mL HA concentration produces a soft, cohesive gel ideal for subtle volumization. Vycross technology, combining high- and low-molecular-weight HA, improves integration, reduces post-injection edema, and sustains results for up to 12 months. Clinical trials report 85% of patients maintained improvement at this endpoint, underscoring its durability. Compared to Restylane Silk or Belotero Balance, Volbella’s optical clarity lowers the risk of the Tyndall effect—a bluish discoloration from superficial placement.

This filler excels in patients with mild-to-moderate hollowing and intact skin elasticity, such as a 45-year-old presenting with early infraorbital shadowing. For severe volume loss or prominent fat herniation, denser fillers like Juvederm Voluma or surgical options may be more appropriate. Contraindications include active periocular infections (e.g., blepharitis) or prior hypersensitivity to HA or lidocaine, though the latter, present at 0.3%, enhances procedural comfort. In rare cases of suspected sensitivity, a patch test may be considered.

Injection Techniques for Optimal Outcomes

Begin with standardized photography under consistent lighting (e.g., a ring light at 45 degrees) to document hollowing and shadow patterns. Mark injection sites along the infraorbital rim, approximately 2–3 mm below the margin, using a sterile marker. While Volbella contains lidocaine, applying a 5% lidocaine-prilocaine cream 20 minutes prior can improve patient tolerance. Discuss expectations clearly, emphasizing that Volbella softens hollows rather than eliminates fat prolapse.

Recommended Techniques

Select either a 25G cannula (1–1.5 inches) or a 30G needle based on patient anatomy and practitioner preference. Cannulas, inserted laterally near the zygoma, minimize bruising, while needles offer precise bolus placement. Inject deeply along the periosteum with 0.2 mL aliquots to address hollowing, transitioning to mid-dermal threading with 0.1 mL near the medial canthus for seamless integration. Limit total volume to 0.1–0.5 mL per side to prevent overcorrection, which may result in periocular fullness by day three.

Employ serial puncture (boluses spaced 2–3 mm apart) or linear threading (retrograde deposition along the hollow), delivering filler at 0.02 mL/second to monitor tissue response. Elevating the skin with a pinch-and-pull technique protects deeper structures. Aim for a 1:1 correction ratio, reserving additional volume for subsequent sessions if needed.

Post-Injection Massage

Apply gentle pressure with sterile gloves for 10–15 seconds per side to ensure even distribution and minimize irregularities. Avoid excessive manipulation, which may displace the product or exacerbate edema.

Layering with Other Treatments

For midface volume loss contributing to hollowing, administer Juvederm Voluma (0.5–1 mL per cheek) along the zygoma first to provide structural support. Follow with Volbella to refine residual shadowing, ideally staging treatments 1–2 weeks apart.

Safety Considerations and Complication Management

Administer filler slowly, using minimal pressure over 5–10 seconds per injection site to reduce vascular risk. Aspiration, though limited by small-gauge needles, may be performed for 2 seconds as a precautionary measure. Avoid overfilling, which can compress tissues and distort contours; additional product can be introduced at follow-up if indicated.

Recognizing Complications

Vascular occlusion manifests as immediate blanching, livedo reticularis, or persistent pain. The Tyndall effect, less frequent with Volbella, appears within 24 hours if placed superficially. Transient edema (48–72 hours) and ecchymosis (up to 7 days) are common but require monitoring for asymmetry.

Treatment Protocols

• Occlusion: Cease injection, apply warm compresses (40–45°C) for 10 minutes, and administer hyaluronidase (150–300 units per side, diluted in saline) along the affected vessel. Massage post-dissolution and refer to a specialist if visual changes occur.
• Tyndall Effect: Use 50–100 units of hyaluronidase or observe if mild.
• Edema/Ecchymosis: Recommend cold compresses (10 minutes hourly); oral arnica is optional.

Patient Follow-Up

Schedule a 2-week follow-up to assess symmetry and patient satisfaction. Minor adjustments (0.1–0.2 mL) may be performed to optimize results.

Conclusion

Juvederm Volbella Frequently Asked Questions