Anatomical-based filler injection techniques for the midcheek groove and infraorbital region: Narrative review

TL;DR

This paper reviews anatomical injection techniques for facial rejuvenation in the midcheek and infraorbital regions using hyaluronic acid fillers.

Contribution

It synthesizes anatomy-based strategies for filler injection, emphasizing layer-specific approaches and ethnic considerations.

Findings

Cannula-assisted subcision followed by deep and superficial filler placement improves midcheek correction.

Hyaluronidase and product rheology knowledge help manage overfill and irregularities.

Current evidence is limited to case series with a need for standardized, controlled studies.

Abstract

The infraorbital hollow and midcheek groove (“Indian bands”) are anatomically complex transition zones where ligamentous, vascular, and fat compartments converge. Safe and predictable correction with hyaluronic acid (HA) fillers requires precise, layer-specific anatomical understanding.

To synthesize anatomy-based injection strategies for the infraorbital–midcheek continuum, including diagnostic triage, technique selection, complication mitigation, and ethnic-specific considerations.

We conducted a narrative review based on a structured search of MEDLINE, PubMed, and Ovid databases using predefined keywords related to “Dark Circle,” “Midcheek Groove,” “Indian Band,” “Dermal Fillers,” and “Facial Anatomy.” Eligible anatomical dissections, imaging-based mappings, and clinical outcome studies were qualitatively synthesized; no original patient data were collected, and no PRISMA flow diagram or quantitative meta-analysis was performed.

Cannula-assisted subcision to partially release fibrous retaining bands, followed by deep support (deep malar fat pad/suborbicularis oculi fat [SOOF]) and selective superficial blending, appears to improve midcheek groove correction in published series using Maili Volume and Precise. Management of overfill or surface irregularity relies on hyaluronidase and an understanding of product rheology (elastic modulus G′, cohesivity, elasticity). However, the available evidence remains heterogeneous and predominantly case-series level, with limited standardized outcomes, patient-reported measures, and long-term follow-up.

An anatomy-based, layer-specific approach can enhance predictability and safety for infraorbital–midcheek rejuvenation, but current recommendations are largely experience-driven. Future work should prioritize controlled clinical validation, complication registries, and population-specific optimization of technique with robust, quantitative and patient-centered outcomes.

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