We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Surgical Pearls |

Filler Enhancement of the Superior Periocular Area ONLINE FIRST

Julie A. Woodward, MD1; Nicole Langelier, MD2
[+] Author Affiliations
1Departments of Ophthalmology and Dermatology, Duke University Medical Center, Durham, North Carolina
2Duke University Department of Ophthalmology, Durham, North Carolina
JAMA Facial Plast Surg. Published online June 23, 2016. doi:10.1001/jamafacial.2016.0636
Text Size: A A A
Published online


This Surgery Pearl reports that detailed knowledge of anatomy and careful placement of hyaluronic acid filler can be used to restore volume to the eyebrow, forehead, and superior sulcus to improve appearance and patient satisfaction.

Human appearance and nonverbal communication are largely influenced by the superior periocular area. Therefore, patients desire this area to appear as vital as possible. Appropriate volume of the fat compartments of the eyebrow and eyelid, including the frontalis fat, retro-orbicularis oculi fat (ROOF), and preaponeurotic fat are essential for a youthful appearance (Figure 1A, Figure 2). These fat compartments also allow for smooth movement of surrounding tissues to facilitate eyelid function and facial expression.

Figures in this Article

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

First Page Preview

View Large
First page PDF preview


Place holder to copy figure label and caption
Figure 1.
Upper Periocular Anatomy

A, Fat compartments. Tarsal plate (a), palpebral arcade (b), Mullers muscle (c), nasal fat pad (d), central preaponeurotic orbital fat pad (e), retro-orbicularis oculi fat (ROOF) (f), transverse artery of the ROOF, a branch of the supraorbital artery (g), angular artery (h), dorsal nasal artery (i). B, Arteries. Supratrochlear arteries (a), supraorbital arteries (b), and large transverse artery (c), which is a branch of the supraorbital artery that travels through the ROOF.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.
Before and After Photographs of Patient Shown in Video Demonstration

A, Before injection of hyaluronic acid filler to the upper periocular area. B, Immediately after injection. A 30-gauge needle was used to inject filler into the superior sulcus space subcutaneously and posterior to the orbital septum (0.1 cm3 per side) (Belotero; Merz). A 27-gauge cannula was used to volumize the roof (0.1 cm3 per side) (Belotero). A 30-gauge needle was used to inject filler in the periosteal plane at 3 injection points above the lateral corrugator (0.2 cm3 per side) (Restylane Silk; Galderma). A 27-gauge cannula was used to introduce filler diluted 1:1 with saline to the pregaleal plane and massaged into place (0.2 cm3 per side (Restylane Silk). C, One week after treatment to the superior periocular area, the bilateral temple hollowing was treated with filler introduced to the preperiosteal plane with a 27-gauge needle and the subcutaneous plane with a 27-gauge cannula (about 0.7 cm3 per side) (Juvéderm Voluma; Allergan).

Graphic Jump Location




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.



Filler Technique for Rejuvenation of the Upper Periocular Area

Hyaluronic acid filler is used to rejuvenate the upper periocular area by volumizing the eyebrow, filling a hollow superior sulcus, and smoothing the forehead contour.

Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Collections