Management of Lateral Orbital Hollowing With Hyaluronic Acid Filler

Background: Lateral orbital hollowing is a subtle yet influential contributor of periorbital ageing. It results from attenuation of subcutaneous fat, atrophy of the lateral orbital fat pad, and descent of the orbicularis oculi muscle, creating a concavity that contributes to a fatigued and aged appearance. Objectives: To evaluate the efficacy and safety of supraperiosteal hyaluronic acid (HA) filler injection for lateral orbital hollowing, with outcomes assessed at the longest available follow-up (6 mo) by both patients and physicians using the Global Aesthetic Improvement Scale (GAIS). Methods: A single-centre prospective case series enrolled 48 consecutive patients (40 women, 8 men; mean age 46.2±5.8 y) between July and November 2025, treated with cross-linked HA. All injections were performed by a single experienced aesthetic physician using a 30-gauge blunt cannula introduced through a lateral entry point 1.5 cm from the canthus, delivering 0.5 to 0.8 mL per side in the supraperiosteal plane. Standardised photographs were obtained at baseline and at follow-up visits (earliest 1 mo; longest 6 mo). GAIS ratings were completed by 2 independent physicians and by patients; patient satisfaction was additionally summarised as the proportion rating outcomes as good/very good/exceptional versus slight/none. Results: Follow-up was completed in 48/48. The shortest photographic interval presented was 1 month and the longest follow-up was 6 months. At 6 months, physician GAIS was 4.4±0.5 and patient GAIS was 4.5±0.6. On patient GAIS, 43/48 (89.6%) rated the outcome as “very good” or “exceptional,” while 5/48 (10.4%) rated “good”; no patients rated “slight” or “none” (0% dissatisfied). Adverse events were minor and self-limited: bruising in 13/48 (27.1%) and oedema in 14/48 (29.2%); each resolved within 1 week. No serious complications occurred. Conclusions: Supraperiosteal HA placement for lateral orbital hollowing restored the lateral contour with high satisfaction and minimal downtime through 6 months. Presenting clinical photographs in a single composite figure enables a clear baseline-to-follow-up comparison. Longer-term follow-up beyond 6 months is needed to better define durability and late events in this region. Level of Evidence: Level IV.